ArticleBMC psychology2026
Nicotine dependence associated with e-cigarette use, depressive symptoms, and psychological resilience among northern Thai adolescents: a cross-sectional study.
Article in BMC psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis 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.
methodsA 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.
resultsOverall, 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.
conclusionsNicotine 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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