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Cited by 237Smoking Behavior and CessationSuicide and Self-Harm StudiesSubstance Abuse Treatment and Outcomes

Smoking and suicide: A brief overview

Open access
Hughes, John R.·2008·Drug and Alcohol Dependence
DOI 10.1016/j.drugalcdep.2008.06.003PMC PMC2585177
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Abstract

This article provides a brief overview of the rationales, possible mechanisms and epidemiological data on the association of smoking, smoking cessation and cessation medications with suicide. Current smoking is reliably associated with suicide both in case-control and cohort studies. The three most plausible (but relatively untested) explanations for the association are that smokers have pre-existing conditions that increase their risk for suicide, smoking causes painful and debilitating conditions that might lead to suicide, and smoking decreases serotonin and monoamine oxidase levels. Stopping smoking appears to lead to major depression in some smokers; thus, it could induce suicide; however, smoking cessation has not been associated with suicide in the few studies available. Regulatory agencies have stated bupropion, rimonabant and varenicline appear to be associated with suicide; however, the data for these statements have not been presented in sufficient detail to assess their validity. Most prior data have come from post hoc analyses. Studies that a priori focus on understanding smoking and suicide are now needed.

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  • Alcohol misuse and mental illness account for part, but not all, of the link between smoking and suicide.

    “The underlying mechanism for this increased risk is unclear, although confounding by alcohol misuse and mental illness seems to explain some, but certainly not all, of the association.1”

    From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [1]

    In Results §3.2, the review reports that the smoking–suicide association persisted in several studies after controlling for major depression, alcohol or drug abuse, and other psychiatric disorders. It also reports studies in which adjustment eliminated the association, but cautions that the adjusted factors may be mediators rather than confounders. Thus, the source supports an association not consistently removed by adjustment, but does not establish that confounding by alcohol misuse and mental illness explains part of it. (LLM, conf=0.82)

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  • Active smokers have about two to three times the risk of suicidality compared with people who never smoked.

    “Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,1–4”

    From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [1]

    Section 3.2.2 (page unavailable) reports that current smoking is associated with suicidal thoughts, plans, and deaths, with odds ratios and relative risks typically greater than 2.0. It does not establish a typical upper bound of threefold or specify that the comparison group was exclusively never-smokers. (LLM, conf=0.82)

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Cites

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1 of the 105 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Department of Veterans Affairs recent safety issues regarding varenicline (Chantix™) National PBM Bulletin 2008
  2. Hughes JR The effects of abstinence from tobacco: Etiology, determinants, epidemiology, significance Nicotine and Tobacco Research 2007a 9 329 339 17365765
  3. Smith GD Phillips AN Neaton JD Smoking as "independent" risk factor for suicide: Illustration of an artifact from observational epidemiology? Lancet 1999 340 709 712 1355809
  4. Sudak HC Psychiatric emergencies Kaplan & Sadock's Comprehensive Testbook of Psychiatry 1999 7th Edition New York Lippincott Williams and Wilkins

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Authors
Hughes, J. R.
Affiliations
University of Vermont (US)
Corresponding author
Hughes, John R.
ORCID
Hughes, John R.
Venue
Drug and Alcohol Dependence
Publisher
Elsevier BV
Published
2008-12
Volume
98
Issue
3
Pages
169-178
ISSN
0376-8716 (ISSN-L)
DOI
10.1016/j.drugalcdep.2008.06.003
PMC
PMC2585177
OpenAlex
W2062560594
Cited by
236
References
105
Citations by year
2026: 3 · 2025: 6 · 2024: 9 · 2023: 1 · 2022: 4 · 2021: 12 · 2020: 39 · 2019: 12 · 2018: 13 · 2017: 7 · 2016: 12 · 2015: 16 · 2014: 18 · 2013: 14 · 2012: 15
FWCI
1.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Drug and Alcohol Dependence (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute on Drug Abuse (DA00490, K05DA000490)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
smoking, suicide, smoking cessation, smoking cessation medication, bupropion, rimonabant, varenicline, major depressive disorder, serotonin, monoamine oxidase, suicide risk factors, suicide epidemiology
MeSH terms
Antidepressive Agents, Cannabinoids, Humans, Smoking, Suicide, Biomarkers, Smoking Cessation, Self-Injurious Behavior, Nicotinic Agonists

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