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Am J Prev Med. 2019 Mar;56(3):420-428. doi: 10.1016/j.amepre.2018.09.016.

Nicotine Dependence and Pre-Enlistment Suicidal Behavior Among U.S. Army Soldiers.

Author information

1
Department of Psychiatry, University of California, San Diego, La Jolla, California. Electronic address: campbell-sills@ucsd.edu.
2
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
3
Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
4
Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.
5
Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
6
Department of Psychology, Harvard University, Cambridge, Massachusetts.
7
Department of Psychiatry, University of California, San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; VA San Diego Healthcare System, San Diego, California.

Abstract

INTRODUCTION:

Identification of modifiable risk factors for suicidal behaviors is a priority for the U.S. Army. This study investigated associations of nicotine dependence with suicidal behaviors among incoming soldiers.

METHODS:

Lifetime DSM-IV nicotine dependence, mental disorders, suicidal behaviors, and their ages of onset were retrospectively assessed in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) New Soldier Study. Discrete-time survival analysis of person-year data from 30,436 soldiers was performed to evaluate associations of nicotine dependence with subsequent suicidal ideation, plans, and attempts. Among respondents with lifetime ideation (n=4,060), models tested associations of nicotine dependence with progression from ideation to first onset of plan, from plan to first attempt, and, among ideators without plans, from ideation to first unplanned attempt. A hierarchy of models incorporated increasing controls for other risk factors. Data were collected in 2011-2012 and analyzed in 2017-2018.

RESULTS:

In models controlling for sociodemographic characteristics, nicotine dependence was associated with onset of all suicidal behaviors (AORs, 2.07-4.08, p<0.001) and with each type of progression of suicidal behavior (AORs, 1.48-2.44, p<0.005). After adjusting for childhood adversities and mental disorders, nicotine dependence remained associated with onset of ideation (AOR=1.27, 95% CI=1.10, 1.46, p=0.001) and attempt (AOR=1.83, 95% CI=1.41, 2.37, p<0.001); and with progression from ideation to unplanned attempt (AOR=2.03, 95% CI=1.17, 1.74, p<0.001).

CONCLUSIONS:

Nicotine dependence exhibited associations with onset of suicidal ideation and suicide attempt-and with progression from ideation to unplanned attempt-that were independent of other measured risk factors. Awareness of associations of nicotine dependence with suicidal behaviors may inform risk assessment, facilitate targeting of prevention efforts, and provide further impetus for reducing nicotine dependence.

PMID:
30777160
PMCID:
PMC6383784
[Available on 2020-03-01]
DOI:
10.1016/j.amepre.2018.09.016

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