Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts

• First study to evaluate specifically tobacco dependence in suicide attempters.
• Heavy tobacco dependence is associated with recurrent and medically severe attempts.
• High impulsivity and heavy tobacco dependence: risk of recurrent attempts.

AimsTobacco dependence and suicidal behaviors have been repeatedly associated in several studies but their relationship is still unclear. We aim to investigate, specifically, the association between the level of tobacco dependence and the severity of suicidal outcomes among suicide attempters, as well as the relationship of impulsivity with both conditions.MethodsWe examined a cross-sectional sample of 542 adult suicide attempters to compare the characteristics of the attempts depending on the level of tobacco dependence, which was assessed with the Fagerstrom test.ResultsSmokers with heavy dependence (Fagerstrom ≥7) made more attempts and reached higher medical lethality compared to non-smokers. Smokers with moderate dependence were not associated with features of severity in the suicide attempts. The combination of high impulsivity and heavy tobacco dependence showed an additive effect on the number of suicide attempts.ConclusionsA high or very high level of tobacco dependence could indicate a specific vulnerability leading to more severe suicide attempts. Impulsive attempters with heavy tobacco dependence were particularly at risk.