García-Jiménez Jesús, Gómez-Sierra Francisco José, Martínez-Hortelano Alicia, Moreno-Merino Paula, Girela-Serrano Braulio, Molero Patricio, Gutiérrez-Rojas Luis
Department of Psychiatry, San Cecilio University Hospital, Granada, Spain.
Mental Health Unit at La Mata, University Hospital of Torrevieja, Alicante, Spain.
Front Psychiatry. 2023 May 19;14:1179733. doi: 10.3389/fpsyt.2023.1179733. eCollection 2023.
OBJECTIVE: Bipolar disorder (BD) is a highly prevalent, chronic and recurrent mental illness. The smoking rates in patients with BD are much higher than those of the general population, and BD is associated with an increased risk of suicide. An association between smoking and suicidal behavior has been found in the general population, this systematic review examines whether there is evidence of an association between smoking and suicide behavior in patients with BD. METHOD: A database search was carried out in Medline, Embase, The Cochrane Library, Scopus, and Web of Science, updated until December 31st, 2021, according to the 2020 PRISMA guidelines. We identified prospective and retrospective studies that included patients diagnosed with BD types I, II, and not otherwise specified, and in which smoking and suicidal behavior were correlated. Articles that focused exclusively on other mental disorders were excluded. The Ottawa-Newcastle scale was used to assess the methodological quality of the included articles. RESULTS: Fifteen articles ( = 7,395) met all the inclusion criteria. In nine of these articles, the authors found an association between smoking and suicidal behavior in BD, while in the remaining six articles, this association was not found. A great deal of variability was observed between articles, particularly in the measurement of suicidal behavior and tobacco consumption. The risk of bias, as assessed by the NOS, was high for most of the included articles, except for two papers, whose risk was low. CONCLUSION: It was not possible to establish a clear relationship between tobacco use and the risk of suicide in BD patients due to the heterogeneity of the articles included in this systematic review, which had different sample sizes and methodological issues. However, both conditions are highly prevalent and have a negative impact on the prognosis of BD. Therefore, a systematic approach is needed, based on accurate measurement of a patient's smoking habits and their risk of suicidal behavior, in order to establish an appropriate therapeutic plan. ADDITIONAL INFORMATION: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors and was registered on PROSPERO with the CRD42022301570 on January 21th 2022.
目的：双相情感障碍（BD）是一种高度流行、慢性且复发性的精神疾病。BD患者的吸烟率远高于普通人群，且BD与自杀风险增加有关。在普通人群中已发现吸烟与自杀行为之间存在关联，本系统评价旨在研究BD患者中是否存在吸烟与自杀行为之间关联的证据。 方法：根据2020年PRISMA指南，在Medline、Embase、Cochrane图书馆、Scopus和Web of Science中进行数据库检索，更新至2021年12月31日。我们纳入了前瞻性和回顾性研究，这些研究纳入了诊断为I型、II型双相情感障碍及未另行指定类型的患者，且其中吸烟与自杀行为具有相关性。专门关注其他精神障碍的文章被排除。使用渥太华-纽卡斯尔量表评估纳入文章的方法学质量。 结果：15篇文章（n = 7395）符合所有纳入标准。其中9篇文章的作者发现BD患者中吸烟与自杀行为之间存在关联，而其余6篇文章未发现这种关联。各文章之间观察到很大的差异，尤其是在自杀行为和烟草消费的测量方面。除两篇风险较低的论文外，大多数纳入文章经NOS评估的偏倚风险较高。 结论：由于本系统评价中纳入的文章存在样本量不同和方法学问题等异质性，无法明确确定BD患者吸烟与自杀风险之间的关系。然而，这两种情况都高度流行且对BD的预后有负面影响。因此，需要一种基于准确测量患者吸烟习惯及其自杀行为风险的系统方法，以制定适当的治疗方案。 附加信息：本研究未接受公共、商业或非营利部门任何资助机构的特定资助，并于2022年1月21日在PROSPERO上注册，注册号为CRD42022301570。
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