Suicide attempt is of specific interest. It is the behavior most proximal to suicide and is a major risk factor for completed suicide (along with mental or physical illness, physical or psychological pain, isolation, losses (relationship, work, financial)) [17]. Furthermore, suicide attempt itself often causes significant social disturbances to the person’s milieu including family, police and hospital services. Suicide attempts have been associated with nicotine dependence [13,18–20], current smoking [19,20], heavy smoking (20+ cigarettes smoked daily) [15], and with longer duration of smoking (14 years or more) [21]. In some [13,15,19] but not in all studies [18,21] adjustment for substance use, Axis I and Axis II mental disorders nullified this relationship. Tobacco use behavior status can change over time (e.g., current to former tobacco use, former to current tobacco use). To our knowledge, the risk of a suicide attempt in association with such changes has not been previously reported.
