Is Smoking Associated With Suicide in Bipolar Patients?

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Sir: Ostacher et al.¹ published an interesting article suggesting that smoking is independently associated with suicide attempt in patients suffering from bipolar disorder. All new hypotheses leading to a best comprehension about suicide behavior in bipolar-disordered patients are welcomed, particularly because suicide rates are higher in people with bipolar disorder than in all other psychiatric-diagnosed subjects²: if this hypothesis holds true, it turns out to be even more important since it is known that cardiovascular and respiratory causes of death are greater in bipolar patients than in the general population and that a well-established association exists between those conditions and smoking.³

However, we must proceed with extreme caution in attributing smoking as an independent risk factor for suicide.’ ‹’ ‹