{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:49:51Z","timestamp":1782920991349,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Suicidal behavior and self-harm are major public health concerns among adolescents, particularly those with depressive disorders. While smoking has been linked to suicidality in general populations, its independent role in both suicidal behavior and self-harm within well-characterized clinical samples of youth with depressive disorders remains understudied. This study consecutively enrolled 2,343 adolescents (aged 12\u201318 years) diagnosed with unipolar depression, bipolar disorder, or depressive episode according to DSM-5 criteria at Nanhai Public Health Hospital of Foshan City and The Third People\u2019s Hospital of Foshan between January 2025 and December 2025. Suicidal behavior (\u22651 suicide attempt) and self-harm (intentional self-injury or poisoning regardless of intent) were assessed via clinical interviews. Multivariable binary logistic regression models were constructed to identify factors independently associated with each outcome, adjusting for age, sex, education, income, parental education, psychiatric diagnosis, family history of mental illness, physical disease, and smoking status. Among 2,343 participants (mean age 14.99\u00a0\u00b1\u00a01.65 years; 77.8% female), the prevalence of self-harm was 76.0% and suicidal behavior was 44.2%. In fully adjusted models, smoking status was the only variable significantly associated with suicidal behavior after adjustment for measured covariates: current smokers (OR\u00a0=\u00a02.74, 95% CI: 1.81\u20134.22, P&amp;lt;0.001) and past quitters (OR\u00a0=\u00a02.32, 95% CI: 1.66\u20133.28, P&amp;lt;0.001) had higher odds compared to never smokers. For self-harm, current smoking was significantly associated with increased risk (OR\u00a0=\u00a02.31, 95% CI: 1.33\u20134.37, P\u00a0=\u00a00.006). Education level showed a borderline association with self-harm, with each additional year of schooling corresponding to a 10% lower odds (OR\u00a0=\u00a00.90, 95% CI: 0.81\u20131.00, P\u00a0=\u00a00.050); however, this finding should be interpreted cautiously given the exploratory nature of the analysis. No other demographic or clinical variables, including age, sex, or psychiatric diagnosis, were independently associated with either outcome. Smoking was strongly associated with both suicidal behavior and self\u2212harm after adjustment for measured demographic and clinical covariates. These findings underscore the importance of assessing tobacco use as a potential clinical marker of vulnerability in youth mental health settings.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1859568","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:22:42Z","timestamp":1782919362000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Smoking as a correlate of suicidal behavior and self-harm in adolescents with depressive disorders"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoxia","family":"Wu","sequence":"first","affiliation":[{"name":"Nanhai Public Health Hospital of Foshan","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ding","sequence":"additional","affiliation":[{"name":"Nanhai Public Health Hospital of Foshan","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaquan","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, The Third People\u2019s Hospital of Foshan","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijuan","family":"Gao","sequence":"additional","affiliation":[{"name":"Nanhai Public Health Hospital of Foshan","place":["Foshan, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1111\/acps.13237","article-title":"Non-suicidal self-injury and its co-occurrence with suicidal behavior: An epidemiological-study among adolescents and young adults","volume":"142","author":"Voss","year":"2020","journal-title":"Acta Psychiatr Scand"},{"key":"B2","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1186\/s12888-023-05348-w","article-title":"The effect of childhood trauma on suicide risk: the chain mediating effects of resilience and mental distress","volume":"23","author":"Yao","year":"2023","journal-title":"BMC Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s10964-024-01969-w","article-title":"Risk and protective factors of self-harm and suicidality in adolescents: An umbrella review with meta-analysis","volume":"53","author":"Richardson","year":"2024","journal-title":"J Youth Adolesc"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1037\/abn0000807","article-title":"Suicide-relevant information processing in unipolar and bipolar depression: An eye-tracking study","volume":"132","author":"Li","year":"2023","journal-title":"J Psychopathol Clin Sci"},{"key":"B5","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1186\/s40359-024-02236-0","article-title":"The effect of depression on non-suicidal self-injury and psychological status in adolescents with unipolar and bipolar disorders","volume":"12","author":"Ye","year":"2024","journal-title":"BMC Psychol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2022.01.103","article-title":"Predictors of suicidal ideation, suicide attempt and suicide death among people with major depressive disorder: A systematic review and meta-analysis of cohort studies","volume":"302","author":"Li","year":"2022","journal-title":"J Affect Disord"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s00406-023-01716-5","article-title":"Clinical predictors of suicidal ideation, suicide attempts and suicide death in depressive disorder: a systematic review and meta-analysis","volume":"274","author":"Riera-Serra","year":"2024","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2017.03.016","article-title":"Unpacking the impact of adverse childhood experiences on adult mental health","volume":"69","author":"Merrick","year":"2017","journal-title":"Child Abuse Negl"},{"key":"B9","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12916-023-02808-8","article-title":"Associations of bullying perpetration and peer victimization subtypes with