title: Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts.
abstract: OBJECTIVE
  Tobacco dependence and suicidal behaviors have been repeatedly associated in several studies but their relationship is still unclear. We aim to investigate, specifically, the association between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters, as well as the relationship of impulsivity with both conditions.
  
  
  METHODS
  We examined a cross-sectional sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence, which was assessed with the Fagerstrom test.
  
  
  RESULTS
  Smokers with heavy dependence (Fagerstrom ≥7) made more attempts and reached higher medical lethality compared to non-smokers. Smokers with moderate dependence were not associated with features of severity in the suicide attempts. The combination of high impulsivity and heavy tobacco dependence showed an additive effect on the number of suicide attempts.
  
  
  CONCLUSIONS
  A high or very high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts. Impulsive attempters with heavy tobacco dependence were particularly at risk.
authors.affiliation: Department of Psychiatry, CHRU Nimes, 585 Chemin du Mas de Lauze, 30029 Nîmes, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France. Electronic address: jorge.lopezcastroman@chu-nimes.fr.
authors.forename: Jorge
authors.initials: J
authors.lastname: Lopez-Castroman
authors.affiliation: Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Cerrato
authors.affiliation: Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France.
authors.forename: Severine
authors.initials: S
authors.lastname: Beziat
authors.affiliation: Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Jaussent
authors.affiliation: Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Guillaume
authors.affiliation: Department of Emergency Psychiatry and Post-Acute Care, CHRU Montpellier, 191 Av. du Doyen Gaston Giraud, 34093 Montpellier, France; Inserm U1061, Université Montpellier, 39 Av. Charles Flahault, 34093 Montpellier, France; Fondamental Foundation, 40 Rue de Mesly, 94000 Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Courtet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013406:Suicide, Attempted / Q000523:psychology*; D014029:Tobacco Use Disorder / Q000523:psychology*; D055815:Young Adult
keywords: Cigarette; Impulsive-aggression; Self-harm; Smoking