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Association Between Disability and Suicide-Related Outcomes Among U.S. Adults

      Introduction

      Although research has analyzed the sociodemographic and socioeconomic risks for suicide, only recently has suicide risk for people with disabilities been examined. This study investigates the associations between disability and distinct suicide-related outcomes, including suicidal ideation, suicide planning, and suicide attempt.

      Methods

      This nationally representative, cross-sectional study comprised secondary analyses of the 2015–2019 National Survey on Drug Use and Health conducted in 2020 (N=198,640, representing 229,556,289 U.S. adults). Disability status comprised the presence of any disability; hearing, vision, mobility, cognitive, complex activity, or ≥2 limitations; and 1, 2, 3, 4, or ≥5 limitations. Suicide-related outcomes in the past year included none, suicidal ideation only, suicide planning, and suicide attempt. Multivariable logistic regression was applied to estimate the AORs.

      Results

      Overall, 19.8% reported any disability. Results showed that people with disabilities were significantly more likely than those without disabilities to report suicidal ideation (AOR=2.13, 95% CI=1.93, 2.36), suicide planning (AOR=2.66, 95% CI=2.27, 3.11), and suicide attempt (AOR=2.47, 95% CI=2.05, 2.98). Furthermore, individuals within each limitation count group were significantly more likely than people without disabilities to report suicide-related outcomes (p<0.001), with the largest magnitudes among those with ≥5 limitations for suicidal ideation (AOR=3.80, 95% CI=2.32, 6.23), suicide planning (AOR=6.45, 95% CI=3.52, 11.80), and suicide attempt (AOR=8.19, 95% CI=4.45, 15.07).

      Conclusions

      People with various types of functional disabilities had an elevated risk for suicide-related outcomes, compared with people without disabilities. The more limitations a person had progressively increased their risk. These findings call for focused attention to the mental health of people with disabilities, including suicide prevention efforts that accommodate their needs.
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      REFERENCES

        • National Action Alliance for Suicide Prevention: Research Prioritization Task Force
        A prioritized research agenda for suicide prevention: an action plan to save lives.
        National Action Alliance for Suicide Prevention and Research Prioritization Task Force, Rockville, MDPublished 2014
        • Hedegaard H
        • Curtin SC
        • Warner M
        Increase in suicide mortality in the United States, 1999–2018.
        National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MDPublished April 2020
      1. WISQARSTM: fatal injury reports, national, regional and state, 1981 - 2019. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. https://webappa.cdc.gov/sasweb/ncipc/mortrate.html. Updated February 20, 2020. Accessed June 15, 2021.

        • Substance Abuse and Mental Health Services Administration
        Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MDPublished September 2020
      2. Data & statistics (WISQARSTM): cost of injury reports. Centers for Disease Control and Prevention. https://wisqars.cdc.gov:8443/costT/cost_Part1_Intro.jsp. Updated September 18, 2014. Accessed June 15, 2021.

        • Borges G
        • Nock MK
        • Haro Abad JM
        • et al.
        Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys.
        J Clin Psychiatry. 2010; 71: 1617-1628https://doi.org/10.4088/JCP.08m04967blu
        • Schweininger S
        • Forbes D
        • Creamer M
        • et al.
        The temporal relationship between mental health and disability after injury.
        Depress Anxiety. 2015; 32: 64-71https://doi.org/10.1002/da.22288
        • Chu C
        • Klein KM
        • Buchman-Schmitt JM
        • Hom MA
        • Hagan CR
        • Joiner TE
        Routinized assessment of suicide risk in clinical practice: an empirically informed update.
        J Clin Psychol. 2015; 71: 1186-1200https://doi.org/10.1002/jclp.22210
      3. Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Division of Human Development and Disability. Disability and Health Data System (DHDS) Data [online]. https://dhds.cdc.gov. Accessed August 23, 2021.

