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. 2000 May;90(5):768–773. doi: 10.2105/ajph.90.5.768

Cigarettes and suicide: a prospective study of 50,000 men.

M Miller 1, D Hemenway 1, E Rimm 1
PMCID: PMC1446219  PMID: 10800427

Abstract

OBJECTIVES: This study examined the relation between smoking and suicide, controlling for various confounders. METHODS: More than 50,000 predominantly White, middle-aged and elderly male health professionals were followed up prospectively with biennial questionnaires from 1986 through 1994. The primary end point was suicide. Characteristics controlled for included age, marital status, body mass index, physical activity, alcohol intake, coffee consumption, and history of cancer. RESULTS: Eighty-two members of the cohort committed suicide during the 8-year follow-up period. In age-adjusted analyses with never smokers as the comparison group, the relative risk of suicide was 1.4 (95% confidence interval [CI] = 0.8, 2.3) among former smokers, 2.6 (95% CI = 0.9, 7.5) for light smokers (< 15 cigarettes/day), and 4.5 (95% CI = 2.3, 8.8) among heavier smokers. After adjustment for potential confounders, the relative risks were 1.4 (95% CI = 0.9, 2.4), 2.5 (95% CI = 0.9, 7.3), and 4.3 (95% CI = 2.2, 8.5), respectively. CONCLUSION: We found a positive, dose-related association between smoking and suicide among White men. Although inference about causality is not justified, our findings indicate that the smoking-suicide connection is not entirely due to the greater tendency among smokers to be unmarried, to be sedentary, to drink heavily, or to develop cancers.

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Selected References

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  1. Ames R. G. Respiratory disease and suicide among U.S. coal miners: is there a relationship? Am J Prev Med. 1985 Nov-Dec;1(6):58–60. [PubMed] [Google Scholar]
  2. Anda R. F., Williamson D. F., Escobedo L. G., Mast E. E., Giovino G. A., Remington P. L. Depression and the dynamics of smoking. A national perspective. JAMA. 1990 Sep 26;264(12):1541–1545. [PubMed] [Google Scholar]
  3. Breslau N., Kilbey M. M., Andreski P. Nicotine dependence and major depression. New evidence from a prospective investigation. Arch Gen Psychiatry. 1993 Jan;50(1):31–35. doi: 10.1001/archpsyc.1993.01820130033006. [DOI] [PubMed] [Google Scholar]
  4. Breslau N., Kilbey M. M., Andreski P. Vulnerability to psychopathology in nicotine-dependent smokers: an epidemiologic study of young adults. Am J Psychiatry. 1993 Jun;150(6):941–946. doi: 10.1176/ajp.150.6.941. [DOI] [PubMed] [Google Scholar]
  5. Breslau N., Peterson E. L., Schultz L. R., Chilcoat H. D., Andreski P. Major depression and stages of smoking. A longitudinal investigation. Arch Gen Psychiatry. 1998 Feb;55(2):161–166. doi: 10.1001/archpsyc.55.2.161. [DOI] [PubMed] [Google Scholar]
  6. Brown R. A., Lewinsohn P. M., Seeley J. R., Wagner E. F. Cigarette smoking, major depression, and other psychiatric disorders among adolescents. J Am Acad Child Adolesc Psychiatry. 1996 Dec;35(12):1602–1610. doi: 10.1097/00004583-199612000-00011. [DOI] [PubMed] [Google Scholar]
  7. Carmody T. P. Affect regulation, nicotine addiction, and smoking cessation. J Psychoactive Drugs. 1989 Jul-Sep;21(3):331–342. doi: 10.1080/02791072.1989.10472175. [DOI] [PubMed] [Google Scholar]
  8. Chiles J. A., Benjamin G. A., Cahn T. S. Who smokes? Why?: Psychiatric aspects of continued cigarette usage among lawyers in Washington State. Compr Psychiatry. 1990 Mar-Apr;31(2):176–184. doi: 10.1016/0010-440x(90)90022-k. [DOI] [PubMed] [Google Scholar]
