MedWire News: Current cigarette smoking is a predictor for current and 9-month suicidal ideation and behavior in bipolar disorder (BD) patients, suggest US study results.
Studies have shown that BD patients are four times as likely to have nicotine dependence than the general population. Furthermore, cigarette smoking in BD individuals has been associated with suicidal behavior, although the precise relationship between the two remains unclear.
To investigate, Michael Ostacher (Harvard Medical School, Boston, Massachusetts) and colleagues examined the association between smoking, suicidality, and prospective suicide attempts in 116 BD patients over a 9-month period.
In total, 27% of patients were smokers who showed significantly higher rates of lifetime substance abuse disorders (61% vs 33%), were younger (37.3 vs 46.7 years), and had an earlier age of BD onset (14.4 vs 18.4 years) compared with non-smokers.
Current smoking was associated with higher baseline and 9-month follow-up Suicide Behaviors Questionnaire (SBQ) scores after adjusting for smoking status, gender, anxiety comorbidity, recovery status, age at first episode, and lifetime substance abuse.
However, this association was not significant after adjusting for impulsivity, using Barratt Impulsiveness Scale scores, suggesting that “the link between suicide may in part be explained by impulsivity, although power was limited by the relatively small number of smokers, and SBQ scores were higher in this model,” say the researchers.
Overall, eight (7%) patients attempted suicide between baseline and 9-month follow-up, with smokers 5.25-fold more likely to attempt suicide than nonsmokers (16.1% vs 3.5%).
“While the predictive value of smoking in and of itself for the identification of patients with BD at risk for suicide is small, it may be a useful addition to other clinical risk factors in a comprehensive assessment of suicide risk,” say the researchers.
They call for further research to better understand the link between smoking and elevated suicidality in BD, “with attention to personality characteristics, impulsivity, and the effect of periods of fluctuating nicotine use, withdrawal, and discontinuation.”
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