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| Smoking Associated With Suicide in Bipolar Disorder | ||||||||
| 2007-02-10 | ||||||||
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NEW YORK (Reuters Health) Jan 17 - Findings published in the December issue of the Journal of Clinical Psychiatry suggest that smoking may be independently associated with suicidal behavior in subjects with bipolar disorder. "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," Dr. Michael J. Ostacher, of Massachusetts General Hospital, Boston, and colleagues write. The researchers retrospectively studied 399 outpatients who were treated in a bipolar specialty clinic from December 1999 to October 2004. The team used the Affective Disorders Evaluation and the Mini-Interventional Neuropsychiatric Interview to assess diagnosis, mood state, course of illness, functioning, and psychiatric comorbidities. Overall, 155 (38.8%) of the subjects had a history of daily smoking. An association was observed between having ever smoked and earlier age at onset of first depressive or manic episode, lower Global Assessment of Functioning scores, and higher Clinical Global Impressions-Bipolar Disorder scale scores. Having ever smoked was also associated with a lifetime history of having made a suicide attempt (47% of smokers versus 25% of never smokers). Smokers were also more likely to have a history of comorbid disorders: anxiety disorders, alcohol abuse and dependence, and substance abuse and dependence. On logistic regression analysis, having made a suicide attempt (OR = 2.25) and a history of substance abuse (OR = 2.30) both remained significantly associated with smoking. "Because smoking was associated with suicide attempts after controlling for comorbid conditions and illness severity, this study gives further evidence that there is a factor independent of mood, such as the impulsivity/aggression factor postulated to be associated with suicide, that is more common in smokers," Dr. Ostacher and colleagues surmise. "Whether this factor leads to the initiation of smoking in patients with bipolar disorder, or, instead, is a result of cigarette use itself cannot be answered by this study," they note. "The independent association between smoking and suicidal behavior may point to smoking as an area for further exploration as an endophenotype associated with impulsive behavior in bipolar families." J Clin Psychiatry 2006;67:1907-1911. | ||||||||
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