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Smoking and suicide: biological and social evidence and causal mechanisms
  1. Margaret Green1,
  2. Sarah Turner2,
  3. Jitender Sareen3
  1. 1Adult Mental Health, Health Sciences Centre, Winnipeg, Manitoba, Canada
  2. 2Departments of Psychiatry and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  3. 3Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
  1. Correspondence to Dr Jitender Sareen, PZ430 PsychHealth Centre, 771 Bannatyne Avenue, Winnipeg, MB, Canada; sareen{at}cc.umanitoba.ca

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Introduction

Smoking as a risk factor for death by suicide has been a controversial area of inquiry. Over the last 20 years, there has been an expanding body of literature demonstrating that smokers have an increased risk of death by suicide. In this editorial, we highlight some of the key studies providing support for the relationship between smoking and suicide. Next, we discuss some of the key biopsychosocial mechanisms that may explain the link between smoking and suicide.

Epidemiological studies on smoking and suicide

Cross-sectional and longitudinal epidemiological studies have shown that cigarette smoking is associated with suicide death and suicidal behaviours. Expanding on the 2012 meta-analysis on smoking and suicide death by Li et al,1 Poorolajal and Darvishi published a meta-analysis of 63 studies on smoking and suicide.2 Both meta-analyses conclude that cigarette smoking is associated with a significantly increased risk of suicidal ideation, plans, attempts and deaths, and that there is a dose response relationship, that is, suicide risk increased with number of cigarettes smoked per day.

Recently, we highlighted the importance of considering suicide as another cause of death associated with smoking using evidence from the longitudinal study by Carter et al.3 In this study, data were pooled and analysed from five contemporary US cohort studies (Cancer Prevention Study II Nutrition cohort, the Nurses’ Health Study I cohort, the Health Professionals Follow-up Study cohort, the Women’s Health Initiative cohort and the National Institutes of Health-American Academy of Retired Persons (AARP) Diet and Health Study cohort) collected between 2000 and 2011 with 421 378 men and 532 651 women who were …

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