Psychiatry research · 2026
Tobacco craving and suicidal risk in a cohort of subjects with schizophrenia: results from the national FACE-SZ cohort.
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Tessier Arnaud, Fatseas Mélina, Dansou Yecodji, Godin Ophélia, Berna Fabrice, Capdevielle Delphine, Belmonte Cristobal, Chereau Isabelle, Llorca Pierre-Michel, Coulon Nathalie, Leigner Sylvain, D'amato Thierry, Rey Romain, Dubertret Caroline, Fond Guillaume, Boyer Laurent, Passerieux Christine, Urbach Mathieu, Pignon Baptiste, Schürhoff Franck, Szöke Andrei, Mallet Jasmina, Misdrahi David, Face-Sz (Fondamental Academic Center Of Expertise For Schizophrenia Group)
Аннотация
BACKGROUND: Tobacco use is highly prevalent among individuals with schizophrenia and exacerbates craving, a key METHODS: Data were collected from 1769 patients within the FondaMental Expert Centers for Schizophrenia network. Sociodemographic, clinical, addictive, suicidal, and treatment-related variables were analyzed using both univariate and multivariate logistic regression models. Mediation analyses were performed to ensure robust statistical inference.
RESULTS: The prevalence of tobacco smoking was 52.8% (n = 878). Higher tobacco craving scores were significantly correlated with increased suicidal ideation (p = 0.004), more frequent suicide attempts (p < 0.001), and higher suicide scores (p < 0.001). In the multivariable analysis, no significant associations were found between craving scores and all suicide outcomes. Regression models confirmed a strong association between tobacco craving and lifetime alcohol use disorder (AUD) (p < 0.001). Mediation analyses showed that AUD does not mediate the craving-suicide relationship (indirect effects p > 0.05).
CONCLUSIONS: These findings highlight the complex interplay between clinical severity, substance use, and suicidality in shaping craving levels among patients with schizophrenia. Mediation analyses showed that AUD does not explain the craving-suicide relationship, indicating that these represent separate, parallel risk pathways. Assessment of tobacco craving and comorbid substance use, particularly AUD, is essential when assessing suicide risk. These findings have important implications for suicide prevention and treatment strategies in individuals with schizophrenia and co-occurring substance use disorders.
RESULTS: The prevalence of tobacco smoking was 52.8% (n = 878). Higher tobacco craving scores were significantly correlated with increased suicidal ideation (p = 0.004), more frequent suicide attempts (p < 0.001), and higher suicide scores (p < 0.001). In the multivariable analysis, no significant associations were found between craving scores and all suicide outcomes. Regression models confirmed a strong association between tobacco craving and lifetime alcohol use disorder (AUD) (p < 0.001). Mediation analyses showed that AUD does not mediate the craving-suicide relationship (indirect effects p > 0.05).
CONCLUSIONS: These findings highlight the complex interplay between clinical severity, substance use, and suicidality in shaping craving levels among patients with schizophrenia. Mediation analyses showed that AUD does not explain the craving-suicide relationship, indicating that these represent separate, parallel risk pathways. Assessment of tobacco craving and comorbid substance use, particularly AUD, is essential when assessing suicide risk. These findings have important implications for suicide prevention and treatment strategies in individuals with schizophrenia and co-occurring substance use disorders.