title: Nicotine dependence is associated with suicide attempts and self-mutilation among adolescent females.
abstract: OBJECTIVE
  There are no studies investigating the degree of nicotine dependence (ND) and suicidality among underage adolescents. Our aim was to investigate the relationship between ND and various forms of suicidal behavior among adolescent psychiatric inpatients in Finland.
  
  
  METHODS
  Data were collected from 508 patients (age, 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. The level of ND was assessed by the modified Fagerström Tolerance Questionnaire. Information on adolescents' suicide attempts and self-mutilation as well as psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnoses was obtained by using the Schedule for Affective Disorder and Schizophrenia for School-Age Children.
  
  
  RESULTS
  After adjusting for adolescents' age and psychiatric diagnoses, a more than 4-fold risk for suicide attempts (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.3-17.2) and self-mutilative behavior (OR, 4.5; 95% CI, 1.6-13.3) was found among female adolescents with a high level of ND compared to nonsmoking adolescent females. In addition, the risk for suicide attempts was only increased by a high level of ND, whereas the risk for self-mutilation was increased among females with mild ND as well. Among males, the level of ND was not associated with suicide attempts or self-mutilative behavior.
  
  
  CONCLUSIONS
  The level of ND should be taken into account when evaluating adolescent suicidality. Further sex-specific studies with accurate measurements of nicotine and its metabolites in relation to various suicidal and self-destructive behaviors are needed.
authors.affiliation: Department of Psychiatry, Oulu University Hospital, Finland. kaisa.riala@oulu.fi
authors.forename: Kaisa
authors.initials: K
authors.lastname: Riala
authors.forename: Helinä
authors.initials: H
authors.lastname: Hakko
authors.forename: Pirkko
authors.initials: P
authors.lastname: Räsänen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D017677:Age Distribution; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005190:Family; D005260:Female; D005387:Finland / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012652:Self Mutilation / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology