title: Smoking predicts suicidality: findings from a prospective community study.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Max-Planck-Institute of Psychiatry, Clinic and Clinical Psychology and Epidemiology, Kraepelinstreet 2-10, 80804 Munich, Germany. bronisch@mpipsykl.mpg.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Bronisch
authors.forename: Michael
authors.initials: M
authors.lastname: Höfler
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013223:Statistics as Topic; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000523:psychology