ArticlePsychological medicine2017
Prospective association between tobacco smoking and death by suicide: a competing risks hazard analysis in a large twin cohort with 35-year follow-up.
Article in Psychological medicine, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 32 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
32 citing papers in PubMed, 2 syntheses or guidelines pooled it, 60 citations in OpenAlex.
- Association between illegal drug use and cigarette smoking among Ethiopian students: A systematic review and meta-analysis.PloS one · 2024Pooled it
- Proposal for the Inclusion of Tobacco Use in Suicide Risk Scales: Results of a Meta-Analysis.International journal of environmental research and public health · 2021Pooled it
- Randomized double-blind placebo-controlled multicenter trial for the effects of a polyherbal remedy, Yokukansan (YiganSan), in smokers with depressive tendencies.BMC complementary medicine and therapies · 2022Trial
- Predictors of Neuropsychiatric Adverse Events with Smoking Cessation Medications in the Randomized Controlled EAGLES Trial.Journal of general internal medicine · 2019Trial
- Smoking Initiation, Age at Onset of Symptoms and Suicide Attempts Among Patients With Bipolar Disorder: Comparisons With Non-Psychiatric Adults.Bipolar disorders · 2026Article
- Prevalence of Suicidal Behavior and Self-Injury Endorsement Among Saudi Medical Students: A Cross-Sectional Study of Academic Year Trajectories and Associated Factors.Healthcare (Basel, Switzerland) · 2026Article
- Prenatal Adversities and Risk of Persistent Youth Psychopathology and Altered Cortical Thinning.JAMA psychiatry · 2026Article
- Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study.Addictive behaviors reports · 2025Article
- Association of Adverse Prenatal Exposure Burden with Persistent Psychopathology and Accelerated Cortical Thinning in Youth.medRxiv : the preprint server for health sciences · 2025Article
- Assessment and analysis of factors influencing suicidal ideation in young adults: a large cohort study using an elastic network logistic regression model.BMC psychiatry · 2025Article
- Gender differences in the association between smoking and the risk of suicide in depressed patients: a longitudinal national cohort study.Frontiers in psychiatry · 2025Article
- Does the Path From Cigarette Smoking to Suicide Death Go Through the Hospital? A Causal Mediation Analysis in a National Canadian Sample.Tobacco use insights · 2025Article
- Use of Tobacco Products and Suicide Attempts Among Elementary School-Aged Children.JAMA network open · 2024Article
- Suicide attempts in the adult Mexican population: an analysis of sociodemographic characteristics and associated factors.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2024Observational
- Self-reported suicidal behaviours and associated factors in the general population of Latvia (2010-2018).The International journal of social psychiatry · 2023Article
- Smoking Cessation Medication Prescribing for Smokers With and Without Mental Illness.Psychiatric services (Washington, D.C.) · 2023Article
- Article
- Nicotine dependence affects cardiopulmonary endurance and physical activity in college students in Henan, China.Tobacco induced diseases · 2023Article
- Opioid use as a proximal risk factor for suicidal behavior in young adults.Suicide & life-threatening behavior · 2022Article
- Identifying long-term and imminent suicide predictors in a general population and a clinical sample with machine learning.BMC psychiatry · 2022Article
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundThe relationship between smoking and suicide remains controversial.
methodA total of 16 282 twin pairs born before 1958 in Finland and alive in 1974 were queried with detailed health and smoking questionnaires in 1975 and 1981, with response rates of 89% and 84%. Smoking status and dose, marital, employment, and socio-economic status, and indicators of psychiatric and somatic illness were assessed at both time points. Emergent psychiatric and medical illness and vital status, including suicide determined by forensic autopsy, were evaluated over 35-year follow-up through government registries. The association between smoking and suicide was determined in competing risks hazard models. In twin pairs discordant for smoking and suicide, the prospective association between smoking and suicide was determined using a matched case-control design.
resultsSmokers had a higher cumulative suicide incidence than former or never smokers. Heavy smokers had significantly higher suicide risk [hazard ratio (HR) 3.47, 95% confidence interval (CI) 2.31-5.22] than light smokers (HR 2.30, 95% CI 1.61-3.23) (p = 0.017). Compared with never smokers, smokers, but not former smokers, had increased suicide risk (HR 2.56, 95% CI 1.43-4.59), adjusting for depressive symptoms, alcohol and sedative-hypnotic use, and excluding those who developed serious somatic or psychiatric illness. In twin pairs discordant for smoking and suicide, suicide was more likely in smokers [odds ratio (OR) 6.0, 95% CI 2.06-23.8].
conclusionsAdults who smoked tobacco were more likely to die by suicide, with a large, dose-dependent effect. This effect remained after consideration of many known predictors of suicide and shared familial effects, consistent with the hypothesis that exposure to tobacco smoke increases the risk of suicide.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.