Does Visual Impairment Affect Suicidal Ideation Among Older Adults? Results from National Survey on Drug Use and Health

Background and Purpose: The prevalence of suicidal ideation among older adults has been regarded as a public health concern affecting their quality of life. Depression is the most common diagnosis in older adults who have attempted suicide. Research also revealed that age-related visual impairment (VI) can adversely impact physical and mental health status and performance of daily activities. Despite the adverse effect of VI on geriatric depression and suicide ideation, our knowledge on the relationship between these factors in older adults remains lacking. This study therefore aims to investigate the relative strength of association for VI on suicidal ideation among a nationally representative sample of older adults.

Methods: Study sample was composed of 2,575 adults over 65 years old, drawn from the 2016 National Survey on Drug Use and Health. Respondents were asked if they had serious thoughts about suicide in the past 12 months. VI was assessed by asking if the respondents were blind or had serious difficulty seeing. Gender, race, marital status, educational level, poverty, urbanization, employment status, health status, and mental health challenges were considered as covariates. Complex survey data analysis procedures were employed. Multivariate logistic regression analyses were used to examine the association between VI and suicidal ideation among older adults after adjusting for a comprehensive list of control variables

Results: The vast majority of older adults (84.1%) rated their health as good and 21.4 % of them reported having difficulty with mobility. Various chronic conditions were present among older respondents in the study, including high blood pressure (56.1%), heart condition (38.3%), diabetes (30.5%), cancer (23.6%), and asthma (9.6%). Obesity was reported by 32.3%. Nearly a third of them (28.4%) had visited an emergency department at least once (M=0.54. SD=1.55). Approximately, 6.7% of older adults reported experiencing VI. Relatively lower prevalence of mental health problems was reported in this sample. Only 2.6% reported Major Depressive Episode (MDE) and 1.8% had Substance Use Disorder. Smoking a cigarette during the past month was reported by 10% of them. Finally, a very small proportion of older adults expressed suicidal thoughts (1.63%). Older adults with VI were more likely to report suicidal ideation, compared to their counterparts without VI (OR=3.12, p<0. 05). Of the covariates, MDE was found to be the strongest predictor of suicidal ideation (OR=11.82, p<0. 05).

Conclusions and Implications: The results of this study demonstrate that VI is significantly associated with suicidal ideation among older adults. The association between VI and suicidal ideation could be related to other factors, such as a secondary disability caused by VI. In particular, the self-stigma of becoming a burden to and relying on others may lead geriatric depression and potential suicidal ideation. Subsequently, effective intervention should be tailored to address needs and mental health status of these older adults with visual challenges. More research is needed to identify risk and protective factors associated with suicidal ideation and behavioral health for this population.