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Meta-Analysis
. 2024 Sep 10;24(1):608.
doi: 10.1186/s12888-024-06012-7.

Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis

Abdelaziz A Awad #  1 , Ramaiah Itumalla #  2 , Abhay M Gaidhane  3 , Mahalaqua Nazli Khatib  4 , Suhas Ballal  5 , Pooja Bansal  6 , Manish Srivastava  7 , Isha Arora  8 , MRavi Kumar  9 , Aashna Sinha  10 , Kumud Pant  11   12 , Hashem Abu Serhan  13 , Muhammed Shabil  14   15
Affiliations
Meta-Analysis

Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis

Abdelaziz A Awad et al. BMC Psychiatry. .

Abstract

Background: The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature.

Methods: We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case-control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis.

Results: Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies.

Conclusion: E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.

Keywords: Adolescent health; Electronic cigarettes; Global health targets; Good health and well-being; Mental health; Nicotine; Public health; Self-harm; Suicide; Suicide prevention.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram showing article screening and study selection process
Fig. 2
Fig. 2
Forest plot illustrating the meta-analysis of association of e-cigarettes and suicidal ideation
Fig. 3
Fig. 3
Forest plot illustrating the meta-analysis of association of e-cigarettes and suicidal plan
Fig. 4
Fig. 4
Forest plot illustrating the meta-analysis of association of e-cigarettes and suicide attempt
Fig. 5
Fig. 5
Funnel plot showing publication bias assessment
See this image and copyright information in PMC

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