  9. Clayton P. Smoking and suicide. J Affect Disord. 1998 Jul;50(1):1–2. doi: 10.1016/s0165-0327(98)00038-x. [DOI] [PubMed] [Google Scholar]
  10. Cliff K. S., Grout P., Machin D. Smoking and attitudes to seat belt usage. Public Health. 1982 Jan;96(1):48–52. doi: 10.1016/s0033-3506(82)80029-2. [DOI] [PubMed] [Google Scholar]
  11. Covey L. S., Glassman A. H., Stetner F. Major depression following smoking cessation. Am J Psychiatry. 1997 Feb;154(2):263–265. doi: 10.1176/ajp.154.2.263. [DOI] [PubMed] [Google Scholar]
  12. D'Agostino R. B., Lee M. L., Belanger A. J., Cupples L. A., Anderson K., Kannel W. B. Relation of pooled logistic regression to time dependent Cox regression analysis: the Framingham Heart Study. Stat Med. 1990 Dec;9(12):1501–1515. doi: 10.1002/sim.4780091214. [DOI] [PubMed] [Google Scholar]
  13. Davis A. T., Schrueder C. The prediction of suicide. Med J Aust. 1990 Nov 5;153(9):552–554. [PubMed] [Google Scholar]
  14. Doll R., Peto R., Wheatley K., Gray R., Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. doi: 10.1136/bmj.309.6959.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Friberg L., Cederlöf R., Lorich U., Lundman T., De Faire U. Mortality in twins in relation to smoking habits and alcohol problems. Arch Environ Health. 1973 Nov;27(5):294–304. doi: 10.1080/00039896.1973.10666384. [DOI] [PubMed] [Google Scholar]
  16. Gangat A. E., Simpson M. A., Naidoo L. R. Medication as a potential cause of depression. S Afr Med J. 1986 Aug 16;70(4):224–226. [PubMed] [Google Scholar]
  17. Garrison C. Z., McKeown R. E., Valois R. F., Vincent M. L. Aggression, substance use, and suicidal behaviors in high school students. Am J Public Health. 1993 Feb;83(2):179–184. doi: 10.2105/ajph.83.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Gilbert D. G., Spielberger C. D. Effects of smoking on heart rate, anxiety, and feelings of success during social interaction. J Behav Med. 1987 Dec;10(6):629–638. doi: 10.1007/BF00846659. [DOI] [PubMed] [Google Scholar]
  19. Giovino G. A., Henningfield J. E., Tomar S. L., Escobedo L. G., Slade J. Epidemiology of tobacco use and dependence. Epidemiol Rev. 1995;17(1):48–65. doi: 10.1093/oxfordjournals.epirev.a036185. [DOI] [PubMed] [Google Scholar]
  20. Glass R. M. Blue mood, blackened lungs. Depression and smoking. JAMA. 1990 Sep 26;264(12):1583–1584. [PubMed] [Google Scholar]
  21. Glassman A. H., Covey L. S., Dalack G. W., Stetner F., Rivelli S. K., Fleiss J., Cooper T. B. Smoking cessation, clonidine, and vulnerability to nicotine among dependent smokers. Clin Pharmacol Ther. 1993 Dec;54(6):670–679. doi: 10.1038/clpt.1993.205. [DOI] [PubMed] [Google Scholar]
  22. Glassman A. H., Helzer J. E., Covey L. S., Cottler L. B., Stetner F., Tipp J. E., Johnson J. Smoking, smoking cessation, and major depression. JAMA. 1990 Sep 26;264(12):1546–1549. [PubMed] [Google Scholar]
  23. Glassman A. H., Stetner F., Walsh B. T., Raizman P. S., Fleiss J. L., Cooper T. B., Covey L. S. Heavy smokers, smoking cessation, and clonidine. Results of a double-blind, randomized trial. JAMA. 1988 May 20;259(19):2863–2866. [PubMed] [Google Scholar]
  24. Goff D. C., Henderson D. C., Amico E. Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects. Am J Psychiatry. 1992 Sep;149(9):1189–1194. doi: 10.1176/ajp.149.9.1189. [DOI] [PubMed] [Google Scholar]
