Tobacco craving and suicidal risk in a cohort of subjects with schizophrenia: results from the national FACE-SZ cohort

Tessier A(1), Fatseas M(2), Dansou Y(3), Godin O(3), Berna F(4), Capdevielle
D(5), Belmonte C(5), Chereau I(6), Llorca PM(6), Coulon N(7), Leigner S(7),
D’amato T(8), Rey R(8), Dubertret C(9), Fond G(10), Boyer L(10), Passerieux
C(11), Urbach M(11), Pignon B(12), Schürhoff F(12), Szöke A(12), Mallet J(13),
Misdrahi D(14); Face-Sz (Fondamental Academic Center Of Expertise For
Schizophrenia Group)(3).

Collaborators: Andre M(15), Andrieu-Haller C(16), Ascarain A(17), Berna F(18),
Blanc O(19), Bourguignon E(20), Capdevielle D(15), Cléry M(20), Chereau-Boudet
I(19), Clauss-Kobayashi J(18), Coulon N(21), Dassing R(18), Dorey JM(22), Dubos
J(20), Dubertret C(23), Esselin A(24), Fakra E(25), Fond G(16), Gabayet F(26),
Jarroir M(24), Lacelle D(19), Leboyer M(20), Leignier S(26), Llorca PM(19),
Mallet J(27), Metairie E(28), Michel T(15), Misdrahi D(17), Passerieux C(24),
Pignon B(20), Peri P(28), Portalier C(23), Rey R(22), Roman C(26), Salvat E(17),
Schorr B(18), Schürhoff F(20), Szöke A(20), Tessier A(17), Urbach M(24), Very
E(29), Zinetti-Bertschy A(18).

