• David A Fishbain, John E Lewis, Jinrun Gao, Brandly Cole, and Steele RosomoffRR.
• Department of Psychiatry, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA. d.fishbain@miami.edu
• Pain Med. 2009 Mar 1; 10 (2): 340-6.

ObjectivesThere is significant psychiatric literature indicating that smoking is associated with all forms of suicidality, including suicide ideation. The goal of this study was to determine if smoking is associated with suicide ideation in chronic low back pain (CLBP) patients.DesignCLBP patients identified themselves as either current smokers (N = 81) or nonsmokers (N = 140) and completed a number of evaluation instruments, which included the Beck Depression Inventory (BDI) and the Coping Strategies Questionnaire (CSQ). BDI question number 9 was utilized to define CLBP with suicide ideation and subsequently, in addition, items number 3 and number 6 from the CSQ were added to the BDI item number 9 in order to fully capture CLBP with suicide ideation. Utilizing this expanded definition of suicide ideation (BDI plus CSQ), CLBP smokers were compared with CLBP nonsmokers for the frequency of suicide ideation. Regression analysis was utilized to investigate the CLBP smoking suicide ideation group. Finally, we investigated whether heavy use of alcohol and coffee impacted on CLBP heavy smokers in terms of increasing suicide ideation risk.SettingCLBP patients were recruited from a pain facility.ResultsCLBP smokers were more likely to complain of suicide ideation, and this relationship correlated with the number of cigarettes smoked per day. Seventy-eight percent of the CLBP smokers were classified correctly in terms of the presence of suicide ideation by three variables: diagnosis of major depression, Function Assessment Questionnaire total score, and BDI total score. The relative risk of suicide ideation was increased by combining heavy smoking (greater than one pack per day) with heavy alcohol use.ConclusionsCLBP smokers appear to be at greater risk for suicide ideation than nonsmoking CLBP patients. The risk of suicide ideation is even greater if the CLBP patient is a heavy smoker and has problems with alcohol.

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