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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
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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.
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Background - Literature
• 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.
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Background - Literature
• Integrated Motivational-Volitional Model (O’Connor et al., 2011)
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Background - Aims
• If there is an association between sensory impairment and
suicidal attempt and ideation in the general population
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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
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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?”
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Methods – Measures (Exposures)
• Sensory impairment: Sensory impairment of either kind,
visual or hearing
• Dual sensory impairment: Both visual and hearing
impairment
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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?”.
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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.
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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.
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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
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Results – Suicidal Attempt
Exposure Unadjusted Odds Ratio
(95% CI)
p value Adjusted Odds Ratio (95% CI)
p value
Sensory Impairment (visual or hearing)
3.12 (1.57 to 6.20) 0.001 5.32 (2.54 to 11.15) <0.001
Dual Sensory Impairment
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
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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
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Results – Suicidal Attempt (adjusted for CISR)
Exposure Adjusted Odds Ratio(95% CI)
p value Adjusted Odds Ratio *(95% CI)
p value
Sensory Impairment (visual or hearing)
5.32 (2.54 to 11.15) <0.001 3.42 (1.66 to 7.04) 0.001
Dual Sensory Impairment
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
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Results – Suicidal Ideation (adjusted for CISR)
Exposure Adjusted Odds Ratio(95% CI)
p value Adjusted Odds Ratio *(95% CI)
p value
Sensory Impairment (visual or hearing)
2.06 (1.56 to 2.73) <0.001 1.28 (0.91 to 1.79) 0.154
Dual Sensory Impairment
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