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

Molecular Psychiatry volume 14, pages 1132–1142 (2009)Cite this article

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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Acknowledgements

The NCS data collection was supported by the National Institute of Mental Health (NIMH; R01MH46376). The NCS-2 data collection was supported by the National Institute on Drug Abuse (NIDA; R01DA011121). Data analysis for this paper was additionally supported by NIMH grants R01MH070884, R01MH077883 and U01-MH60220, with supplemental support from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; grant 044780) and the John W Alden Trust. The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government. A complete list of NCS and NCS-2 publications can be found at http://www.hcp.med.harvard.edu/ncs. Send correspondence to ncs@hcp.med.harvard.edu. The NCS-2 is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. These activities were supported by the National Institute of Mental Health (R01 MH070884), the John D and Catherine T MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical Inc., GlaxoSmithKline and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

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Authors and Affiliations

  1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    R C Kessler & N Sampson

  2. National Institute of Psychiatry, Mexico City, Mexico

    G Borges

  3. Universidad Autonoma Metropolitana, Mexico City, Mexico

    G Borges

  4. Harvard Injury Control Research Center, Harvard School of Public Health, Boston, MA, USA

    M Miller

  5. Department of Psychology, Harvard University, Cambridge, MA, USA

    M K Nock

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  1. R C Kessler
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Correspondence to R C Kessler.

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Kessler, R., Borges, G., Sampson, N. et al. The association between smoking and subsequent suicide-related outcomes in the National Comorbidity Survey panel sample. Mol Psychiatry 14, 1132–1142 (2009). https://doi.org/10.1038/mp.2008.78

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