Smoking and the Risk of Suicidal Behavior: A Prospective Study of a Community Sample | Lifestyle Behaviors | JAMA Psychiatry | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Doll  RPeto  R Mortality in relation to smoking: 20 years’ observations on male British doctors.  BMJ 1976;21525- 1536PubMedGoogle ScholarCrossref
Doll  RPeto  RWheatley  KGray  RSutherland  I Mortality in relation to smoking: 40 years’ observations on male British doctors.  BMJ 1994;309901- 911PubMedGoogle ScholarCrossref
Hemenway  DSolnick  SJColditz  GA Smoking and suicide among nurses.  Am J Public Health 1993;83249- 251PubMedGoogle ScholarCrossref
Ross  RKBernstein  LTrent  LHenderson  BEPaganini-Hill  A A prospective study of risk factors for traumatic deaths in a retirement community.  Prev Med 1990;19323- 334PubMedGoogle ScholarCrossref
Paffenbarger  RS  JrLee  I-MLeung  R Physical activity and personal characteristics associated with depression and suicide in American college men.  Acta Psychiatr Scand Suppl 1994;37716- 22PubMedGoogle ScholarCrossref
Tverdal  AThelle  DStensvold  ILeren  PBjartveit  K Mortality in relation to smoking history: 13 years’ follow-up of 68,000 Norwegian men and women 35-49 years.  J Clin Epidemiol 1993;46475- 487PubMedGoogle ScholarCrossref
Smith  GDPhillips  ANNeaton  JD Smoking as “independent” risk factor for suicide: illustration of an artifact from observational epidemiology?  Lancet 1992;340709- 712PubMedGoogle ScholarCrossref
Miller  MHemenway  DRimm  E Cigarettes and suicide: a prospective study of 50,000 men.  Am J Public Health 2000;90768- 773PubMedGoogle ScholarCrossref
Miller  MHemenway  DBell  NSYore  MMAmoroso  PJ Cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers.  Am J Epidemiol 2000;1511060- 1063PubMedGoogle ScholarCrossref
Angst  JClayton  PJ Personality, smoking and suicide: a prospective study.  J Affect Disord 1998;5155- 67PubMedGoogle ScholarCrossref
Avery  DWinokur  G Suicide, attempted suicide, and relapse rates in depression.  Arch Gen Psychiatry 1978;35749- 753PubMedGoogle ScholarCrossref
Barraclough  BBunch  JNelson  BSainsbury  P A hundred cases of suicide: clinical aspects.  Br J Psychiatry 1974;125355- 373PubMedGoogle ScholarCrossref
Brown  GKBeck  ATSteer  RAGrisham  JR Risk factors for suicide in psychiatric outpatients: a 20-year prospective study.  J Consult Clin Psychol 2000;68371- 377PubMedGoogle ScholarCrossref
Ösby  UBrandt  LCorreia  NEkbom  ASparén  P Excess mortality in bipolar and unipolar disorder in Sweden.  Arch Gen Psychiatry 2001;58844- 850PubMedGoogle ScholarCrossref
Høyer  EHMortensen  PBOlesen  AV Mortality and the causes of death in a total national sample of patients with affective disorders admitted for the first time between 1973 and 1993.  Br J Psychiatry 2000;17676- 82PubMedGoogle ScholarCrossref
Coryell  W Diagnosis-specific mortality: primary unipolar depression and Briquet’s syndrome (somatization disorder).  Arch Gen Psychiatry 1981;38939- 942PubMedGoogle ScholarCrossref
Lee  ASMurray  RM The long-term outcome of Maudsley depressives.  Br J Psychiatry 1988;153741- 751PubMedGoogle ScholarCrossref
Surtees  PGBarkley  C Future imperfect: the long-term outcome of depression.  Br J Psychiatry 1994;164327- 341PubMedGoogle ScholarCrossref
Breslau  NPeterson  ELSchultz  LRChilcoat  HDAndreski  P Major depression and stages of smoking: a longitudinal investigation.  Arch Gen Psychiatry 1998;55161- 166PubMedGoogle ScholarCrossref
Fowler  JSVolkow  NDWang  GJPappas  NLogan  JAlexoff  DShea  CSchlyer  DWolf  APWarner  DZezulkova  ICilento  R Inhibition of monoamine oxidase B in the brains of smokers.  Nature 1996;379733- 737PubMedGoogle ScholarCrossref
Wu  L-TAnthony  JC Tobacco smoking and depressed mood in late childhood and early adolescence.  Am J Public Health 1999;891837- 1840PubMedGoogle ScholarCrossref
Goodman  ECapitman  J Depressive symptoms and cigarette smoking among teens.  Pediatrics 2000;106748- 755PubMedGoogle ScholarCrossref
Kandel  DBDavies  MKarus  DYamaguchi  K The consequences in young adulthood of adolescent drug involvement.  Arch Gen Psychiatry 1986;43746- 754PubMedGoogle ScholarCrossref
Hemmingsson  TKriebel  D Smoking at age 18-20 and suicide during 26 years of follow-up: how can the association be explained?  Int J Epidemiol 2003;321000- 1004PubMedGoogle ScholarCrossref
