Research Highlights:

  • E-cigarette users were twice as likely than those who had never used e-cigarettes to report having clinical depression, according to a new study from Johns Hopkins University researchers associated with the American Heart Association’s Tobacco Center of Regulatory Science.
  • Former e-cigarette users also reported higher rates of depression than those who had never used them, although to a lesser degree.
  • These findings were consistent in both men and women and across all ethnicities and age groups, leading researchers to offer caution regarding these additional potential health implications related to e-cigarette use.

DALLAS, Dec. 4, 2019 — E-cigarette users were twice as likely than people who had never used e-cigarettes to report having clinical depression, according to a new study conducted by researchers from Johns Hopkins University and funded through the Tobacco Center of Regulatory Science of the American Heart Association, the leading voluntary health organization devoted to a world of longer, healthier lives.

The findings come from a cross-sectional study of the Behavioral Risk Factor Surveillance System 2016 to 2017 database, the largest national telephone-based survey of randomly sampled adults in the United States. Nearly 900,000 participants age 18 and older with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019.

Researchers found:

  • Current e-cigarettes users were more than twice as likely to report having clinical depression than people who had never used e-cigarettes – 34% vs. 15%.
  • Former e-cigarette users were more likely to report having clinical depression than people who had never used e-cigarettes, but to a lesser degree – 27% vs. 15%.
  • Results were similar in men and women and across different ethnic groups.

The findings also didn’t differ much across age groups, but the correlation of current e-cigarette use and depression was highest among college age students — 18 to 25. Researchers conducted a targeted sub-study of this population because of previous findings that college students are more likely to explore new products, including e-cigarettes. Also, tobacco companies tailor marketing strategies to this group.

“This highlights the potential susceptibility of e-cigarette users in this group to depression at a particularly vulnerable time in their lives, but also warrants pause in what this kind of nicotine addiction may be doing to our children, high schoolers and younger, who we know are using e-cigarettes in epidemic proportions,” said Mariell Jessup, M.D., FAHA, American Heart Association Chief Science and Medical Officer. “Mental health plays an important role in overall health and wellbeing and this connection of e-cigarettes and depression raises even more concern about how these products will impact public health for generations to come.”

The researchers write that their findings, “…warrant careful and thorough evaluation of e-cigarette use in both youth and adults with depression. Physicians should consider routine collection of information pertaining to e-cigarette use during clinic visits, especially in patients with depression, and routine counseling for those who use e-cigarettes, offering support to those who express willingness to quit.”

Researchers said the study provides additional evidence to establish an association between e-cigarette use and depression, which could have potentially significant implications for public health, clinical practice and health policy. The potential mental health consequences may also have regulatory implications for novel tobacco products.

Author names and disclosures are in the manuscript.

The National Heart, Lung, and Blood Institute of the National Institutes of Health and the Food and Drug Administration Center for Tobacco Products funded the study through grants to the American Heart Association which works closely with investigators in institutions across the country to pursue research that can provide evidence to inform tobacco product regulation.

The study was published in JAMA Network Open and is available online.

The American Heart Association recently launched a major three-pronged initiative to battle the growing epidemic of youth e-cigarette use addressing nicotine addiction through an unparalleled scientific research investment, policy and advocacy development and support for students and school leaders in communities across the country. Learn more at

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