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COPD, Smoking & Suicide: Subjective vs. Objective Assessments

Among individuals with smoking exposure with and without COPD, a study identifies “risk factors for suicide/overdose … that emphasize the subjective experience of illness over objective assessments of lung function.” The authors conclude, “One implication of our findings is that the subjective experience of COPD is important in assessing suicide risk among individuals with smoking exposure. Further work is required to determine the generalizability of these results in other health care settings, nonsmoking or lighter smoking populations, and the role of psychological distress.”

The analysis used data for 9,930 participants involved in COPDGene, a multisite, prospective cohort study of individuals with smoking exposure. Factors loaded into the regression model included the primary cause of adjudicated deaths, time to death by suicide/overdose, age, sex, race, BMI, pack-years, current smoking status, airflow limitation (FEV1 % predicted), and dyspnea (modified Medical Research Council scale score ≥ 2).

“The cohort was 47% female and 33% Black (67% White); they had a mean ± SD age of 59.6 ± 9.0 years and a mean FEV1 % predicted of 76.1 ± 25.5,” the investigators write. “Sixty-three individuals died by suicide/overdose. Factors associated with risk of suicide/overdose were current smoking (hazard ratio [HR], 6.44; 95% CI, 2.64-15.67), use of sedative/hypnotics (HR, 2.33; 95% CI, 1.24-4.38), and dyspnea (HR, 2.23; 95% CI, 1.34-3.70). Lower risk was associated with older age (per-decade HR, 0.45; 95% CI, 0.31-0.67), higher BMI (HR, 0.95; 95% CI, 0.91-0.99), and African-American race (HR, 0.41; 95% CI, 0.23-0.74). Severity of airflow limitation (FEV % predicted) was not associated with suicide risk.”

Source: Chest