Tanskanen  AViinamäki  HHintikka  JKoivumaa-Honkanen  H-TLehtonen  J Smoking and suicidality among psychiatric patients.  Am J Psychiatry 1998;155129- 130PubMedGoogle Scholar
Fergusson  DMWoodward  LJHorwood  LJ Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood.  Psychol Med 2000;3023- 29PubMedGoogle ScholarCrossref
Vega  WAGil  AWarheit  GApospori  EZimmerman  R The relationship of drug use to suicide ideation and attempts among African American, Hispanic, and white non-Hispanic male adolescents.  Suicide Life Threat Behav 1993;23110- 119PubMedGoogle Scholar
Garrison  CZMcKeown  REValois  RFVincent  ML Aggression, substance use, and suicidal behaviors in high school students.  Am J Public Health 1993;83179- 184PubMedGoogle ScholarCrossref
Kessler  RCBorges  GWalters  EE Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.  Arch Gen Psychiatry 1999;56617- 626PubMedGoogle ScholarCrossref
Leon  ACFriedman  RASweeney  JABrown  RPMann  JJ Statistical issues in the identification of risk factors for suicidal behavior: the application of survival analysis.  Psychiatry Res 1990;3199- 108PubMedGoogle ScholarCrossref
Nordstrom  PSamuelsson  MAsberg  M Survival analysis of suicide risk after attempted suicide.  Acta Psychiatr Scand 1995;91336- 340PubMedGoogle ScholarCrossref
Fowler  JSLogan  JWang  G-JVolkow  ND Monoamine oxidase and cigarette smoking.  Neurotoxicology 2003;2475- 82PubMedGoogle ScholarCrossref
Buchsbaum  MSCoursey  RDMurphy  DL The biochemical high-risk paradigm: behavioral and familial correlates of low platelet monoamine oxidase activity.  Science 1976;194339- 341PubMedGoogle ScholarCrossref
Mann  JJMalone  KM Cerebrospinal fluid amines and higher-lethality suicide attempts in depressed inpatients.  Biol Psychiatry 1997;41162- 171PubMedGoogle ScholarCrossref
Hughes  JRHatsukami  DKMitchell  JEDahlgren  LA Prevalence of smoking among psychiatric outpatients.  Am J Psychiatry 1986;143993- 997PubMedGoogle Scholar
Breslau  NNovak  SPKessler  RC Psychiatric disorders and stages of smoking.  Biol Psychiatry 2004;5569- 76PubMedGoogle ScholarCrossref
Giovino  GAHenningfield  JETomar  SLEscobedo  LGSlade  J Epidemiology of tobacco use and dependence.  Epidemiol Rev 1995;1748- 65PubMedGoogle Scholar
Lohr  JBFlynn  K Smoking and schizophrenia.  Schizophr Res 1992;893- 102PubMedGoogle ScholarCrossref
Whitfield  JBPang  DBucholz  KKMadden  PAHeath  ACStatham  DJMartin  NG Monoamine oxidase: associations with alcohol dependence, smoking and other measures of psychopathology.  Psychol Med 2000;30443- 454PubMedGoogle ScholarCrossref
Malone  KMWaternaux  CHaas  GLCooper  TBLi  SMann  JJ Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders.  Am J Psychiatry 2003;160773- 779PubMedGoogle ScholarCrossref
Breslau  NDavis  GCSchultz  L Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma.  Arch Gen Psychiatry 2003;60289- 294PubMedGoogle ScholarCrossref
Robins  LNHelzer  JECottler  LBGolding  E NIMH Diagnostic Interview Schedule, Version III Revised.  St Louis, Mo Washington University1989;
Fu  QHeath  ACBucholz  KKNelson  ECGlowinski  ALGoldberg  JLyons  MJTsuang  MTJacob  TTrue  MREisen  SA A twin study of genetic and environmental influences on suicidality in men.  Psychol Med 2002;3211- 24PubMedGoogle ScholarCrossref
Zeger  SLLiang  KY Longitudinal data analysis for discrete and continuous outcomes.  Biometrics 1986;7313- 22Google ScholarCrossref
Diggle  PJLiang  KYZeger  SL Analysis of Longitudinal Data.  New York, NY Oxford University Press1994;
SAS Institute Inc, SAS/STAT User’s Guide, Version 8.  Cary, NC SAS Institute Inc1999;1363- 1464
Weissman  MMKlerman  GLMarkowitz  JSOuellette  R Suicidal ideation and suicide attempts in panic disorder and attacks.  N Engl J Med 1989;3211209- 1214PubMedGoogle ScholarCrossref
Smith  GDPhillips  AN Re: “cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers.”  Am J Epidemiol 2001;153307PubMedGoogle ScholarCrossref
Cohen  LEFelson  M Social change and crime rate trends: a routine activity approach.  Am Sociol Rev 1979;44588- 607Google ScholarCrossref
Gottfredson  MR On the etiology of criminal victimization.  J Crim Law Criminol 1981;72714- 726Google ScholarCrossref
Breslau  NDavis  GCAndreski  PPeterson  E Traumatic events and posttraumatic stress disorder in an urban population of young adults.  Arch Gen Psychiatry 1991;48216- 222PubMedGoogle ScholarCrossref
Original Article
March 2005

