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Cited by 81Suicide and Self-Harm StudiesSmoking Behavior and CessationSubstance Abuse Treatment and Outcomes

The association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample

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Kessler, R C, Borges, G, Sampson, N, Miller, M, Nock, M K·2009·Molecular Psychiatry
DOI 10.1038/mp.2008.78PMC PMC2784156
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Abstract

Controversy exists about whether the repeatedly documented associations between smoking and subsequent suicide-related outcomes (SROs; ideation, plans, gestures and attempts) are due to unmeasured common causes or to causal effects of smoking on SROs. We address this issue by examining associations of smoking with subsequent SROs with and without controls for potential explanatory variables in the National Comorbidity Survey (NCS) panel. The latter consists of 5001 people who participated in both the 1990-2002 NCS and the 2001-2003 NCS follow-up survey. Explanatory variables include sociodemographics, potential common causes (parental history of mental-substance disorders; other respondent childhood adversities) and potential mediators (respondent history of Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised mental-substance disorders). Small gross (that is, without controls) prospective associations are found between history of early-onset nicotine dependence and both subsequent suicide ideation and, among ideators, subsequent suicide plans. None of the baseline smoking measures, though, predicts subsequent suicide gestures or attempts among ideators. The smoking-ideation association largely disappear, but the association of early-onset nicotine dependence with subsequent suicide plans persists (odds ratio=3.0), after adjustment for control variables. However, the latter association is as strong with remitted as active nicotine dependence, arguing against a direct causal effect of nicotine dependence on suicide plans. Decomposition of the control variable effects, furthermore, suggests that these effects are due to common causes more than to mediators. These results refine our understanding of the ways in which smoking is associated with later SROs and for the most part argue against the view that these associations are due to causal effects of smoking.

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  • Definitive causal links are difficult to establish because many suicide risk factors are associated with smoking risk factors.

    “Definitive causal links are challenging to make because many of the risk factors for suicide are associated with risk factors for smoking.12,19”

    From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [19]

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  1. [5]Miller M Hemenway D Bell NS Yore MM Amoroso PJ Cigarette smoking and suicide: a prospective study of 300,000 male active-duty Army soldiers (author reply) Am J Epidemiol 2000 152 692 10873129

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Authors
Kessler, R. C., Borges, G., Sampson, N., Miller, M., & Nock, M. K.
Affiliations
  • Harvard University (US)
  • Universidad Autónoma Metropolitana (MX)
Corresponding author
Kessler, R C
ORCID
Venue
Molecular Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2008-07-22
Volume
14
Issue
12
Pages
1132-1142
ISSN
  • 1359-4184 (ISSN-L)
  • 1476-5578
DOI
10.1038/mp.2008.78
PMC
PMC2784156
OpenAlex
W2137473284
Cited by
81
References
46
Citations by year
2026: 2 · 2025: 2 · 2023: 2 · 2022: 3 · 2021: 8 · 2020: 3 · 2019: 2 · 2018: 5 · 2017: 1 · 2016: 12 · 2015: 10 · 2014: 4 · 2013: 7 · 2012: 5
FWCI
5.58
Type
journal article
Language
en
Open access
Licence
Locations
  • Molecular Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
Funders
  • World Health Organization
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • Substance Abuse and Mental Health Services Administration
  • National Institute of Mental Health (R13-MH-066849, R01‐MH070884, R01MH046376, R01MH077883, U01-MH-60220, U13MH066849, U01MH060220, R01‐MH069864)
  • National Institute on Drug Abuse (K05DA015799, R01DA011121, R01DA016558)
  • Fogarty International Center (R03TW006481)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
smoking, suicide, suicidal ideation, suicide planning, suicide attempts, nicotine dependence, common cause, mediation, National Comorbidity Survey, childhood adversity, parental mental illness
MeSH terms
Adolescent, Adult, Female, Follow-Up Studies, Health Services, Humans, Disruptive, Impulse Control, and Conduct Disorders, Male, Mexico, Middle Aged, Psychiatric Status Rating Scales, Retrospective Studies, Risk Factors, Severity of Illness Index, Smoking, Suicide, Tobacco Use Disorder, Comorbidity, Odds Ratio, Young Adult

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