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Smoking and suicidal behaviors in the National Comorbidity Survey: Replication.

Kessler RC, Berglund PA, Borges G, Castilla-Puentes RC, Glantz MD, Jaeger SA, Merikangas KR, Nock MK, Russo LJ, Stang PE

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts 02115, USA. kessler@hcp.med.harvard.edu

Controversy exists about the role of mental disorders in the consistently documented association between smoking and suicidal behavior. This controversy is addressed here with data from the nationally representative National Comorbidity Survey-Replication (NCS-R). Assessments were made of 12-month smoking, suicidal behaviors (ideation, plans, attempts), and DSM-IV disorders (anxiety, mood, impulse-control, and substance use disorders). Statistically significant odds ratios (2.9-3.1) were found between 12-month smoking and 12-month suicidal behaviors. However, the associations of smoking with the outcomes became insignificant with controls for DSM-IV mental disorders. Although clear adjudication among contending hypotheses about causal mechanisms cannot be made from the cross-sectional NCS-R data, the results make it clear that future research on smoking and suicidal behaviors should focus more centrally than previous research on mental disorders either as common causes, markers, or mediators.

Published 15 May 2007 in J Nerv Ment Dis, 195(5): 369-77.
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