Abstract
Background & Aims: Mental health issues have been associated with tobacco smoking. Several studies conducted in large samples of general population found a significant relationship between tobacco smoking and depressive symptoms. However, previous research conducted in Saudi Arabia reported a high prevalence of depression and smoking among a small-scale sample of male expatriate workers but found no correlation. This study aims at investigating the association between self-reported tobacco smoking (cigarette and water pipe smoking) and depressive symptoms in a large representative sample of expatriate workers.

Methods: A cross-sectional survey involving face-to-face interviews of 4575 male expatriate workers in 270 businesses/companies in Riyadh, Saudi Arabia was conducted using a multistage stratified cluster sampling technique to randomly select businesses/companies and participants. Trained research assistants used the Composite International Diagnostic Interview instrument applicable to clinical depression to assess DSM-IV for major depressive disorder and episodes among participants. Smoking was assessed using the WHO standard questions for assessing tobacco exposure and other covariates with a standardized questionnaire. The data were analyzed using logistic regression.

Results: Current smoking is associated with significantly increased likelihood of depressive symptoms (Crude Odds Ratio=1.790 - 1.284) 1.516)). The association remained statistically significant after adjusting for age, self-reported health and income (Adjusted Odds Ratio=- 1.341) 1.590 1.886)).

Conclusions: This study provides new insights into the relationship between tobacco smoking and depressive symptoms. In expatriates, current smoking is associated with significantly increased risk of depressive symptoms. Future research is needed to clarify directionality and mechanism explaining the relationship. Health professionals and policymakers should be aware of the increased risk of depressive symptoms in expatriate workers who are tobacco smokers.

Key words: Tobacco smoking, depressive symptoms, expatriates, tobacco control, mental health services