The Effect of Psychological Dependence on Smoking Cessation

Background/Objectives: This study aimed to examine the relationships between psychological dependence level and nicotine dependence, smoking cessation status, and withdrawal symptoms in smokers, as well as to identify the factors associated with nicotine dependence and smoking cessation status. Methods: This prospective cohort study included 513 participants who presented to a smoking cessation outpatient clinic. Data were collected using a sociodemographic data form, the Fagerström Test for Nicotine Dependence (FTND), and the Test to Assess the Psychological Dependence on Smoking (TAPDS). Smoking status was evaluated eight weeks after the completion of treatment. Results: The mean age of the participants was 36.7 ± 10.6 years, and 60.4% were male. A statistically significant association was found between psychological dependence level and nicotine dependence (p < 0.001). In the low psychological dependence group, low and very low nicotine dependence were observed more frequently than expected, while in the severe psychological dependence group, high nicotine dependence was observed more frequently than expected. A significant association was also found between psychological dependence and smoking cessation status; in the low psychological dependence group, those who quit smoking were observed more frequently than expected (60.0%), while in the severe psychological dependence group, those who could not quit were observed more frequently than expected (61.9%, standardized residual +5.90). Pearson correlation analysis revealed a moderate, positive, and significant relationship between psychological dependence and nicotine dependence (r = 0.41, p < 0.001). Multiple linear regression analysis determined that psychological dependence was the variable most strongly associated with nicotine dependence (β = 0.375, p < 0.001). Multinomial logistic regression analysis demonstrated that a one-unit increase in psychological dependence score was associated with lower odds of quitting smoking (OR = 0.920, 95% CI: 0.896–0.944, p < 0.001) and of reducing smoking (OR = 0.971, 95% CI: 0.944–0.998, p = 0.034). Conclusions: Psychological dependence was significantly associated with nicotine dependence and with lower smoking cessation success. The assessment of psychological dependence and the adoption of multidisciplinary approaches accordingly in smoking cessation treatment may increase treatment success.