Double Trouble: Disabilty and Suicide Attempts in Adolescence

Background: The risk factors for adolescent suicide, a serious and persistent public health problem, are well known, but there are certain vulnerable populations at risk for higher suicide that have been neglected. Youth with disabilities such as ADHD, learning disabilities and psychiatric conditions are known to or commit suicide  or suicide attempts (SA) at disproportionately higher rates, but the suicide risks for other disability sub-groups have received little attention (sensory impairments, autism spectrum disorders (ASD), physical mobility).

 Study objectives:  The aim of this study is to address two questions: (1) What is the relative risk for SA reported by youth identifying different disability conditions?; (2) Does disability status  add to the risk for SA above well-known risk factors for suicide?  We examine a comprehensive range of suicide risk factors, some well known and others typically excluded (e.g. health, activity levels, online posting of nude pictures).

 Methods: This study utilizes crossectional data from the 2012 Dane County Youth Assessment (DCYA), which surveyed high school students (in regular and alternative schools) from fifteen school districts in a large urban and rural county in Wisconsin (study sample=13,925).  The survey is anonymous (though youth with disabilities can receive help to complete the survey). Independent variables that served as moderators or mediators of SA (within last twelve months) pertain to social-demographic background, mental health status, family stability and maltreatment, social relationships, sexual minority status, high risk sexual behavior, substance use and other illegal behavior, school functioning and achievement, and various personal assets or social resources. Multivariate analyses utilized hierarchical binary logistic regression.

 Results: Youth reporting any disability are far more likely to report a SA in the past year than peers without a disability (OR=3.6), and having more than one disability tripled the risk of SA (OR=9.2). Not surprisingly, youth reporting an emotional/psychiatric disability topped the list for suicide attempts in the past year (20.8%), followed by youth with ASD (18.2%). Curiously, youth with ASD reported being most likely, proportionately, to make multiple suicide attempts. It was also unexpected that youth hearing and vision impairments were more likely to report suicide attempts than youth with learning disabilities, ADHD and health-related issues.  All youth with a disability, including each of four groups about which we have little previous information regarding suicidality (hearing, vision and mobility impairments, ASD) were found at markedly elevated risk in every domain we examined (including poverty, sexual risk behavior, sexual minority status, and substance use). Finally, we found indication of a disability increased the odds of SA by 53% beyond the variation explained by psychosocial predictors of SA (Nagelkerke R² D .348--.357, p<.001).

Implications: These findings call attention to populations vulnerable to suicidality that have not received sufficient or adequate (tailored) prevention and intervention efforts. There is also much room for reconceptualizing and broadening the study of disability far beyond the negative impacts of impairment on well-being at the individual and inter-personal level to focus on disability in the sense of environmental barriers to wellbeing (resources, policies, attitudes).