ArticleBMC psychiatry2026
Associations of smoking and alcohol consumption with suicidality in major depressive disorder: a cross-sectional analysis of UK Biobank.
Article in BMC psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMajor depressive disorder (MDD) is associated with an elevated risk of self-harm. However, the independent and combined associations of smoking and alcohol consumption with self-harm ideation and attempts remain unclear.
methodsWe conducted a cross-sectional analysis using data from the UK Biobank. Smoking and alcohol consumption were assessed using baseline touchscreen questionnaires. Self-harm outcomes were ascertained from the Mental Health Questionnaire. Logistic regression models were employed to evaluate the associations between smoking, alcohol consumption, and self-harm outcomes. Restricted cubic spline (RCS) transformations were applied to continuous variables to account for potential non-linear relationships. Subgroup and sensitivity analyses were performed.
resultsAmong 31,359 participants with MDD (excluding those with psychosis, bipolar disorder, or substance use disorders), 17,137 (54.6%) reported self-harm ideation and 2,530 (8.1%) reported self-harm attempts. Smoking and alcohol consumption, as well as their combined exposure, were significantly associated with both self-harm ideation and attempts. Compared with current non-smoker and non-drinker, dual users had elevated odds of self-harm ideation (OR = 1.20, 95% CI: 1.05-1.37) and attempts (OR = 1.30, 95% CI: 1.06-1.61). Each additional cigarette per day was associated with higher odds of self-harm ideation (OR = 1.01, 95% CI: 1.01-1.02) and attempts (OR = 1.02, 95% CI: 1.01-1.04). Alcohol consumption showed J-shaped associations with both self-harm ideation and attempts, with inflection points at 14.00 units/week for ideation and 3.34 units/week for attempts. For self-harm ideation, females exhibited higher odds than males at equivalent consumption levels.
conclusionsThis cross-sectional analysis identified significant associations between smoking, alcohol use, and self-harm behaviors in MDD patients, with higher odds among dual users. CLINICAL TRIAL NUMBER: Not applicable.
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