Smoking and the Risk of Suicidal Behavior: A Prospective Study of a Community Sample

Author Affiliations

Author Affiliations: Department of Epidemiology (Dr Breslau) and Office of the Dean (Dr Davis), College of Human Medicine, Michigan State University, East Lansing; Department of Biostatistics and Research Epidemiology (Drs Schultz and Peterson) and Center for Health Promotion and Disease Prevention (Dr Johnson), Henry Ford Health Systems, Detroit, Mich.

Arch Gen Psychiatry. 2005;62(3):328-334. doi:10.1001/archpsyc.62.3.328

Backgroung  A link between cigarette smoking and suicidal behavior has been reported in clinical and epidemiological studies.

Objective  To examine the association between smoking and suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal behaviors is taken into account.

Design  A longitudinal study of young adults interviewed initially in 1989, with repeated assessments over a 10-year follow-up.

Setting and Participants  The sample was selected from a large health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3, 5, and 10 years after baseline) exceeded 91%.

Main Outcome Measures  Relative risk of occurrence of suicidal behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each reassessment.

Results  Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior depression and substance use disorders (adjusted odds ratio, 1.82; 95% confidence interval, 1.22-2.69). Additionally, current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, adjusting for suicidal predisposition, indicated by prior suicidality, and controlling for prior psychiatric disorders (adjusted odds ratio, 1.74; 95% confidence interval, 1.17-2.54).

Conclusions  The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed cautiously.