Smoking differently modifies suicide risk of affective disorders, substance use disorders, and social factors.
BACKGROUND
Although an association between smoking and suicide has repeatedly been shown, information about a modifying influence of smoking on other risk factors for suicide is lacking.


METHODS
Axis I and Axis II disorders, sociodemographic factors, and tobacco use were assessed by a semi-structured interview including the Structured Clinical Interview for DSM-IV Axis I (SCID-I) and Personality Disorders (SCID-II) in 163 suicides (mean age 49.6+/-19.3 years; 64.4% men;) by psychological autopsy method and by personal interview in 396 living population-based control persons (mean age 51.6+/-17.0 years; 55.8% men).


RESULTS
Smoking status (current smokers, lifetime non-smokers, and former smokers) differently modifies the effects of psychiatric disorders and sociodemographic variables on suicide risk. Former and current smoking modified suicide risk associated with affective disorders, but only current smoking increased suicide risk for substance use disorders. Ex-smokers with affective disorders, particularly with major depression, had less increased suicide risk than current smokers and non-smokers with affective disorders. Estimated suicide risks for personality disorders and 'no professional training' were strongly increased by smoking.


CONCLUSIONS
Due to the small size of some of the subgroups, confidence intervals are wide. Therefore, precise risk estimation is not possible.


CONCLUSIONS
Clinicians should interpret smoking as an indicator of increased risk of suicide for individuals with substance use disorders, personality disorders, and adverse social factors. Further studies are needed to investigate the effects of smoking cessation on suicide risk of patients with psychiatric disorders such as major depression and substance use disorders.
Centre of Psychiatry, Department of Psychiatry, Psychosomatics, and Psychotherapy, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. B.Schneider@em.uni-frankfurt.de
Barbara
B
Schneider
Tilman
T
Wetterling
Klaus
K
Georgi
Bernadette
B
Bartusch
Axel
A
Schnabel
Maria
M
Blettner
D016022:Case-Control Studies; D015897:Comorbidity; D035061:Control Groups; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000523:psychology; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012106:Research; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*