preadolescent's suicidality, non-suicidal self-injury, neurocognition, and brain development","volume":"21","author":"Wen","year":"2023","journal-title":"BMC Med"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.4.773","article-title":"Cigarette smoking, suicidal behavior, and serotonin function in major psychiatric disorders","volume":"160","author":"Malone","year":"2003","journal-title":"Am J Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.04.018","article-title":"Smoking differently modifies suicide risk of affective disorders, substance use disorders, and social factors","volume":"112","author":"Schneider","year":"2009","journal-title":"J Affect Disord"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/da.22108","article-title":"Depression and smoking: a 5-year prospective study of patients with major depressive disorder","volume":"30","author":"Holma","year":"2013","journal-title":"Depress Anxiety"},{"key":"B13","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1080\/13811118.2018.1480986","article-title":"The relationship between smoking and suicidal behavior in psychiatric patients with major depressive disorder","volume":"23","author":"Holma","year":"2019","journal-title":"Arch Suicide Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0376","article-title":"Use of tobacco products and suicide attempts among elementary school-aged children","volume":"7","author":"Lee","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B15","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1186\/s12888-025-06505-z","article-title":"What differentiates adolescents who have attempted suicide from those without suicidal history? A retrospective psychiatric inpatient study","volume":"25","author":"Puzio","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2003.06.008","article-title":"Smoking and suicidality among adolescent psychiatric patients","volume":"34","author":"M\u00e4kikyr\u00f6","year":"2004","journal-title":"J Adolesc Health"},{"key":"B17","article-title":"Preventing suicide: A global imperative","author":"Parekh","year":"2014"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/s2352-4642(18)30403-6","article-title":"Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study","volume":"3","author":"Uddin","year":"2019","journal-title":"Lancet Child Adolesc Health"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2022.1256","article-title":"Prevalence and correlates of suicide and nonsuicidal self-injury in children: A systematic review and meta-analysis","volume":"79","author":"Liu","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g5954","article-title":"Clinical and social outcomes of adolescent self harm: population based birth cohort study","volume":"349","author":"Mars","year":"2014","journal-title":"Bmj"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3109\/00952990.2016.1171327","article-title":"Depression and cigarette smoking behavior: A critical review of population-based studies","volume":"43","author":"Weinberger","year":"2017","journal-title":"Am J Drug Alcohol Abuse"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2012.05.001","article-title":"Association of smoking and nicotine dependence with severity and course of symptoms in patients with depressive or anxiety disorder","volume":"126","author":"Jamal","year":"2012","journal-title":"Drug Alcohol Depend"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/0269881114548296","article-title":"Pilot study of the 5-HT2AR agonist psilocybin in the treatment of tobacco addiction","volume":"28","author":"Johnson","year":"2014","journal-title":"J Psychopharmacol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s40168-023-01589-9","article-title":"Microbiome and tryptophan metabolomics analysis in adolescent depression: roles of the gut microbiota in the regulation of tryptophan-derived neurotransmitters and behaviors in human and mice","volume":"11","author":"Zhou","year":"2023","journal-title":"Microbiome"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.euroneuro.2021.09.006","article-title":"Depression and inflammation: Correlation between changes in inflammatory markers with antidepressant response and long-term prognosis","volume":"54","author":"Kofod","year":"2022","journal-title":"Eur Neuropsychopharmacol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/s2215-0366(19)30030-6","article-title":"Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study","volume":"6","author":"Mars","year":"2019","journal-title":"Lancet Psychiatry"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-018-0258-7","article-title":"Deliberate self-harm among children with disabilities in China: a matched case-control study","volume":"85","author":"Gao","year":"2019","journal-title":"Pediatr Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1007\/s10567-024-00511-5","article-title":"Motivations for self-harm in young people and their correlates: A systematic review","volume":"28","author":"Tang","year":"2025","journal-title":"Clin Child Fam Psychol Rev"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-018-1196-1","article-title":"Gender differences in suicidal behavior in adolescents and young adults: systematic review and meta-analysis of longitudinal studies","volume":"64","author":"Miranda-Mendizabal","year":"2019","journal-title":"Int J Public Health"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2020.113231","article-title":"Suicidal ideation and attempts in unipolar versus bipolar depression: analysis of 131,740 adolescent inpatients nationwide","volume":"291","author":"Patel","year":"2020","journal-title":"Psychiatry Res"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1859568\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T15:22:43Z","timestamp":1782919363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1859568\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":30,"alternative-id":["10.3389\/fpsyt.2026.1859568"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1859568","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"article-number":"1859568"}}