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We estimate the predictive association between tobacco use disorder and the risk of suicide mortality, adjusting for other important variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>The<jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>nited<jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>tates<jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>eterans<jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ealth<jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>dministration (<jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>All individuals who received<jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>services in fiscal year (FY) 2005 and were alive at the start of FY 2006 (<jats:italic>n<\/jats:italic>\u2009=\u20094\u2009863\u2009086).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Tobacco use disorder was assessed via FYs 2004\u201305<jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>National<jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>atient<jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>are<jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>atabase records. The outcome of suicide mortality was assessed during the follow\u2010up interval from the beginning of FY 2006 to the end of FY 2008 using<jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ational<jats:styled-content style=\"fixed-case\">D<\/jats:styled-content>eath<jats:styled-content style=\"fixed-case\">I<\/jats:styled-content>ndex records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Of the 4\u2009863\u2009086 individuals in the study, 4823 died by suicide during the follow\u2010up interval. In the unadjusted model, tobacco use disorder was associated with an increased risk of suicide [hazard ratio (HR)\u2009=\u20091.88; 95% confidence interval (CI)\u2009=\u20091.76, 2.02]. After adjustment for model covariates, the association remained statistically significant, although attenuated (HR\u2009=\u20091.36, 95% CI\u2009=\u20091.27, 1.46).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tobacco use disorder may confer a modest excess risk of death by suicide. Psychiatric disorders may partially explain the relationship between tobacco use disorder and suicide.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.12381","type":"journal-article","created":{"date-parts":[[2013,10,17]],"date-time":"2013-10-17T12:09:34Z","timestamp":1382011774000},"page":"155-162","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["Tobacco use disorder and the risk of suicide mortality"],"prefix":"10.1111","volume":"109","author":[{"given":"Kipling M.","family":"Bohnert","sequence":"first","affiliation":[{"name":"VA National Serious Mental Illness Treatment Resource and Evaluation Center Department of Veterans Affairs Ann Arbor MI USA"},{"name":"Department of Psychiatry University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Ilgen","sequence":"additional","affiliation":[{"name":"VA National Serious Mental Illness Treatment Resource and Evaluation Center Department of Veterans Affairs Ann Arbor MI USA"},{"name":"Department of Psychiatry University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"McCarthy","sequence":"additional","affiliation":[{"name":"VA National Serious Mental Illness Treatment Resource and Evaluation Center Department of Veterans Affairs Ann Arbor MI USA"},{"name":"Department of Psychiatry University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalinda V.","family":"Ignacio","sequence":"additional","affiliation":[{"name":"VA National Serious Mental Illness Treatment Resource and Evaluation Center Department of Veterans Affairs Ann Arbor MI USA"},{"name":"Department of Psychiatry University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic C.","family":"Blow","sequence":"additional","affiliation":[{"name":"VA National Serious Mental Illness Treatment Resource and Evaluation Center Department of Veterans Affairs Ann Arbor MI USA"},{"name":"Department of Psychiatry University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira R.","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Veterans Health Administration Office of Mental Health Services Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,12]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"The Global Burden of Disease: 2004 Update","author":"World Health Organization","year":"2008"},{"key":"e_1_2_6_3_1","first-page":"1","article-title":"Deaths: final data for 2009","volume":"60","author":"Kochanek K. 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