Smoking and the risk of suicidal behavior - A prospective study of a community sample
Smoking and the risk of suicidal behavior - A prospective study of a community sample
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DOI：
10.1001/archpsyc.62.3.328
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发表时间：
2005-03-01
影响因子：
--
通讯作者：
Davis, GC
中科院分区：
文献类型：
--
作者：
Breslau, N;Schultz, LR;Davis, GC
背景：吸烟和自杀行为之间的联系已在临床和流行病学研究中得到报道。目的：研究吸烟和自杀念头之间的联系，或尝试进行一项纵向研究，其中包括与自杀行为时机有关的吸烟和精神障碍的近似状态。设计：一项最初于1989年采访的年轻人的纵向研究，经过10年的重复评估。背景和对象：样本选自代表地理区域的大型健康维护组织，社会经济范围的极端情况除外。每次随访(基线后3年、5年和10年)的应答率超过91%。主要结果指标：通过重复测量的广义估计方程估计在随访间隔期间发生自杀行为的相对风险，通过间隔开始时的吸烟和精神障碍状况来估计。结果：与既往抑郁和物质使用障碍无关，现在每天吸烟，而不是过去吸烟，可以预测随后自杀念头或企图的发生(调整后的优势比为1.82；95%可信区间为1.22-2.69)。此外，现在每天吸烟，而不是过去吸烟，预测了随后发生的自杀念头或企图，调整了自杀倾向，由既往自杀行为指示，并控制了既往精神障碍(调整后的优势比，1.74；95%可信区间，1.17-2.54)。结论：目前吸烟与随后的自杀行为相关的生物学解释尚不清楚。最近对当前吸烟者(而不是戒烟者)单胺氧化酶活性降低(这可能在中枢神经系统5-羟色胺代谢中发挥作用)的观察可能会提供线索，但解释应该谨慎进行。
Backgroung: A link between cigarette smoking and suicidal behavior has been reported in, clinical and epidemiological studies.Objective: To examine the association between smoking and suicidal thoughts or attempt in a longitudinal study, in which proximate status of smoking and psychiatric disorders in relation to timing of suicidal behaviors is taken into account.Design: A longitudinal study of young adults interviewed initially in 1989, with repeated assessments over a 10-year follow-up.Setting and Participants: The sample was selected from a large health maintenance organization representing the geographic area, except for the extremes of the socioeconomic range. The response rate at each follow-up (3, 5, and 10 years after baseline) exceeded 91%.Main Outcome Measures: Relative risk of occurrence of suicidal behaviors during follow-up intervals by status of smoking and psychiatric disorders at the start of the interval, estimated by generalized estimating equations with repeated measures. The National Institute of Mental Health Diagnostic Interview Schedule was used at baseline and at each reassessment.Results: Current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, independent of prior depression and substance use disorders (adjusted odds ratio, 1.82; 95% confidence interval, 1.22-2.69). Additionally, current daily smoking, but not past smoking, predicted the subsequent occurrence of suicidal thoughts or attempt, adjusting for suicidal predisposition, indicated by prior suicidality, and controlling for prior psychiatric disorders (adjusted odds ratio, 1.74; 95% confidence interval, 1.17-2.54).Conclusions: The biological explanation of the finding that current smoking is associated with subsequent suicidal behavior is unclear. Recent observations of lower monoamine oxidase activity (which may play a role in central nervous system serotonin metabolism) in current smokers but not ex-smokers might provide clues, but interpretations should proceed cautiously.