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. 2012 Jun 8;2(3):e000876.
doi: 10.1136/bmjopen-2012-000876. Print 2012.

Smoking and suicidal behaviours in a sample of US adults with low mood: a retrospective analysis of longitudinal data

Lirio S Covey  1 , Ivan Berlin, Mei-Chen Hu, Jahn K Hakes
Affiliations

Smoking and suicidal behaviours in a sample of US adults with low mood: a retrospective analysis of longitudinal data

Lirio S Covey et al. BMJ Open. .

Abstract

Objective: To investigate whether: (1) smoking predicts suicide-related outcomes (SROs), (2) prior SRO predicts smoking, (3) smoking abstinence affects the risk of SRO and (4) psychiatric comorbidity modifies the relationship between smoking and SRO.

Design: Retrospective analysis of longitudinal data obtained in wave 1 (2001-2002) and wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions.

Setting: Face-to-face interviews conducted with persons in the community.

Participants: US adults (N=43 093) aged 18 years or older were interviewed in wave 1 and reinterviewed (N=34 653) 3 years later. For the present study, the sample was the subset of persons (N=7352) who at the wave 2 interview reported low mood lasting 2 weeks or more during the past 3 years and were further queried regarding SRO occurring between waves 1 and 2.

Outcome measures: SRO composed of any of the following: (1) want to die, (2) suicidal ideation, (3) suicide attempt, reported at wave 2. Current smoking reported at wave 2.

Results: Current and former smoking in wave 1 predicted increased risk for wave 2 SRO independently of prior SRO, psychiatric history and socio-demographic characteristics measured in wave 1 (adjusted OR (AOR)=1.41, 95% CI 1.28 to 1.55 for current smoking; AOR=1.32, 95% CI 1.21 to 1.43 for former smoking). Prior SRO did not predict current smoking in wave 2. Compared with persistent never-smokers, risk for future SRO was highest among relapsers (AOR=3.42, 95% CI 2.85 to 4.11), next highest among smoking beginners at wave 2 (AOR=1.82, 95% CI 1.51 to 2.19) and lowest among long-term (4+ years) former smokers (AOR=1.22, 95% CI 1.12 to 1.34). Compared with persistent current smokers, risk for SRO was lower among long-term abstainers (p<0.0001) but not among shorter-term abstainers (p=0.26).

Conclusions: Smoking increased the risk of future SRO independently of psychiatric comorbidity. Abstinence of several years duration reduced that risk.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form (www.icmje.org/coi_disclosure.pdf). (1) JKH received support from NIAAA through the US Census Bureau for the submitted work; (2) LSC, IB and M-CH received no specific support for this work; (3) IB received occasional honoraria for participating in advisory panels of Pfizer Ltd during the past 3 years; (4) in February 2011, LSC provided educational consultation to a law firm regarding mood effects of smoking cessation; (5) JKH and M-CH had no relationships with any company that might have an interest in the submitted work in the previous 3 years; (6) none of the spouses of the authors had financial relationships that may be relevant to the submitted work; (7) none of the authors had a non-financial interest that may be relevant to the submitted work.

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