title: Increased risk of suicide attempt in bipolar patients with severe tobacco dependence.
abstract: BACKGROUND
  The aim of our study was to investigate, in bipolar patients, the association between tobacco status (use and dependence) and history of suicide attempt, and to assess the possible role of inflammation as a missing link in the association between smoking status and history of suicide attempt.
  
  
  METHODS
  A total of 453 adult bipolar out-patients recruited in the French FondaMental Advanced Centres of Expertise for Bipolar Disorder were divided into two subgroups: 274 patients without past history of suicide attempt (non-SA), and 179 patients with a past history of suicide attempt (SA). Tobacco use and dependence, psychiatric and somatic comorbidities, history of childhood abuse, family history of suicide were assessed. Fasting blood tests yielded samples collected for the measurement of high sensitivity (hs-)CRP.
  
  
  RESULTS
  The risk of suicide attempt increased with smoking dependence. Notably, bipolar patients with a history of suicide attempt were three times more likely to have severe tobacco dependence, independently of confounding factors. However, we failed to find arguments promoting the hypothesis of inflammatory markers (through hs-CRP measure) in the link between tobacco dependence and suicidal behavior.
  
  
  CONCLUSIONS
  We found a significant association between severe tobacco dependence and history of suicide attempt, but not with level of CRP, independently of confusing factors. Longitudinal studies taken into account all these potential confusing factors are needed to confirm our results.
authors.affiliation: CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France. Electronic address: d-ducasse@chu-montpellier.fr.
authors.forename: D
authors.initials: D
authors.lastname: Ducasse
authors.affiliation: Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France.
authors.forename: I
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
authors.forename: S
authors.initials: S
authors.lastname: Guillaume
authors.affiliation: FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: FondaMental Foundation, Créteil, France; Hospital Saint-Louis - Lariboisière - Fernand Widal, AP-HP, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: FondaMental Foundation, Créteil, France; AP HM, Psychiatric Pole, Sainte Marguerite, Marseille, France.
authors.forename: R
authors.initials: R
authors.lastname: Belzeaux
authors.affiliation: FondaMental Foundation, Créteil, France; Academic Hospital of Grenoble, Grenoble, France.
authors.forename: T
authors.initials: T
authors.lastname: Bougerol
authors.affiliation: FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France.
authors.forename: B
authors.initials: B
authors.lastname: Etain
authors.affiliation: FondaMental Foundation, Créteil, France; Charles Perrens Hospital, Bordeaux, France.
authors.forename: S
authors.initials: S
authors.lastname: Gard
authors.affiliation: FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Henry
authors.affiliation: FondaMental Foundation, Créteil, France; Brabois Hospital, Academic Hospital of Nancy, Vandoeuvre Les Nancy, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: FondaMental Foundation, Créteil, France; Université Paris-Est, Hopital Chenevier and AP-HP, Créteil, France.
authors.forename: M
authors.initials: M
authors.lastname: Leboyer
authors.affiliation: FondaMental Foundation, Créteil, France; Department of Psychiatry, Princesse-Grace Hospital, Monaco.
authors.forename: J
authors.initials: J
authors.lastname: Loftus
authors.affiliation: FondaMental Foundation, Créteil, France; Academic Hospital of Versailles, Le Chesnay, France.
authors.forename: C
authors.initials: C
authors.lastname: Passerieux
authors.affiliation: CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
authors.forename: P H
authors.initials: PH
authors.lastname: Courtet
authors.affiliation: CHU Montpellier, Hôpital Lapeyronie, Department of Emergency Psychiatry and Post Acute Care, CHRU Montpellier, France; Inserm, U1061 Montpellier, University of Montpellier, Montpellier, France; FondaMental Foundation, Créteil, France.
authors.forename: E
authors.initials: E
authors.lastname: Olié
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D012306:Risk; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000523:psychology*; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000523:psychology*
keywords: C-reactive protein; Dependence; Inflammation; Suicide attempt; Tobacco