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The study by Romain Icick, M.D., of Paris Diderot University and colleagues included 916 patients who had bipolar I or II according to DSM-IV criteria and were from France or Norway. Of these participants, 338 (37%) reported at least one suicide attempt, and 173 reported recurrent suicide attempts—defined by authors as two or more suicide attempts.
Icick and colleagues found that patients with bipolar disorder who smoked tobacco daily were 1.75 times as likely to have a history of recurrent suicides compared with nonsmokers with bipolar disorder. Bipolar patients who smoked tobacco and had cannabis use disorder were 2.65 times as likely to have recurrent suicide attempts as nonsmokers with bipolar disorder, while those who smoked tobacco and had alcohol use disorder were 3.58 times as likely. The available data from patients regarding their smoking history suggested these risks were found only in current smokers and not former smokers.
The investigators also found that bipolar patients who experienced depression (as opposed to mania) as their first symptom or who were women were more likely to have recurrent suicide attempts. These risk factors were independent of smoking status, suggesting they could be used to further stratify patients based on their suicide risk.
Icick and colleagues cautioned that this study used retrospective data that included information from patient self-reports. Therefore, it’s possible that some of the substance use occurred following a suicide attempt so the issue of causality cannot be confirmed, they noted. “It is noticeable, however, that emerging data suggest such a causal relationship between smoking outcomes and both mood states and suicide risk,” Icick and colleagues wrote.
For related information, see the Psychiatric Services article “Low-Burden Strategies to Promote Smoking Cessation Treatment Among Patients With Serious Mental Illness.”
(Image: iStock/boonchai wedmakawand)