  25. Grout P., Cliff K. S., Harman M. L., Machin D. Cigarette smoking, road traffic accidents and seat belt usage. Public Health. 1983 Mar;97(2):95–101. doi: 10.1016/s0033-3506(83)80005-5. [DOI] [PubMed] [Google Scholar]
  26. Haines A. P., Imeson J. D., Meade T. W. Psychoneurotic profiles of smokers and non-smokers. Br Med J. 1980 Jun 14;280(6229):1422–1422. doi: 10.1136/bmj.280.6229.1422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Hall S. M., Havassy B. E., Wasserman D. A. Commitment to abstinence and acute stress in relapse to alcohol, opiates, and nicotine. J Consult Clin Psychol. 1990 Apr;58(2):175–181. doi: 10.1037//0022-006x.58.2.175. [DOI] [PubMed] [Google Scholar]
  28. Hall S. M., Muñoz R. F., Reus V. I., Sees K. L. Nicotine, negative affect, and depression. J Consult Clin Psychol. 1993 Oct;61(5):761–767. doi: 10.1037//0022-006x.61.5.761. [DOI] [PubMed] [Google Scholar]
  29. Hall S. M., Reus V. I., Muñoz R. F., Sees K. L., Humfleet G., Hartz D. T., Frederick S., Triffleman E. Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking. Arch Gen Psychiatry. 1998 Aug;55(8):683–690. doi: 10.1001/archpsyc.55.8.683. [DOI] [PubMed] [Google Scholar]
  30. Hemenway D., Solnick S. J., Colditz G. A. Smoking and suicide among nurses. Am J Public Health. 1993 Feb;83(2):249–251. doi: 10.2105/ajph.83.2.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Henningfield J. E., Miyasato K., Jasinski D. R. Abuse liability and pharmacodynamic characteristics of intravenous and inhaled nicotine. J Pharmacol Exp Ther. 1985 Jul;234(1):1–12. [PubMed] [Google Scholar]
  32. Hughes J. R., Hatsukami D. K., Mitchell J. E., Dahlgren L. A. Prevalence of smoking among psychiatric outpatients. Am J Psychiatry. 1986 Aug;143(8):993–997. doi: 10.1176/ajp.143.8.993. [DOI] [PubMed] [Google Scholar]
  33. Jobes D. A., Berman A. L., Josselson A. R. Improving the validity and reliability of medical-legal certifications of suicide. Suicide Life Threat Behav. 1987 Winter;17(4):310–325. doi: 10.1111/j.1943-278x.1987.tb00071.x. [DOI] [PubMed] [Google Scholar]
  34. Kandel D. B., Davies M. Adult sequelae of adolescent depressive symptoms. Arch Gen Psychiatry. 1986 Mar;43(3):255–262. doi: 10.1001/archpsyc.1986.01800030073007. [DOI] [PubMed] [Google Scholar]
  35. Kaplan S. L., Landa B., Weinhold C., Shenker I. R. Adverse health behaviors and depressive symptomatology in adolescents. J Am Acad Child Psychiatry. 1984 Sep;23(5):595–601. doi: 10.1016/s0002-7138(09)60353-8. [DOI] [PubMed] [Google Scholar]
  36. Kawachi I., Colditz G. A., Ascherio A., Rimm E. B., Giovannucci E., Stampfer M. J., Willett W. C. A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA. J Epidemiol Community Health. 1996 Jun;50(3):245–251. doi: 10.1136/jech.50.3.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Kendler K. S., Neale M. C., MacLean C. J., Heath A. C., Eaves L. J., Kessler R. C. Smoking and major depression. A causal analysis. Arch Gen Psychiatry. 1993 Jan;50(1):36–43. doi: 10.1001/archpsyc.1993.01820130038007. [DOI] [PubMed] [Google Scholar]
  38. Kinnunen T., Doherty K., Militello F. S., Garvey A. J. Depression and smoking cessation: characteristics of depressed smokers and effects of nicotine replacement. J Consult Clin Psychol. 1996 Aug;64(4):791–798. doi: 10.1037//0022-006x.64.4.791. [DOI] [PubMed] [Google Scholar]
  39. Klatsky A. L., Armstrong M. A. Alcohol use, other traits, and risk of unnatural death: a prospective study. Alcohol Clin Exp Res. 1993 Dec;17(6):1156–1162. doi: 10.1111/j.1530-0277.1993.tb05221.x. [DOI] [PubMed] [Google Scholar]
