Association of Vision Impairment with Suicide Ideations, Plans, and Attempts Among Adults in the United Staates

Purpose: Suicide and vision impairment (VI) become growing public health problems. According to the three-step theory of suicide, intolerable physical pain of VI and inescapable psychological pain become a major cause of suicide. Previous studies on this topic have limitations including use of small non-probability sampling and failure to control for covariates relating to suicide thinking and behaviors. To address these research gaps, this study aims to investigate the relative strength of association for VI on suicidal ideations, plans, and attempts among adults in the US.

Methods: Study sample was composed of 128,740 adults 18 years and older, drawn from the 2015-2017 National Survey on Drug Use and Health (NSDUH). Respondents were asked if they had serious thoughts, plans, and attempts about suicide in the past 12 months. VI was assessed by asking if the respondents were blind or had serious difficulty seeing. Covariates include demographics (age, gender, race, education, income, employment, marital status, and insurance), health status, seeking mental health treatment, health behaviors of drinking and smoking, religious service attendance, and diagnosis of major depressive episodes (MDE). 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. Complex survey data analysis procedures were employed.

Results: Approximately, 3.9% of adults reported experiencing VI. Among adults with VI, 12.7% reported MDE. While a small proportion of those without VI reported suicidal thoughts (4.0%), plans (1.1%), and attempts (1.0%), a relatively high proportion of adults with VI had seriously thought about suicide (9.1%), suicide plans (3.0%), and attempted suicide (2.0%) in the past year. Adults with VI were more likely to experience suicidal ideation, plans, and attempts, compared to their counterparts without VI (OR=1.87, OR=1.65; OR=1.80, respectively). Protective factors of suicidal thoughts, plans, and attempts involved younger age, having insurance, being in good health, and attending religious services. Not being married, heavy smoking, diagnosis of MDE, and seeking mental health treatment in the past year were risk factors. Of the covariates, MDE was the strongest predictor of suicidal ideation, plans, and attempts (OR=6.95, OR=7.11, OR= 4.06 respectively).

Conclusions: With findings demonstrating strong association between VI and suicide, this study suggested the importance of screening suicidal ideation, plans, and attempts among adults with VI as well as the need for developing mental health services targeted for adults with VI. Whereas the Three-Step Theory argued two distinct processes of suicidal thoughts and the progression to attempts and plans, findings identified common factors related to suicide among adults with VI. In this study the directionality between mental health treatment and suicide and between suicidal ideation and behaviors (plans and attempts) cannot be determined because NSDUH did not recall the temporal order. Considering tremendous social burden of suicide, more research is needed to identify risk and protective factors associated with suicidal ideation and behaviors for vulnerable populations.