Clinical Markers Associated with Risk of Suicide or Drug Overdose Among Heavy Smokers - A Longitudinal Follow-Up Study of the COPDGene Cohort.

Academic Article


  • BACKGROUND: Studies have shown that chronic obstructive pulmonary disease (COPD) and smoking are associated with increased suicide risk. To date there are no prospective studies examining suicide risk among smokers along a spectrum of pulmonary disease ranging from completely normal spirometry to severe COPD. RESEARCH QUESTION: Which clinical variables predict death by suicide or overdose of indeterminate intent in a large cohort of heavy smokers within the COPDGene study? STUDY DESIGN AND METHODS: We studied data from 9,930 participants involved in COPDGene, a multisite, prospective cohort study of current and former smokers. Primary cause of adjudicated deaths was identified using death certificates, family reports, and medical records. We examined time to death by suicide/overdose as the primary outcome in Cox regression adjusted for age, sex, race, BMI, pack-years, current smoking status, airflow limitation (%predicted FEV1), dyspnea (mMRC‚Č•2), 6-minute walk distance, supplemental oxygen use, and severe exacerbations in the prior year with time varying covariates and other causes of death as a competing risk. RESULTS: The cohort was 47% female, 33% Black (67% White), had a mean (SD) age of 59.6 (9.0) years, and mean FEV1 %predicted of 76.1 (25.5). 63 individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (HR=6.44, 95% CI 2.64-15.67), use of sedative/hypnotics (HR=2.33, 95% CI 1.24-4.38), and dyspnea (HR=2.23, 95% CI 1.34-3.70). Lower risk of was associated with older age (per decade HR=0.45, 95% CI 0.31-0.67), higher BMI (HR=0.95, 95% CI 0.91-0.99), and African American race (HR=0.41, 95% CI 0.23-0.74). Severity of airflow limitation (FEV %predicted) was not associated with suicide risk. INTERPRETATION: In this well-characterized cohort of current and former smokers with and without COPD, we identified risk factors for suicide/overdose that emphasize the subjective experience of illness over objective assessments of lung function.
  • Published In

  • Chest  Journal
  • Keywords

  • Chronic obstructive pulmonary disease, overdose, prospective cohort study, suicide deaths, tobacco smoking
  • Digital Object Identifier (doi)

    Author List

  • Adviento BA; Regan EA; Make BJ; Han MK; Foreman MG; Iyer AS; Bhatt SP; Kim V; Bon J; Soler X