Tobacco Use and 12-Month Suicidality Among Adults in the United States

Introduction: To examine how 12-month prevalences of suicidality vary by tobacco use.

Methods: Data were from 325 800 adults who participated in the 2008-2014 National Survey on Drug Use and Health. Descriptive analyses and multivariable multinomial logistic regression models were applied.

Results: Among adults aged 18 or older in the United States during 2008-2014, 27.4% (annual average, standard error [SE] = 0.14%) were never tobacco users, 38.8% (SE = 0.17%) were former tobacco users, 5.9% (SE = 0.07%) were past-year users of other types of tobacco (non-cigarette), 20.2% (SE = 0.13%) were past-year cigarette-only users, and 7.7% (SE = 0.07%) were past-year users of cigarettes plus other types of tobacco; 2.6% (SE = 0.04%) had suicidal ideation only, 0.7% (SE = 0.02%) had suicidal ideation and suicide plan only, and 0.5% (SE = 0.02%) attempted suicide. After controlling for covariates, compared with never tobacco users, past-year users of cigarettes plus other types of tobacco were at elevated risk of all examined suicidality outcomes (adjusted relative risks [ARRs] = 1.2-1.7), and past-year cigarette-only users were at higher risk of suicide attempt (ARR = 1.4). Early age of first tobacco use was associated with higher risk of suicidal ideation and suicide plan among former tobacco users, past-year tobacco users, and past-year cigarette users (ARRs = 1.2-1.6). Among past-year tobacco users, frequencies of cigarette and cigar use were associated with suicide attempt (ARRs = 1.4-1.7). Nicotine dependence was associated with suicide attempt among past-year cigarette users (ARR = 1.2).

Conclusions: Tobacco use is associated with 12-month suicidality among adults. Patients who use tobacco should be assessed further for mental health status and suicide risk.

Implications: Our results revealed that tobacco use is independently associated with the 12-month suicidality outcomes among adults and identified how the prevalences of 12-month suicidality outcomes vary by tobacco use status and use characteristics among adults. These results have important clinical implications. Future research should assess the effectiveness of tobacco use questions as simple screeners for more extensive assessment of mental health status and suicide risk.