the association between sensory impairment and suicidal

DIVISION OF PSYCHIATRY

The association between sensory impairment and suicidal ideation and attempt

Cross-sectional analysis of nationally representative English household data

Maitri KhuranaDivision of PsychiatryUniversity College London

8th July 2021


Background - Literature

• Identifying risk factors is

important as it is considered a

preventable cause of death (Rim

et al., 2015).

• One such risk factor could be

the presence of sensory

impairments.



• Individuals with sensory impairments such as visual and

hearing, tend to report poorer quality of life and mental

health (Eisele et al., 2015).

• The literature is sparse and inconsistent (Meyer-Rochow et al.,

2015).

• Most current research comes from the elderly population.



• Integrated Motivational-Volitional Model (O’Connor et al., 2011)


Background - Aims

• If there is an association between sensory impairment and

suicidal attempt and ideation in the general population


Methods

• We analysed data from the 4th Adult Psychiatric Morbidity

Survey 2014

• Sample:

- English adults aged 16 and over

- Living in private households

• N=13,313 invited and N=7546 successful interviews

conducted


Methods – Measures (Exposures)

• Visual impairment:

1. “With your glasses or contact lenses if you wear any, do you

have any difficulty seeing ordinary newsprint at arm's length?

2. “With your glasses or contact lenses if you wear any, do you

have any difficulty clearly seeing the face of someone across a

room, that is from 4 meters or 12 feet away?"

• Hearing impairment: “Do you have any difficulty hearing, or

use a hearing aid?”


Methods – Measures (Exposures)

• Sensory impairment: Sensory impairment of either kind,

visual or hearing

• Dual sensory impairment: Both visual and hearing

impairment


Methods – Measures (Outcomes)

• Suicidal Ideation:

“Have you ever thought of taking your life, even though you

would not actually do it?”

• Suicide Attempt:

“Have you ever made an attempt to take your life, by taking an

overdose of tablets or in some other way?”.


Methods – Measures

• Covariates: Gender, age, socioeconomic status (IMD),

ethnicity (white and other) and diabetes.

Note: Depression and anxiety were not adjusted for in the main

analyses as they are likely to be on the causal pathway in the

association between sensory impairment and suicidality.


Methods – Statistical analysis

• Multivariable logistic regression models to describe the

association between each type of impairment and suicide

attempt and suicidal ideation.

• We used complete case analysis.

• Sensitivity analysis included best and worst-case scenario.

• Post-hoc analyses with CIS-R scores and each covariate.


Results – Suicidal Ideation

Exposure Unadjusted Odds Ratio

(95% CI)

p value Adjusted Odds Ratio (95% CI)

p value

Sensory Impairment (visual or hearing)

1.54 (1.19 to 2.00) 0.001 2.06 (1.56 to 2.73) <0.001

Dual Sensory Impairment

1.85 (1.18 to 2.89) 0.007 2.76 (1.67 to 4.57) <0.001

Visual Impairment 1.81 (1.36 to 2.41) <0.001 2.05 (1.51 to 2.78) <0.001

Hearing Impairment 1.26 (0.92 to 1.74) 0.146 1.90 (1.34 to 2.67) <0.001


Results – Suicidal Attempt

Exposure Unadjusted Odds Ratio

(95% CI)

p value Adjusted Odds Ratio (95% CI)

p value


3.12 (1.57 to 6.20) 0.001 5.32 (2.54 to 11.15) <0.001


2.88 (0.95 to 8.77) 0.062 6.14 (1.73 to 21.79) 0.005

Visual Impairment 3.68 (1.76 to 7.70) 0.001 4.97 (2.37 to 10.41) <0.001

Hearing Impairment 1.80 (0.78 to 4.16) 0.165 3.58 (1.40 to 9.16) 0.008


Results – Main Findings

• Those with sensory impairments had greater odds of having

thought of and attempted suicide in the past year.

• Age was a strong negative confounder.

• There appeared to be evidence to support some contribution

of depression and anxiety to this association.


