Proposal for the Inclusion of Tobacco Use in Suicide Risk Scales: Results of a Meta-Analysis

Abstract

There is an association between smoking and suicide, even though the direction and nature of this relationship remains controversial. This meta-analysis aimed to evaluate the association between smoking and suicidal behaviours (ideation, planning, suicide attempts, and death by suicide). On 24 August 2020, we searched the PubMed, Cochrane library, Scopus, Web of Science, TRIP, and SCIENCE DIRECT databases for relevant articles on this topic. Twenty prospective cohort studies involving 2,457,864 participants were included in this meta-analysis. Compared with never smokers, former and current smokers had an increased risk of death by suicide (relative risk [RR] = 1.31; 95% CI [1.13, 1.52] and RR = 2.41; 95% CI [2.08, 2.80], respectively), ideation (RR = 1.35; 95% CI [1.31, 1.39] and RR = 1.84; 95% CI [1.21, 2.78]), and attempted suicide (RR = 1.27; 95% CI [0.56, 2.87] and RR = 1.71; 95% CI [0.73, 3.97]). Moreover, compared to never smokers, current smoker women (RR = 2.51; 95% CI [2.06–3.04] had an increased risk of taking their own life (Q = 13,591.53; p < 0.001) than current smoker men (RR = 2.06; 95% CI [1.62–2.62]. Furthermore, smoking exposure (former and current smokers) was associated with a 1.74-fold increased risk (95% CI [1.54, 1.96]) of suicidal behaviour (death by suicide, ideation, planning, or attempts). Thus, because of the prospective relationship between smoking and suicidal behaviours, smoking should be included in suicide risk scales as a useful and easy item to evaluate suicide risk.

Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors

“…Similarly, people who declared being in a relationship had a lower propensity to attempt suicide. This finding is similar to those of studies conducted in other countries, in which not being married or, more specifically, being divorced or experiencing a family breakdown was repeatedly reported as an associated factor for attempting suicide 36 - 38 .…”

“…Alcohol consumption may also be related to the presence of psychiatric disorders that increase suicide attempts 43 . Similarly, tobacco smoking has been identified as an associated factor for suicidal behavior regardless of prior psychiatric or medical diagnoses or treatment 38 , 44 possibly because addictive behaviors tend to affect people with a lower perception of danger, who are more impulsive and more likely to engage in life-threatening behaviors and who tend to act rashly 45 .…”

Individual-level risk factors for suicide mortality in the general population: an umbrella review

“…In total, we included data from 33 meta-analyses reporting on 38 risk factors for suicide mortality ( appendix pp 15–16 ). 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 …”

Sociodemographic and environmental characteristics associated with thoughts of death and suicidal ideation in community-dwelling residents of a rural town in Japan: analyses from a perspective of accompanying problems

“…The relationship between depression and smoking has been extensively studied, and a causal inference has been argued; however, a consensus has not yet been reached [ 32 ]. Furthermore, the risk of death from suicide among current smokers has increased among female smokers [ 33 ]. In this regard, we did not observe any statistical interaction between current smoking and gender or K6 scores.…”