        • Lutz J
        • Fiske A
        Functional disability and suicidal behavior in middle-aged and older adults: a systematic critical review.
        J Affect Disord. 2018; 227: 260-271https://doi.org/10.1016/j.jad.2017.10.043
        • Lund EM
        • Nadorff MR
        • Galbraith K
        • Thomas KB
        Comparing the internal consistency, overall scores, and response patterns on the Suicidal Behavior Questionnaire-Revised in people with and without disabilities.
        Rehabil Couns Bull. 2019; 62: 108-120https://doi.org/10.1177/0034355217728926
        • Mellqvist Fässberg M
        • Östling S
        • Braam AW
        • et al.
        Functional disability and death wishes in older Europeans: results from the EURODEP concerted action.
        Soc Psychiatry Psychiatr Epidemiol. 2014; 49: 1475-1482https://doi.org/10.1007/s00127-014-0840-1
        • Filiberti A
        • Ripamonti C
        • Totis A
        • et al.
        Characteristics of terminal cancer patients who committed suicide during a home palliative care program.
        J Pain Symptom Manage. 2001; 22: 544-553https://doi.org/10.1016/s0885-3924(01)00295-0
        • Kim YA
        • Bogner HR
        • Brown GK
        • Gallo JJ
        Chronic medical conditions and wishes to die among older primary care patients.
        Int J Psychiatry Med. 2006; 36: 183-198https://doi.org/10.2190/3QXD-UR0H-K8FH-2CU8
        • Milner A
        • Bollier AM
        • Emerson E
        • Kavanagh A
        The relationship between disability and suicide: prospective evidence from the Ten to Men cohort.
        J Public Health (Oxf). 2019; 41: 707-713https://doi.org/10.1093/pubmed/fdy197
        • Lutz J
        • Morton K
        • Turiano NA
        • Fiske A
        Health conditions and passive suicidal ideation in the Survey of Health, Ageing, and Retirement in Europe.
        J Gerontol B Psychol Sci Soc Sci. 2016; 71: 936-946https://doi.org/10.1093/geronb/gbw019
        • Meltzer H
        • Brugha T
        • Dennis MS
        • et al.
        The influence of disability on suicidal behaviour.
        Alter. 2012; 6: 1-12https://doi.org/10.1016/j.alter.2011.11.004
        • Van Orden KA
        • Witte TK
        • Cukrowicz KC
        • Braithwaite SR
        • Selby EA
        • Joiner Jr., TE
        The interpersonal theory of suicide.
        Psychol Rev. 2010; 117: 575-600https://doi.org/10.1037/a0018697
        • RTI International
        2015 National Survey on drug use and health methodological resource book, field interviewer manual.
        RTI International, Research Triangle Park, NC2014
        • RTI International
        2016 National Survey on Drug Use and Health: field interviewer manual, field interviewer computer manual.
        RTI International, Research Triangle Park, NCPublished September 2015
        • RTI International
        2017 National Survey on Drug Use and Health: field interviewer manual, field interviewer computer manual.
        RTI International, Research Triangle Park, NCPublished September 2016
        • RTI International
        2018 National Survey on Drug Use and Health: field interviewer manual, field interviewer computer manual.
        RTI International, Research Triangle Park, NCPublished September 2017
        • Turecki G
        • Brent DA
        Suicide and suicidal behaviour.
        Lancet. 2016; 387: 1227-1239https://doi.org/10.1016/S0140-6736(15)00234-2
        • Guo L
        • Xu Y
        • Deng J
        • et al.
        Association between nonmedical use of prescription drugs and suicidal behavior among adolescents [published correction appears in JAMA Pediatr. 2017;171(1):94].
        JAMA Pediatr. 2016; 170: 971-978https://doi.org/10.1001/jamapediatrics.2016.1802
        • Horner-Johnson W
        • Dobbertin K
        • Lee JC
        • Andresen EM
        • Expert Panel on Disability and Health Disparities
        Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.
        Health Serv Res. 2014; 49: 1980-1999https://doi.org/10.1111/1475-6773.12195
      4. Rural-urban continuum codes. U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes/. Updated December 10, 2020. Accessed April 27, 2021.

