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Bidirectional association between smoking and depressive symptoms. Observational longitudinal data used to emulate randomized clinical trial.


Tobacco smoking and depression are strongly associated in middle age women. We will use data from the mid cohort to emulate the design of two randomized clinical trials. The first trial is aimed at evaluating whether the presence of depressive symptoms has a causal effect on the inability to stop, or the need to restart, smoking in middle age women. The second trial is aimed at elucidating whether smoking has a causal effect on the incidence of depressive symptoms in these women.