The present cross-sectional study investigates the association between smoking and psychopathology (ICD-10 diagnosis), history of suicide attempts and socio-demographic characteristics in a sample of 180 adult hospitalized patients. Results confirmed a high frequency of current smokers (63.3%) and heavy smokers with > or =20 cigarettes/day (47.4%). Smoking was significantly associated with being on invalid pension, social welfare or unemployed (>70% of smokers, p=0.008), a history of suicide attempts (73.2%, p=0.04) and the primary mental health diagnosis (p=0.004). A majority of patients (57.8%) presented at least one comorbid condition. Multivariate logistic regression indicated that disorders due to psychoactive substances, either as a primary diagnosis or as a comorbid condition, were significantly associated with smoking, in addition to significant effects of age group, financial resources and history of suicide attempts. Investigation of health beliefs showed that psychopathology did not compromise a realistic appreciation of smoke-related health risks. These results underline the importance of taking into account socio-demographic factors and substance use comorbidity in designing targeted interventions to reduce smoking in psychiatric patients.