Asthma and suicidal ideation with and without suicide attempts among adults in the United States: What is the role of cigarette smoking and mental disorders?

Department of Mental Health, The Johns Hopkins University School of Public Health, Baltimore, Maryland 21205, USA.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology (Impact Factor: 2.6). 05/2008; 100(5):439-46. DOI: 10.1016/S1081-1206(10)60468-1
Source: PubMed


Evidence of a respiratory diseases and suicidal ideation and suicide attempts link exists. To improve our understanding of the mechanism underlying these links, there is a need for examination of the relationship between specific respiratory disease, such as asthma, and suicidal ideation and behavior. In addition, studies need to examine many common risk factors that may play a role in the association between asthma and suicidal ideation and suicide behavior.
To examine the association between asthma and suicidal ideation with and without attempts among adults in the United States, specifically investigating the role of cigarette smoking, nicotine dependence, depression, anxiety, and alcohol abuse.
Data on 5,692 individuals 18 years and older were drawn from the US National Comorbidity Survey Replication. Descriptive and multivariate logistic regression analyses were conducted to examine the study objectives.
The estimates of lifetime prevalence for suicidal ideation without and with attempts and asthma were 8.7%, 4.2%, and 12.0%, respectively. Being a woman, a current smoker, depressed, anxious, an alcohol abuser, or nicotine dependent increased the likelihood of suicidal ideation with attempts and asthma. Asthma was significantly (P < .001) associated with suicidal ideation with but not without attempts. Adjustment for smoking, nicotine dependence, age, sex, and race/ethnicity decreased the association between asthma and suicidal ideation with attempts by 16%. Similarly, adjustment for depression, panic disorder, and alcohol abuse led to a 12.4% decrease in this relationship. Despite these adjustments, independently or combined, a statistically significant (P = .02) association remained between asthma and suicidal ideation with attempts.
Cigarette smoking and concurrent mental health conditions may independently account for significant proportions of the association between asthma and suicidal ideation with attempts. More research is needed to further elucidate the mechanism of the remaining association between asthma and suicide attempts. Modification of smoking behaviors and effective treatment of depression, anxiety, alcohol abuse, and possibly asthma are important suicide prevention strategies.

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Available from: Erick Messias, Nov 11, 2014
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    • ". However, the findings from the present study showed higher frequency of mental disorders among people with asthma and the risk was attenuated after adjusting for these. It therefore supports mental health screening and treatment programs in asthma as potential suicide and self-harm prevention strategies [20]. "
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    ABSTRACT: Objective Few studies have investigated the relationship between asthma and suicidality-related outcomes in the world. We sought to investigate the association between asthma and risk of non-fatal self-harm in a large national sample. Methods Cases aged 10 years and over were identified from Taiwan’s National Health Insurance Research Database with a new primary diagnosis of asthma (ICD-9:493) between 2000 and 2008. Case status required the presence of any inpatient diagnosis of asthma and/or at least two recorded diagnoses and one year’s duration of asthma in outpatient services. These 27,781 cases were compared to 138,905 sex- and age- matched controls and both groups were followed until end of 2008 for instances of self-harm, defined as ICD-9 codes E950-E959 (self-harm causes) and E980-E989 (undetermined causes). Competing risk adjusted Cox regression analyses were applied, adjusting for sex, age, residence (urban/rural), insurance premium, episode of psychiatric disease, montelukast, Charlson comorbidity index and mortality. Results Of the 166,686 subjects, 445 carried out self-harm during a mean (SD) follow-up period of 5.84 (2.35) years. Asthma (hazard ratio = 1.70, 95% CI: 1.35-2.14), age, residence, episode of psychiatric disease and Charlson comorbidity index were independent risks on self-harm in the fully adjusted model. Conclusions Asthma was associated with increased risk of self-harm in this population, independent of a number of potential confounding factors including montelukast use. This reinforces the need to consider mental health in routine asthma care, and to consider asthma as a potentially important stressor in people with comorbid mental disorder.
    Journal of Psychosomatic Research 09/2014; 77(6). DOI:10.1016/j.jpsychores.2014.08.017 · 2.74 Impact Factor
    • "Our study brings out the hypothesis that asthma might not be the cause of higher incidence of suicidality in itself, but instead be associated with higher high risk behaviors, such as substance use, and to 2-week sadness, which in turn could be a proxy for depression, increasing suicidality. There is evidence to show that an association between depression, medication non-adherence, and unhealthy behaviors , like smoking and alcohol use, may be involved in reports of current asthma symptoms in this population (Clarke et al., 2008). "
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    ABSTRACT: We assessed the association between asthma and suicidality in a nationally representative sample of US high school students. Data came from the 2007, 2009, and 2011 Youth Risk Behavioral Surveys. Weighted prevalence estimates and adjusted odds ratios were calculated. Subjects with asthma are more likely to report 2-week sadness (35.2%) compared to those without asthma (26.7%). Teens with asthma are also more likely to report suicide ideation (20.1% vs. 15%), planning (15.7% vs. 12.1%), attempt (10.1% vs. 6.9%), and treatment for attempt (3.5% vs. 2%). Although the unadjusted association between lifetime asthma and suicide attempts is statistically significant (crude odds ratio 1.5 (95% CI 1.3-1.8)), after controlling for confounders, that association is no longer statistically significant (AOR 1.2 (1-1.6)). Thus, this increase in suicidality seems to be due to the increased prevalence of sadness among teens with asthma. Similar patterns were seen in the 2007 and 2009 surveys.
    167th Annual Meeting, American Psychiatry Association; 05/2014
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    • "A number of studies have found statistically significant links between asthma and suicide ideation (Druss and Pincus, 2000; Goodwin and Marusic, 2004) and suicide attempts (SA). One longitudinal (Goodwin and Eaton, 2005) and two cross-sectional (Clarke et al., 2008; Goodwin and Marusic, 2004) studies have "
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    ABSTRACT: Asthma and suicide attempts are leading causes of morbidity and mortality among adults in the United States. The objective of this study was to investigate the relationship between asthma and suicidal ideation and suicide attempt among adults in the United States, and to examine whether timing of asthma, mood disorders, poverty, allergies, cigarette smoking and sex differences confound these relationships. Data were drawn from the Third National Health and Nutrition Examination Survey (NHANES III), a representative sample of adults (N = 6584) in the United States. Logistic regression analyses were used to examine the relationships between current and former asthma and suicidal ideation and suicide attempt, adjusting for demographics, poverty, smoking, allergies and mood disorders. Current asthma is significantly associated with an increased likelihood of suicidal ideation (OR: 1.77, CI: 1.11, 2.84) and suicide attempt (OR: 3.26, CI: 1.97, 5.39), after adjusting for mood disorders, smoking, poverty and demographics. There does not appear to be a significant relationship between former asthma and suicidal ideation or suicide attempt. These findings confirm and extend previous evidence by showing that the link between asthma and suicide-related outcomes is evident among adults in a representative sample and that this relationship persists after adjusting for a range of variables. This study may provide an empiric foundation for including asthma in the clinical assessment of suicide risk.
    Journal of Psychiatric Research 06/2012; 46(8):1002-7. DOI:10.1016/j.jpsychires.2012.04.024 · 3.96 Impact Factor
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