Smoking predicts suicidality: Findings from a prospective community study

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Research report

Smoking predicts suicidality: Findings from a prospective community study

Thomas Bronischa, , , Michael Höflera, b and Roselind Lieba, c
aMax-Planck-Institute of Psychiatry, Clinic and Clinical Psychology and Epidemiology, Kraepelinstreet 2-10, 80804 Munich, Germany
bTechnical University of Dresden, Clinical Psychology and Psychotherapy, Mommsenstreet 3, 01187 Dresden, Germany
cUniversity of Basel, Epidemiology and Health Psychology, Missionsstrasse 60-62, 4055 Basel, Switzerland
Received 4 July 2007;
revised 10 October 2007;
accepted 10 October 2007.
Available online 19 November 2007.

Abstract
Background
The temporal relationship between smoking and suicidality is not yet clear. This article examines associations between smoking and suicidality and their temporal ordering of onset.
Methods
Baseline and four-year follow-up data were used from the Early Developmental Stages of Psychopathology (EDSP) study, a prospective longitudinal study of adolescents and young adults in Munich, Germany. We assessed smoking (occasional and regular), nicotine dependence, suicidal ideation and suicide attempts using the standardized Munich-Composite International Diagnostic Interview (M-CIDI).
Results
Suicide ideation and suicide attempts were strongly associated with occasional and regular smoking and nicotine dependence at baseline (Odds ratios [OR] range from 1.4 to 16.4). In the prospective analyses, prior occasional, regular smoking and nicotine dependence increased the risk for new onset of suicide ideation (OR range from 1.5 to 2.7) and prior regular smoking and nicotine dependence increased also the risk for onset of suicide attempt(s) (OR range between 3.1 and 4.5). Pre-existing suicidality could not be shown to be associated with subsequent smoking or nicotine dependence. Associations remained stable when participants who fulfilled DSM-IV-criteria for major depression were excluded.
Limitations
The sample is confined to an age cohort of 14 to 24 years. No completed suicides could be observed.
Conclusions
The presence of associations between prior smoking and subsequent suicidality, in concert with the lack of associations between prior suicidality and subsequent smoking suggests the existence of an independent pathway from smoking to suicidality.

Keywords: Suicide attempts; Suicide ideas; Smoking; Community study

Article Outline
1. Introduction
2. Methods
2.1. Design
2.2. Sample
2.3. Diagnostic assessment
2.4. Assessment of suicidality
2.5. Definition of smoking and nicotine dependence
2.6. Statistical analyses
3. Results
3.1. Lifetime prevalence of smoking, nicotine dependence and suicidality at baseline
3.2. Baseline associations between smoking behavior and suicidality
3.3. Is the presence of pre-existing smoking related to the risk for onset of suicide ideation and suicide attempts during the four year prospective follow-up interval?
3.4. Does the presence of pre-existing suicidality predict the risk for onset of smoking during the four year follow-up interval?
4. Discussion
Role of Funding Source
Conflict of interest
Acknowledgements
References
Table 1.
Lifetime prevalence of smoking, nicotine dependence and suicidality at baseline (N = 3021)
The gender difference is significant at p < .05. Asterisks indicate the group with the higher rate. Odds Ratios females versus males are for suicide ideation OR = 1.6; 95% CI = 1.2–2.0; for suicide attempts OR = 2.3; 95% CI = 1.3–4.1; for occasional smoking OR = 0.6; 95% CI = 0.5–0.8; for non-dependent regular smoking OR = 0.9; 95% CI = 0.7–1.2; and for dependent regular smoking OR = 0.9; 95% CI = 0.7–1.2.a Never used any tobacco product in lifetime.b Never used any tobacco product on a daily basis for more than four weeks in lifetime.c Among the N = 2222 respondents with at least occasional use, N = 7 used exclusively tobacco products other than cigarettes.d Smoked cigarettes daily for at least for weeks in lifetime but have never fulfilled DSM-IV criteria for nicotine dependence.e Smoked cigarettes daily for at least for weeks in lifetime and fulfill DSM-IV criteria for nicotine dependence.f Excludes suicide attempt(s).

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Table 2.
Baseline associations between smoking status and suicidaliy (N = 3021)
N indicates unweighted number, %w weighted percentages, OR Odds Ratio; CI Confidence Interval.
The odds ratio is significant p < .05; all odds ratios are controlled for age and gender, alcohol and drug use.a Never used any tobacco product in lifetime.b Never used any tobacco product on a daily basis for more than four weeks in lifetime.c Smoked cigarettes daily for at least four weeks in lifetime but have never fulfilled DSM-IV criteria for nicotine dependence.d Smoked cigarettes daily for at least four weeks in lifetime and fulfilled DSM-IV criteria for nicotine dependence.e Excludes suicide attempt(s).

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Table 3.
Association between smoking status baseline and new onset of suicide ideation during the four year follow-up period
N indicates unweighted number, %w weighted percentages, OR Odds Ratio; CI Confidence Interval:
All analyses were controlled for drug and alcohol use.
The odds ratio is significant p < .05; all odds ratios are controlled for age and gender, alcohol and drug use. N = 23 reported attempts.a Never used any tobacco product in lifetime.b Never used any tobacco product on a daily basis for more than four weeks in lifetime.c Smoked cigarettes daily for at least four weeks in lifetime but have never fulfilled DSM-IV criteria for nicotine dependence.d Smoked cigarettes daily for at least four weeks in lifetime and fulfilled DSM-IV criteria for nicotine dependence.

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Table 4.
Associations between smoking status baseline and new onset of suicide attempts during the four year follow-up period
N indicates unweighted number, %w weighted percentages, OR Odds Ratio; CI Confidence Interval:
All analyses were controlled for suicide ideation at baseline as well as for drug and alcohol use.
The odds ratio is significant p < .05; all odds ratios are controlled for age and gender and alc and drug use.a Never used any tobacco product in lifetime.b Never used any tobacco product on a daily basis for more than four weeks in lifetime.c Smoked cigarettes daily for at least four weeks in lifetime but have never fulfilled DSM-IV criteria for nicotine dependence.d Smoked cigarettes daily for at least four weeks in lifetime and fulfilled DSM-IV criteria for nicotine dependence.

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Table 5.
Associations between suicide ideation/attempt(s) at baseline and incident smoking during the four-year follow-up
N indicates unweighted number, %w weighted percentages, OR Odds Ratio; CI Confidence Interval; all odds ratios are controlled for age and gender and occasional smoking at baseline.

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Journal of Affective DisordersVolume 108, Issues 1-2, May 2008, Pages 135-145