Nicotine dependence associated with e-cigarette use, depressive symptoms, and psychological resilience among northern Thai adolescents: a cross-sectional study
AI Summary
High e-cigarette use (28.3%), with 74.9% of users meeting nicotine dependence criteria among northern Thai adolescents.
Nicotine dependence was associated with greater depressive symptom severity (mild dependence AOR 2.07), and peer or family exposure increased severity.
Severity of nicotine dependence was not associated with psychological resilience, indicating need for mental health informed e-cigarette prevention.
BMC Psychol. 2026 May 14. doi: 10.1186/s40359-026-04767-0. Online ahead of print.
ABSTRACT
BACKGROUND: This study examined associations between nicotine dependence related to e-cigarette use, depressive symptoms, and psychological resilience among adolescents in northern Thailand, where e-cigarette use is prohibited.
METHODS: A school-based cross-sectional study was conducted among 1,263 middle school students aged 11-16 years in northern Thailand between May and June 2025. Data were collected using self-administered questionnaires assessing sociodemographic characteristics, e-cigarette and other substance use, nicotine dependence (PS-ECDI), depressive symptoms (PHQ-A), and psychological resilience (RS-15). Ordinal logistic regression was used to examine associations between nicotine dependence, severity of depressive symptoms, and psychological resilience.
RESULTS: Overall, 28.3% of participants reported e-cigarette use, and 74.9% of those met criteria for nicotine dependence. E-cigarette use was more prevalent among females than males (33.3% vs. 22.6%). Mild nicotine dependence was associated with greater depressive symptom severity (adjusted odds ratio [AOR] = 2.07, 95% CI: 1.13-3.79). Peer combustible cigarette smoking (AOR = 2.43, 95% CI: 1.19-4.97) and initial exposure to e-cigarettes through family members (AOR = 23.10, 95% CI: 2.66-200.94) or friends (AOR = 7.28, 95% CI: 1.29-41.25) were also associated with higher depressive symptom severity. In contrast, peer e-cigarette use (AOR = 0.46, 95% CI: 0.22-0.98) and past-year alcohol (AOR = 0.35, 95% CI: 0.19-0.65) use were associated with lower depressive symptom severity. However, nicotine dependence severity was not associated psychological resilience.
CONCLUSIONS: Nicotine dependence related to e-cigarette use was associated with depressive symptom severity, but not with psychological resilience, among adolescents in a public school in Northern Thailand, highlighting the need for mental health-informed approaches to e-cigarette prevention.
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