Nicotine Inhalation and Suicide: Clinical Correlates and Behavioral Mechanisms

Abstract

Background and Objectives Extensive evidence links smoking and suicide independently of psychiatric diagnoses, but there are questions about the pathophysiology and specificity of this relationship. We examined characteristics of this linkage to identify potential transdiagnostic mechanisms in suicide and its prevention. Methods We reviewed literature that associated suicide with smoking and e‐cigarettes, including the temporal sequence of smoking and suicide risk and their shared behavioral risk factors of sensitization and impulsivity. Results Smoking is associated with increased suicide across psychiatric diagnoses and in the general population, proportionately to the number of cigarettes smoked per day. Rapid nicotine uptake into the brain through inhalation of conventional cigarettes, electronic cigarettes (e‐cigarette), or even second‐hand smoke can facilitate long‐term sensitization and short‐term impulsivity. Both impair action regulation and predispose to negative affect, continued smoking, and suicidal behavior. Intermittent hypoxia, induced by cigarettes or e‐cigarettes, synergistically promotes impulsivity and sensitization, exacerbating suicidality. Two other shared behavioral risks also develop negative urgency (combined impulsivity and negative affect) and cross‐sensitization to stressors or to other addictive stimuli. Finally, early smoking onset, promoted by e‐cigarettes in never‐smokers, increases subsequent suicide risk. Conclusion and Scientific Significance Prevention or cessation of nicotine inhalation can strategically prevent suicidality and other potentially lethal behavior regardless of psychiatric diagnoses. Medications for reducing smoking and suicidality, especially in younger smokers, should consider the neurobehavioral mechanisms for acute impulsivity and longer‐term sensitization, potentially modulated more effectively through glutamate antagonism rather than nicotine substitution. (Am J Addict 2021;30:316–329)

Prevalence of tobacco smoking in a sample of general secondary school students in Cairo and its correlation to other psychiatric disorders

“…Moreover, we found a significant relation between cigarette smoking and mood symptoms that was consistent with [ 6 ] as there is bitemporal relation between them as written before; also our study found a significant relation between cigarette smoking and suicidal ideations and the same was found by Swann et al [ 42 ]; this finding can be attributed to many factors first of them the presence of depressive symptoms which may progress leading to such ideas, also impulsivity which is highly significant with tobacco smoking and negative health consequences of smoking.…”

Use of Tobacco Products and Suicide Attempts Among Elementary School–Aged Children

“…18,33,34 However, several nationwide surveys have reported an increased risk of SAs among middle school and high school students with a lifetime use of e-cigarettes 16,35,36 and vaping devices. [37][38][39][40] Additional work suggests that the association between smoking and SAs may be largest for smoking initiation, 41 which is consistent with the relatively early developmental patterns observed in the present work.…”

“…In recent years, e-cigarettes, vapes, and flavored nicotine products have gained wide popularity, in part because they are often marketed as safe alternatives to conventional cigarettes . However, several nationwide surveys have reported an increased risk of SAs among middle school and high school students with a lifetime use of e-cigarettes and vaping devices . Additional work suggests that the association between smoking and SAs may be largest for smoking initiation, which is consistent with the relatively early developmental patterns observed in the present work.…”

Risk Factors for Self-Harm Ideation Among Persons Treated With Opioids for Chronic Low Back Pain

“…Also, cigarette smoking, lower pain acceptance, and poor physical health-related QoL were not found to be predictive of suicidal ideation in the multivariate analysis, as might have been expected based on the prior studies. 60 The literature suggests that women are prone to admitting to thoughts of suicide more often than men, while men are more prone to dying by suicide than women 61; however, gender was not a significant predictor of admitting to thoughts of self-harm in our study. Even though a higher percentage of males were found to have a greater frequency of thoughts of self-harm compared with women in this study (group 3 52.3% vs. 47.6%), these differences were nonsignificant.…”

“…This suggests that other predisposing factors, such as history of trauma, poor self-love, perceptions of not being loved, and emotional distress, contribute more to thoughts of self-harm than the persistent nature of the pain alone. Also, cigarette smoking, lower pain acceptance, and poor physical health-related QoL were not found to be predictive of suicidal ideation in the multivariate analysis, as might have been expected based on the prior studies 60 …”