Everyone knows that cigarette smoking can cause lung cancer, heart disease, low birth weight, and high blood pressure, among other health hazards.

But you may be surprised to learn that there are also mental health risks related to smoking, according to a new study.

Professor Hagai Levine at Hebrew University of Jerusalem’s-Hadassah Braun School of Public Health and Community Medicine published these groundbreaking findings in the journal PLOS ONE with Assistant Prof. Tatjana Gazibara at the University of Belgrade and PhD student Marija Milic at the University of Pristina.

Together, they surveyed more than 2,000 students enrolled at Serbian universities with differing socio-political and economic environments. The survey showed that students who smoked were two to three times more likely to suffer from clinical depression compared to non-smoking peers.

At the University of Pristina, 14% of smokers suffered from depression as opposed to 4% of their non-smoking peers, and at Belgrade University the numbers were 19% to 11%, respectively.

No matter their economic or socio-political backgrounds, students who smoked also had higher rates of depressive symptoms and lower mental health scores (such as vitality and social functioning) than did non-smoking students.

“Our study adds to the growing body of evidence that smoking and depression are closely linked,” shared Levine. “While it may be too early to say that smoking causes depression, tobacco does appear to have an adverse effect on our mental health.”