title: Joint heavy use of alcohol, cigarettes and coffee and the risk of suicide.
abstract: OBJECTIVE
  To estimate the relationship between joint heavy use of alcohol, cigarettes and coffee, and the risk of suicide in a general population with high rate of suicide.
  
  
  METHODS
  Prospective cohort analyses.
  
  
  METHODS
  Finland.
  
  
  METHODS
  Data from 36,689 adult (age range 25-64 years) men and women who participated in the population surveys between 1972 and 1992.
  
  
  METHODS
  The mortality of the cohort was monitored for a mean of 14.4 years, which yielded 169 suicides. Criteria for heavy use of each psychoactive substance were defined as follows: alcohol (> 120 g/week), cigarettes (> or = 21/day) and coffee (> or = seven cups/day).
  
  
  RESULTS
  About half the men and 80% of the women did not use any of the psychoactive substances heavily. Every third man and every fifth woman used one substance heavily, and the prevalence for those who exceeded criteria for joint heavy use of two substances was 9% for men and 1% for women. Joint heavy use of all three substances was rare. The adjusted relative risk of suicide increased linearly with increasing level of joint heavy use of alcohol, cigarettes and coffee. Among subjects with heavy use of one substance the risk was 1.55 (95% CI = 1.10, 2.18), with joint heavy use of two substances 2.22 (95% CI = 1.37, 3.61), and with joint heavy use of all three substances 3.99 (95% CI = 1.80, 8.84) compared with no heavy use.
  
  
  CONCLUSIONS
  Clustering of the heavy use of alcohol, cigarettes and coffee could serve as a new marker for increased risk of suicide.
authors.affiliation: Department of Psychiatry, University of Kuopio, PO Box 1777, 70211 Kuopio, Finland. antti.tanskanen@kuh.fi
authors.forename: A
authors.initials: A
authors.lastname: Tanskanen
authors.forename: J
authors.initials: J
authors.lastname: Tuomilehto
authors.forename: H
authors.initials: H
authors.lastname: Viinamäki
authors.forename: E
authors.initials: E
authors.lastname: Vartiainen
authors.forename: J
authors.initials: J
authors.lastname: Lehtonen
authors.forename: P
authors.initials: P
authors.lastname: Puska
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology*; D003069:Coffee / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000523:psychology*; D013405:Suicide / Q000523:psychology*; D000092864:Suicide Prevention
chemical_list: D003069:Coffee