  40. Kozlowski L. T. Psychosocial influences on cigarette smoking. NIDA Res Monogr. 1979 Aug;(26):97–125. [PubMed] [Google Scholar]
  41. Levi F., Bulliard J. L., La Vecchia C. Suicide risk among incident cases of cancer in the Swiss Canton of Vaud. Oncology. 1991;48(1):44–47. doi: 10.1159/000226893. [DOI] [PubMed] [Google Scholar]
  42. Lohr J. B., Flynn K. Smoking and schizophrenia. Schizophr Res. 1992 Dec;8(2):93–102. doi: 10.1016/0920-9964(92)90024-y. [DOI] [PubMed] [Google Scholar]
  43. Louhivuori K. A., Hakama M. Risk of suicide among cancer patients. Am J Epidemiol. 1979 Jan;109(1):59–65. doi: 10.1093/oxfordjournals.aje.a112659. [DOI] [PubMed] [Google Scholar]
  44. Maron D. J., Telch M. J., Killen J. D., Vranizan K. M., Saylor K. E., Robinson T. N. Correlates of seat-belt use by adolescents: implications for health promotion. Prev Med. 1986 Nov;15(6):614–623. doi: 10.1016/0091-7435(86)90066-6. [DOI] [PubMed] [Google Scholar]
  45. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976 Feb;103(2):226–235. doi: 10.1093/oxfordjournals.aje.a112220. [DOI] [PubMed] [Google Scholar]
  46. Paffenbarger R. S., Jr Contributions of epidemiology to exercise science and cardiovascular health. Med Sci Sports Exerc. 1988 Oct;20(5):426–438. [PubMed] [Google Scholar]
  47. Paffenbarger R. S., Jr, King S. H., Wing A. L. Chronic disease in former college students. IX. Characteristics in youth that predispose to suicide and accidental death in later life. Am J Public Health Nations Health. 1969 Jun;59(6):900–908. doi: 10.2105/ajph.59.6.900. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Paffenbarger R. S., Jr, Lee I. M., Leung R. Physical activity and personal characteristics associated with depression and suicide in American college men. Acta Psychiatr Scand Suppl. 1994;377:16–22. doi: 10.1111/j.1600-0447.1994.tb05796.x. [DOI] [PubMed] [Google Scholar]
  49. Patton G. C., Carlin J. B., Coffey C., Wolfe R., Hibbert M., Bowes G. Depression, anxiety, and smoking initiation: a prospective study over 3 years. Am J Public Health. 1998 Oct;88(10):1518–1522. doi: 10.2105/ajph.88.10.1518. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Patton G. C., Hibbert M., Rosier M. J., Carlin J. B., Caust J., Bowes G. Is smoking associated with depression and anxiety in teenagers? Am J Public Health. 1996 Feb;86(2):225–230. doi: 10.2105/ajph.86.2.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Pomerleau O. F. Nicotine and the central nervous system: biobehavioral effects of cigarette smoking. Am J Med. 1992 Jul 15;93(1A):2S–7S. doi: 10.1016/0002-9343(92)90619-m. [DOI] [PubMed] [Google Scholar]
  52. Pomerleau O. F., Pomerleau C. S. Neuroregulators and the reinforcement of smoking: towards a biobehavioral explanation. Neurosci Biobehav Rev. 1984 Winter;8(4):503–513. doi: 10.1016/0149-7634(84)90007-1. [DOI] [PubMed] [Google Scholar]
  53. Rich C. L., Young D., Fowler R. C. San Diego suicide study. I. Young vs old subjects. Arch Gen Psychiatry. 1986 Jun;43(6):577–582. doi: 10.1001/archpsyc.1986.01800060071009. [DOI] [PubMed] [Google Scholar]
  54. Rimm E. B., Chan J., Stampfer M. J., Colditz G. A., Willett W. C. Prospective study of cigarette smoking, alcohol use, and the risk of diabetes in men. BMJ. 1995 Mar 4;310(6979):555–559. doi: 10.1136/bmj.310.6979.555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Rimm E. B., Giovannucci E. L., Stampfer M. J., Colditz G. A., Litin L. B., Willett W. C. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. Am J Epidemiol. 1992 May 15;135(10):1114–1136. doi: 10.1093/oxfordjournals.aje.a116211. [DOI] [PubMed] [Google Scholar]
