Drs Han and Compton Reply

See letter by Williams and Steinberg and article by Han et al

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Drs Han and Compton Reply

To the Editor: We welcome the critique of our study by Drs Williams and Steinberg and agree about the importance of addressing tobacco use in suicide-related research. Smoking is associated with increased risk of suicide behavior and death by suicide.1-5 Although some studies have reported that smoking or nicotine may worsen mood and increase impulsivity and aggression that lead to suicide,2-4 the mechanisms explaining this relationship are unclear.1 To better understand the etiology of suicidal behavior, reveal the relationship between smoking and suicide behavior, and improve suicide prevention efforts, it is important to understand whether smoking is associated with suicide attempt among adult suicidal ideators based on nationally representative data.

Our study6 included analysis of whether smoking might trigger further progression from suicidal ideation to plan and attempt or from ideation directly to attempt at the bivariate and multivariate levels. After controlling for covariates, our results showed that tobacco use status (current, past, or never), nicotine dependence (yes or no), and the number of days smoked in the past month were not associated with suicide attempt in the past 12 months among adults with past-year suicidal ideation regardless of their suicide plan status. We did not mention these specific analyses in the manuscript because of the nonsignificant results and the limited number of words allowed in the article.

Nevertheless, based on the comments raised by Drs Williams and Steinberg and previous studies showing a dose-response association between the number of cigarettes smoked per day (CSPD) and death by suicide,3,6 we now have extended our work to examine the association between the number of CSPD and suicide attempt among adult suicidal ideators. This ongoing research indicates that after adjusting for covariates, the average number of CSPD is associated with suicide attempt only among suicidal ideators without a suicide plan. As a smoking intensity measure, the impact of the number of CSPD on suicide attempt among adult suicidal ideators is independent from sociodemographic characteristics, alcohol use and use disorders, illicit drug use and use disorders, and the number of times arrested or booked in the past year. Intensive smoking may trigger further progression from suicidal ideation directly to attempt. This result is critical for the suicide prevention efforts because without the process of developing a suicide plan, the time window for the prevention efforts might be limited. We expect to continue these analyses and encourage future research to better understand the complex relationships among suicidal ideation, suicide behavior, death by suicide, and smoking using various tobacco use measures and nationally representative data with sufficient sample size.

References

1. Hughes JR. Smoking and suicide: a brief overview. Drug Alcohol Depend. 2008;98(3):169-178. PubMed doi:10.1016/j.drugalcdep.2008.06.003

2. Breslau N, Schultz LR, Johnson EO, et al. Smoking and the risk of suicidal behavior: a prospective study of a community sample. Arch Gen Psychiatry. 2005;62(3):328-334. PubMed doi:10.1001/archpsyc.62.3.328

3. Li D, Yang X, Ge Z, et al. Cigarette smoking and risk of completed suicide: a meta-analysis of prospective cohort studies. J Psychiatr Res. 2012;46(10):1257-1266. PubMed doi:10.1016/j.jpsychires.2012.03.013

4. Parrott AC. Cigarette-derived nicotine is not a medicine. World J Biol Psychiatry. 2003;4(2):49-55. PubMed doi:10.3109/15622970309167951

5. Lucas M, O’ Reilly EJ, Mirzaei F, et al. Cigarette smoking and completed suicide: results from 3 prospective cohorts of American adults. J Affect Disord. 2013;151(3):1053-1058. PubMed doi:10.1016/j.jad.2013.08.033

6. Han B, Compton WM, Gfroerer J, et al. Prevalence and correlates of past 12-month suicide attempt among adults with past-year suicidal ideation in the United States. J Clin Psychiatry. 2015;76(3):295-302. doi:10.4088/JCP.14m09287 PubM

Beth Han, MD, PhD, MPHa

Beth.Han@samhsa.hhs.gov

Wilson M. Compton, MD, MPEb

aSubstance Abuse and Mental Health Services Administration, Rockville, Maryland

bNational Institute on Drug Abuse of the National Institutes of Health, Bethesda, Maryland

Potential conflicts of interest: Dr Compton is a stock shareholder in Pfizer, 3M, and General Electric, unrelated to the submitted work. Dr Han has no personal affiliations or financial relationships with any commercial interest to disclose relative to this letter.

Funding/support: None reported.

Disclaimer: The views and opinions expressed in this letter are those of the authors and should not be construed to represent the views of the Substance Abuse and Mental Health Services Administration, the National Institute on Drug Abuse of the National Institutes of Health, or the US Department of Health and Human Services.

J Clin Psychiatry 2015;76(11):1571-1572

dx.doi.org/10.4088/JCP.15lr10027a

© Copyright 2015 Physicians Postgraduate Press, Inc.