Tobacco smoking and other substance use disorders associated with recurrent suicide attempts in bipolar disorder.

•Recurrent suicide attempts (RSA) regarded the majority of suicide attempters.•RSA were associated to tobacco smoking independently from other substances.•Associations between RSA and tobacco smoking were found in both countries.•Alcohol and cannabis abuse/dependence were also associated with RSA.•RSA were associated with female gender and depressive polarity at bipolar onset.