  56. Rogot E., Murray J. L. Smoking and causes of death among U.S. veterans: 16 years of observation. Public Health Rep. 1980 May-Jun;95(3):213–222. [PMC free article] [PubMed] [Google Scholar]
  57. Rosenberg M. L., Davidson L. E., Smith J. C., Berman A. L., Buzbee H., Gantner G., Gay G. A., Moore-Lewis B., Mills D. H., Murray D. Operational criteria for the determination of suicide. J Forensic Sci. 1988 Nov;33(6):1445–1456. [PubMed] [Google Scholar]
  58. Ross R. K., Bernstein L., Trent L., Henderson B. E., Paganini-Hill A. A prospective study of risk factors for traumatic deaths in a retirement community. Prev Med. 1990 May;19(3):323–334. doi: 10.1016/0091-7435(90)90032-f. [DOI] [PubMed] [Google Scholar]
  59. Roy A., Linnoila M. Alcoholism and suicide. Suicide Life Threat Behav. 1986 Summer;16(2):244–273. doi: 10.1111/j.1943-278x.1986.tb00354.x. [DOI] [PubMed] [Google Scholar]
  60. Sacks J. J., Nelson D. E. Smoking and injuries: an overview. Prev Med. 1994 Jul;23(4):515–520. doi: 10.1006/pmed.1994.1070. [DOI] [PubMed] [Google Scholar]
  61. Sainsbury P., Jenkins J. S. The accuracy of officially reported suicide statistics for purposes of epidemiological research. J Epidemiol Community Health. 1982 Mar;36(1):43–48. doi: 10.1136/jech.36.1.43. [DOI] [PMC free article] [PubMed] [Google Scholar]
  62. Smith G. D., Phillips A. N., Neaton J. D. Smoking as "independent" risk factor for suicide: illustration of an artifact from observational epidemiology? Lancet. 1992 Sep 19;340(8821):709–712. [PubMed] [Google Scholar]
  63. Smith J. C., Mercy J. A., Conn J. M. Marital status and the risk of suicide. Am J Public Health. 1988 Jan;78(1):78–80. doi: 10.2105/ajph.78.1.78. [DOI] [PMC free article] [PubMed] [Google Scholar]
  64. Stampfer M. J., Willett W. C., Speizer F. E., Dysert D. C., Lipnick R., Rosner B., Hennekens C. H. Test of the National Death Index. Am J Epidemiol. 1984 May;119(5):837–839. doi: 10.1093/oxfordjournals.aje.a113804. [DOI] [PubMed] [Google Scholar]
  65. Stefanis C. N., Kokkevi A. Depression and drug use. Psychopathology. 1986;19 (Suppl 2):124–131. doi: 10.1159/000285143. [DOI] [PubMed] [Google Scholar]
  66. Tanskanen A., Viinamäki H., Hintikka J., Koivumaa-Honkanen H. T., Lehtonen J. Smoking and suicidality among psychiatric patients. Am J Psychiatry. 1998 Jan;155(1):129–130. doi: 10.1176/ajp.155.1.129. [DOI] [PubMed] [Google Scholar]
  67. Tverdal A., Thelle D., Stensvold I., Leren P., Bjartveit K. Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35-49 years. J Clin Epidemiol. 1993 May;46(5):475–487. doi: 10.1016/0895-4356(93)90025-v. [DOI] [PubMed] [Google Scholar]
  68. Warburton D. M. Nicotine and the smoker. Rev Environ Health. 1985;5(4):343–390. [PubMed] [Google Scholar]
  69. Wells A. J., English P. B., Posner S. F., Wagenknecht L. E., Perez-Stable E. J. Misclassification rates for current smokers misclassified as nonsmokers. Am J Public Health. 1998 Oct;88(10):1503–1509. doi: 10.2105/ajph.88.10.1503. [DOI] [PMC free article] [PubMed] [Google Scholar]
  70. de Leon J., Dadvand M., Canuso C., White A. O., Stanilla J. K., Simpson G. M. Schizophrenia and smoking: an epidemiological survey in a state hospital. Am J Psychiatry. 1995 Mar;152(3):453–455. doi: 10.1176/ajp.152.3.453. [DOI] [PubMed] [Google Scholar]

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