Strengths

• The present study contributes to the limited literature.

• We used nationally representative data.

• Findings were adjusted for five predetermined

sociodemographic and clinical covariates and were robust to

sensitivity analyses simulating the biases introduced by

missing data.


Limitations

• Cross-Sectional nature of the dataset - reverse causation

effect cannot be ruled out.

• Sensory impaired population could be quite heterogenous.

• Certain settings that have populations that may be at higher

risk for suicidal ideation and attempt - example: inpatient

units, prisons, etc. could not be explored.


Limitations

• The APMS survey may have excluded people who are unable

to live independently in private households due to their

impairments

• Our measure of hearing impairment included participants

using a hearing aid.

• Self-reported measures are susceptible to social desirability

bias.


Interpretation and implications

• Since both of these impairments involve communication

difficulties, access to mental health care may be limited.

• GPs, ophthalmologists and otolaryngologists could be warned

about these results.

• Further research is needed to understand mediators such us

loneliness, stigma of disability, locus of control, self

perception, self esteem.

• Longitudinal research is required.


Conclusion

• Our findings provide strong evidence to support a cross-

sectional association between sensory impairments and

suicide attempt and ideation. In view of the cross-sectional

nature of the data, further longitudinal research is warranted

to explore the temporal relationship.


References

• Eisele, M., Lange, C., Scherer, M., Kaduszkiewicz, H., König, H. H., Hajek, A., … Pentzek, M. (2015). Determinants

of health-related quality of life in older primary care patients: Results of the longitudinal observational AgeCoDe

Study. British Journal of General Practice, 65(640), e716–e723. https://doi.org/10.3399/bjgp15X687337

• Meyer-Rochow, V. B., Hakko, H., Ojamo, M., Uusitalo, H., & Timonen, M. (2015). Suicides in visually impaired

persons: A nation-wide register-linked study from Finland based on thirty years of data. PLoS ONE.

https://doi.org/10.1371/journal.pone.0141583

• O’Connor, R. (2011). The Integrated Motivational-Volitional Model of Suicidal Behavior. Crisis, 32(6), 295-298.

doi: 10.1027/0227-5910/a000120

https://doi.org/10.3399/bjgp15X687337

https://doi.org/10.1371/journal.pone.0141583


References

• Rim, T. H., Lee, C. S., Lee, S. C., Chung, B., & Kim, S. S. (2015). Influence of visual acuity on suicidal ideation,

suicide attempts and depression in South Korea. British Journal of Ophthalmology, 99(8), 1112–1119.

https://doi.org/10.1136/bjophthalmol-2014-306518

https://doi.org/10.1136/bjophthalmol-2014-306518


Results – Suicidal Attempt (adjusted for CISR)

Exposure Adjusted Odds Ratio(95% CI)

p value Adjusted Odds Ratio *(95% CI)

p value


5.32 (2.54 to 11.15) <0.001 3.42 (1.66 to 7.04) 0.001


6.14 (1.73 to 21.79) 0.005 2.31 (0.59 to 8.99) 0.227

Visual Impairment 4.97 (2.37 to 10.41) <0.001 3.29 (1.43 to 7.57) 0.005

Hearing Impairment 3.58 (1.40 to 9.16) 0.008 1.05 (0.82 to 5.11) 0.122


Results – Suicidal Ideation (adjusted for CISR)

Exposure Adjusted Odds Ratio(95% CI)

p value Adjusted Odds Ratio *(95% CI)

p value


2.06 (1.56 to 2.73) <0.001 1.28 (0.91 to 1.79) 0.154


2.76 (1.67 to 4.57) <0.001 1.48 (0.80 to 2.76) 0.213

Visual Impairment 2.05 (1.51 to 2.78) <0.001 1.18 (0.81 to 1.72) 0.398

Hearing Impairment 1.90 (1.34 to 2.67) <0.001 1.37 (0.93 to 2.00) 0.107

the association between sensory impairment and suicidal

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