title: Smoking and suicidality in patients with a psychotic disorder.
abstract: Cigarette smoking has been associated with an increased risk of suicide. Patients with psychosis are more likely to smoke cigarettes and are also at an increased risk of suicide. The aim of this study was to compare risk for suicidal behavior among patients with psychosis who were current smokers, previous smokers and nonsmokers. We studied 1812 of the 1825 participants who took part in the Australian Survey of High Impact Psychosis (SHIP) for whom smoking data was available. We identified predictors for lifetime suicide attempts using univariate logistic regression analysis. These variables were retained for the multiple logistic regression models if they were a significant predictor of lifetime suicide attempts. A series of multiple logistic regressions were then conducted to predict lifetime suicide attempts using current smoking status and lifetime smoking status as independent variables, respectively, while controlling for the retained predictor variables. Current smoking and lifetime smoking were statistically significant predictors of lifetime suicide attempts. However adding the covariates to a logistic regression model reduced this association to non-significance. The strongest predictors were self-harm in the past 12 months, the presence of lifetime depressive symptoms and a diagnosis of psychotic depression. Identification of suicide risk factors is essential for successful suicide prevention. While previous research highlights the importance of cigarette smoking as an important risk factor for suicidal behaviors including in patients with psychosis, these results must be interpreted within the context of methodological issues.
authors.affiliation: Hunter Valley Mental Health Service, 10/555 High Street, Maitland, NSW 2320, Australia. Electronic address: Anoop.Sankaranarayanan@hnehealth.nsw.gov.au.
authors.forename: Anoop
authors.initials: A
authors.lastname: Sankaranarayanan
authors.affiliation: St Vincent's Mental Health, PO Box 2900, Fitzroy, VIC 3065, Australia. Electronic address: sam.mancuso@svhm.org.au.
authors.forename: Serafino
authors.initials: S
authors.lastname: Mancuso
authors.affiliation: St. Vincent's Hospital Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia. Electronic address: David.CASTLE@svhm.org.au.
authors.forename: David
authors.initials: D
authors.lastname: Castle
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D001714:Bipolar Disorder; D003430:Cross-Sectional Studies; D003863:Depression; D003865:Major Depressive Disorder; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data
keywords: Cigarette smoking and suicide; Psychosis and suicide; Suicide; Suicide risk factors