The Relationship Between Smoking and Suicidal Behavior, Comorbidity, and Course of Illness in Bipolar Disorder
J Clin Psychiatry 2006;67(12):1907-1911
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Objectives: The rate of smoking in
people with bipolar disorder is much greater than in
the general population, but the implications of
smoking for the course of bipolar disorder have
not been well studied. The purpose of this
retrospective study was to examine the relationship
between smoking, severity of bipolar disorder, suicidal behavior, and psychiatric and substance
use disorder comorbidity.
Method: We evaluated 399 outpatients
with bipolar disorder who were treated in a
bipolar specialty clinic from December 1999 to
October 2004. Diagnosis, mood state, course of
illness, functioning, and psychiatric comorbidities
were assessed using the Affective Disorders
Evaluation and the Mini-International Neuropsychiatric
Results: Of the 399 patients evaluated,
155 (38.8%) had a history of daily smoking. Having ever smoked was associated with earlier age
at onset of first depressive or manic episode,
lower Global Assessment of Functioning scores,
higher Clinical Global Impressions-Bipolar
Disorder scale scores, lifetime history of a suicide
attempt (47% for smokers vs. 25% for those who had never smoked), and lifetime comorbid
disorders: anxiety disorders, alcohol abuse and
dependence, and substance abuse and dependence. In a
logistic regression model including these factors,
suicide attempts and substance dependence were
significantly associated with smoking in patients
with bipolar disorder.
Conclusions: Bipolar patients with
lifetime smoking were more likely to have earlier age
at onset of mood disorder, greater severity of
symptoms, poorer functioning, history of a suicide
attempt, and a lifetime history of comorbid
anxiety and substance use disorders. Smoking may
be independently associated with suicidal behavior in bipolar disorder.