Author information:
(1)Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000 Bordeaux, France; Fondation
Fondamental, Créteil, France; Department of Universitary and General Psychiatry,
Charles Perrens Hospital, Bordeaux, France. Electronic address:
.
(2)Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000 Bordeaux, France; Department
of Addictology, CHU Bordeaux, Bordeaux, France.
(3)Fondation Fondamental, Créteil, France.
(4)Fondation Fondamental, Créteil, France; University Hospitals of Strasbourg,
Department of Psychiatry, University of Strasbourg, INSERM U1114, Strasbourg,
France.
(5)Fondation Fondamental, Créteil, France; University Department of Adult
Psychiatry, La Colombière Hospital, CHU Montpellier, France.
(6)Fondation Fondamental, Créteil, France; CHU Clermont-Ferrand, Psychiatry B
department, Clermont-Auvergne University, Clermont-Ferrand, France.
(7)Fondation Fondamental, Créteil, France; Psychosocial Rehabilitation Referral
Center, Alpes-Isère Hospital, Grenoble, France.
(8)Fondation Fondamental, Créteil, France; INSERM U1028, CNRS UMR5292, Lyon
Neuroscience Research Center, Claude Bernard Lyon 1 University, Team PSYR2, Le
Vinatier Hospital, Bron, France.
(9)Fondation Fondamental, Créteil, France; AP-HP, Department of Psychiatry,
Louis Mourier Hospital, Inserm UMR1266, Institute of Psychiatry and Neuroscience
of Paris, University Paris Descartes, Université Paris Diderot, Sorbonne Paris
Cité, Colombe, France.
(10)Fondation Fondamental, Créteil, France; Marseille University hospital,
Aix-Marseille Univ, School of medicine – La Timone Medical Campus, EA 3279:
Department of Epidemiology and Health Economics, Marseille, France.
(11)Fondation Fondamental, Créteil, France; Versailles Hospital, Department of
Adult Psychiatry and Addictology, Paris-Saclay University, DisAP-DevPsy-CESP,
INSERM UMR1018, Le Chesnay, France.
(12)Fondation Fondamental, Créteil, France; Paris-Est-Créteil University (UPEC),
AP-HP, Henri Mondor Hospital, DMU IMPACT, INSERM, IMRB, Translational
Neuropsychiatry, Fondation FondaMental F-94010 Créteil, France.
(13)Fondation Fondamental, Créteil, France; Psychiatry department, CHU d’Orléans
et EPSM du Loiret, ORLEANS, France; Brain-Clinicial and Experimental
Neuroplasticity (B-CLINE), Laboratoire Interdisciplinaire pour l’Innovation et
la Recherche en Santé d’Orléans (LI2RSO), Université d’Orléans, Orléans, France.
(14)Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000 Bordeaux, France; Fondation
Fondamental, Créteil, France; Department of Universitary and General Psychiatry,
Charles Perrens Hospital, Bordeaux, France.
(15)Fondation Fondamental, France; University Department of Adult Psychiatry, La
Colombiere Hospital, CHU Montpellier, University of Montpellier 1, Inserm 1061,
Montpellier, France.
(16)Fondation Fondamental, France; AP-HM, la Conception Hospital, Aix-Marseille
Univ, School of medicine – La Timone Medical Campus, EA 3279: CEReSS – Health
Service Research and Quality of Life Center, 27 Boulevard Jean Moulin, 13005
Marseille, France.
(17)Fondation Fondamental, France; General and University Psychiatry Department,
Charles Perrens Hospital, Univ. Bordeaux, CNRS, INCIA, UMR 5287 ECOPSY, F-33076,
F-33000 Bordeaux, France.
(18)Fondation Fondamental, France; Strasbourg University Hospital, University of
Strasbourg, INSERM U1114, Federation of Translational Psychiatry, Strasbourg,
France.
(19)Fondation Fondamental, France; Clermont-Ferrand University Hospital, rue
montalembert, Clermont-Ferrand Cedex 1, France.
(20)Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team,
DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d’Addictologie
des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly,
94000 Créteil, France.
(21)Fondation Fondamental, France; INSERM U955, Translational Psychiatry Team,
DHU Pe-PSY, Centre Expert Schizophrénie, Pôle de Psychiatrie et d’Addictologie
des Hôpitaux Universitaires Henri Mondor, Paris Est University, 40 rue de Mesly,
94000 Créteil, France; Schizophrenia Expert Center and Psychosocial
Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France.
(22)Fondation Fondamental, France; INSERM, U1028; CNRS, UMR5292, University Lyon
1, Lyon Neuroscience Research Center, PSYR2 Team, le Vinatier Hospital,
Schizophrenia Expert Centre, Lyon, F-69000, France.
(23)Fondation Fondamental, France; AP-HP, Department of Psychiatry, Louis
Mourier Hospital, Inserm UMR1266, Institute of Psychiatry and Neuroscience of
Paris, University Paris Descartes, Université Paris Diderot, Sorbonne Paris
Cité, Faculté de médecine, Colombes, France.
(24)Fondation Fondamental, France; Versailles Hospital, Department of Adult
Psychiatry and Addictology, Centre Hospitalier de Versailles, DisAP-DevPsy-CESP,
INSERM UMR1018, University of Paris-Saclay, University of Versailles
Saint-Quentin-En-Yvelines 94807, 177 rue de Versailles, 78157 Le Chesnay,
Villejuif, France.
(25)Fondation Fondamental, France; Department of Psychiatry, University Hospital
of Saint-Etienne, Saint-Etienne, France.
(26)Fondation Fondamental, France; Schizophrenia Expert Center and Psychosocial
Rehabilitation Reference Center, Alpes Isère Hospital, Grenoble, France.
(27)Fondation Fondamental, France; Psychiatry department, CHU d’Orléans et EPSM
du Loiret, Brain-Clinicial and Experimental Neuroplasticity (B-CLINE),
Laboratoire Interdisciplinaire pour l’Innovation et la Recherche en Santé
d’Orléans (LI2RSO), Université d’Orléans, Orléans, France.
(28)Fondation Fondamental, France; Department of Psychiatry (AP-HM),
Sainte-Marguerite University Hospital, Marseille, France.
(29)Fondation Fondamental, France; Department of Psychiatry, Psychotherapies,
Art-therapy, Toulouse University Hospital, Equipe de Recherche sur les
Rationalités Philosophiques et les Savoirs – EA3051, Université de Toulouse –
Jean Jaurès, Toulouse, France.

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.

Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.

DOI: 10.1016/j.psychres.2026.117028
PMID: 41740363 [Indexed for MEDLINE]

Conflict of interest statement: Declaration of competing interest The authors
declare the following financial interests/personal relationships which may be
considered as potential competing interests: Fondation Fondamental reports
financial support was provided by French National Research Agency. This work was
supported by the Fondation FondaMental (RTRS Santé Mentale) and by the
Investissements d’Avenir program managed by the ANR under reference
ANR-11-IDEX-0004–02 and ANR-10-COHO-10–01. The funding source had no role in the
study design, data collection, analysis, preparation of the manuscript, or
decision to submit the manuscript for publication. If there are other authors,
they declare that they have no known competing financial interests or personal
relationships that could have appeared to influence the work reported in this
paper.

Auteurs Bordeaux Neurocampus