Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis

Abdelaziz A Awad; Ramaiah Itumalla; Abhay M Gaidhane; Mahalaqua Nazli Khatib; Suhas Ballal; Pooja Bansal; Manish Srivastava; Isha Arora; MRavi Kumar; Aashna Sinha; Kumud Pant; Hashem Abu Serhan; Muhammed Shabil

doi:10.1186/s12888-024-06012-7

Association of electronic cigarette use and suicidal behaviors: a systematic review and meta-analysis

BMC Psychiatry. 2024 Sep 10;24(1):608. doi: 10.1186/s12888-024-06012-7.

Authors

Abdelaziz A Awad^#¹, Ramaiah Itumalla^#², Abhay M Gaidhane³, Mahalaqua Nazli Khatib⁴, Suhas Ballal⁵, Pooja Bansal⁶, Manish Srivastava⁷, Isha Arora⁸, MRavi Kumar⁹, Aashna Sinha¹⁰, Kumud Pant^{11

12}, Hashem Abu Serhan¹³, Muhammed Shabil^{14

15}

Affiliations

¹ Faculty of Medicine, Al-Azhar University, Cairo, 11651, Egypt. awad.abdelaziz.0505@gmail.com.
² School of Management, The Apollo University, Chittoor, Andhra Pradesh, 517127, India.
³ School of Epidemiology and Public Health, Jawaharlal Nehru Medical College, and Global Health Academy, Datta Meghe Institute of Higher Education, Wardha, India. abhay.psm@dmiher.edu.in.
⁴ Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
⁵ Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to Be University), Bangalore, Karnataka, India.
⁶ Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India.
⁷ Department of Cardiology, NIMS University, Jaipur, India.
⁸ Chandigarh Pharmacy College, Chandigarh Group of College, Jhanjeri, Mohali, Punjab, 140307, India.
⁹ Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India.
¹⁰ School of Applied and Life Sciences, Division of Research and Innovation, Uttaranchal University, Dehradun, India.
¹¹ Department of Biotechnology, Graphic Era (Deemed to Be University), Clement Town Dehradun, 248002, India.
¹² Department of Allied Sciences, Graphic Era Hill University Clement Town Dehradun, Clement Town Dehradun, 248002, India.
¹³ Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar. habuserhan@hamad.qa.
¹⁴ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
¹⁵ Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, 51001, Iraq.

^# Contributed equally.

Abstract

Background: The proliferation of electronic cigarettes (e-cigarettes) has presented new challenges in public health, particularly among adolescents and young adults. While marketed as safer than tobacco and as cessation aids, e-cigarettes have raised concerns about their long-term health and psychosocial impacts, including potential links to increased suicidal behaviors. This study aims to evaluate the relationship between e-cigarette use and suicidal behaviors by conducting a systematic review of the current literature.

Methods: We searched PubMed, Web of Science, and EMBASE for studies up to March 10, 2024, examining the relationship between e-cigarette use and suicidal behaviors. Eligible studies included cross-sectional, longitudinal, retrospective, prospective, and case-control designs. Meta-analysis was performed to calculate pooled odds ratios (ORs). Newcastle Ottawa scale was used to assess the quality of studies. R software (V 4.3) was used to perform the meta-analysis.

Results: Our analysis included fourteen studies, predominantly from the US and Korea, with participants ranging from 1,151 to 255,887. The meta-analysis identified a significant association between e-cigarette use and an increased risk of suicidal ideation (OR = 1.489, 95% CI: 1.357 to 1.621), suicide attempts (OR = 2.497, 95% CI: 1.999 to 3.996), and suicidal planning (OR = 2.310, 95% CI: 1.810 to 2.810). Heterogeneity was noted among the studies.

Conclusion: E-cigarette use is significantly associated with the risk of suicidal behaviors, particularly among adolescents. The findings underscore the necessity for caution in endorsing e-cigarettes as a safer smoking alternative and call for more extensive research to understand the underlying mechanisms. Public health strategies should be developed to address and mitigate the risks of suicidal behaviors among e-cigarette users.

Keywords: Adolescent health; Electronic cigarettes; Global health targets; Good health and well-being; Mental health; Nicotine; Public health; Self-harm; Suicide; Suicide prevention.

Publication types

Systematic Review
Meta-Analysis

MeSH terms

Adolescent
Electronic Nicotine Delivery Systems / statistics & numerical data
Humans
Suicidal Ideation*
Suicide, Attempted* / psychology
Suicide, Attempted* / statistics & numerical data
Vaping* / psychology
Young Adult