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| Smoking Associated With Suicide in Bipolar Disorder |
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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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