        • Klonsky ED
        • May AM
        Differentiating suicide attempters from suicide ideators: a critical frontier for suicidology research.
        Suicide Life Threat Behav. 2014; 44: 1-5https://doi.org/10.1111/sltb.12068
        • Klonsky ED
        • May AM
        The Three-Step Theory (3ST): a new theory of suicide rooted in the “ideation-to-action” framework.
        Int J Behav Cogn Ther. 2015; 8: 114-129https://doi.org/10.1521/ijct.2015.8.2.114
        • Burke TA
        • Alloy LB
        Moving toward an ideation-to-action framework in suicide research: a commentary on May and Klonsky (2016).
        Clin Psychol (New York). 2016; 23: 26-30https://doi.org/10.1111/cpsp.12134
        • Klonsky ED
        • Saffer BY
        • Bryan CJ
        Ideation-to-action theories of suicide: a conceptual and empirical update.
        Curr Opin Psychol. 2018; 22: 38-43https://doi.org/10.1016/j.copsyc.2017.07.020
        • Clark L
        • Dombrovski AY
        • Siegle GJ
        • et al.
        Impairment in risk-sensitive decision-making in older suicide attempters with depression.
        Psychol Aging. 2011; 26: 321-330https://doi.org/10.1037/a0021646
        • Lara E
        • Olaya B
        • Garin N
        • et al.
        Is cognitive impairment associated with suicidality? A population-based study.
        Eur Neuropsychopharmacol. 2015; 25: 203-213https://doi.org/10.1016/j.euroneuro.2014.08.010
        • Khazem LR
        • Jahn DR
        • Cukrowicz KC
        • Anestis MD
        Physical disability and the interpersonal theory of suicide.
        Death Stud. 2015; 39: 641-646https://doi.org/10.1080/07481187.2015.1047061
        • Hooley JM
        • Franklin JC
        • Nock MK
        Chronic pain and suicide: understanding the association.
        Curr Pain Headache Rep. 2014; 18: 435https://doi.org/10.1007/s11916-014-0435-2
        • Rokach A
        • Lechcier-Kimel R
        • Safarov A
        Loneliness of people with physical disabilities.
        Soc Behav Pers. 2006; 34: 681-700https://doi.org/10.2224/sbp.2006.34.6.681
        • Khazem LR
        • Jahn DR
        • Cukrowicz KC
        • Anestis MD
        Health conditions, physical disabilities, perceived burdensomeness, and depressive symptoms influence suicidal ideation.
        Death Stud. 2017; 41: 220-225https://doi.org/10.1080/07481187.2016.1251509
        • Shim E-
        • Song YW
        • Park SH
        • Lee KM
        • Go DJ
        • Hahm BJ
        Examining the relationship between pain catastrophizing and suicide risk in patients with rheumatic disease: the mediating role of depression, perceived social support, and perceived burdensomeness.
        Int J Behav Med. 2017; 24: 501-512https://doi.org/10.1007/s12529-017-9648-1
        • Fishbain DA
        • Bruns D
        • Bruns A
        • et al.
        The perception of being a burden in acute and chronic pain patients is associated with affirmation of different types of suicidality.
        Pain Med. 2016; 17: 530-538https://doi.org/10.1111/pme.12889
        • Wilson KG
        • Heenan A
        • Kowal J
        • Henderson PR
        • McWilliams LA
        • Castillo D
        Testing the interpersonal theory of suicide in chronic pain.
        Clin J Pain. 2017; 33: 699-706https://doi.org/10.1097/AJP.0000000000000451
        • Lohman MC
        • Raue PJ
        • Greenberg RL
        • Bruce ML
        Reducing suicidal ideation in home health care: results from the CAREPATH depression care management trial.
        Int J Geriatr Psychiatry. 2016; 31: 708-715https://doi.org/10.1002/gps.4381
        • Pelton MK
        • Crawford H
        • Robertson AE
        • Rodgers J
        • Baron-Cohen S
        • Cassidy S
        Understanding suicide risk in autistic adults: comparing the interpersonal theory of suicide in autistic and non-autistic samples.
        J Autism Dev Disord. 2020; 50: 3620-3637https://doi.org/10.1007/s10803-020-04393-8
        • Ahmedani BK
        • Westphal J
        • Autio K
        • et al.
        Variation in patterns of health care before suicide: a population case-control study.
        Prev Med. 2019; 127105796https://doi.org/10.1016/j.ypmed.2019.105796
        • Melhem NM
        • Brent D
        Do brief preventive interventions for patients at suicide risk work?.
        JAMA Psychiatry. 2020; 77: 997-999https://doi.org/10.1001/jamapsychiatry.2020.1287
        • Doupnik SK
        • Rudd B
        • Schmutte T
        • et al.
        Association of suicide prevention interventions with subsequent suicide attempts, linkage to follow-up care, and depression symptoms for acute care settings: a systematic review and meta-analysis.
        JAMA Psychiatry. 2020; 77: 1021-1030https://doi.org/10.1001/jamapsychiatry.2020.1586
        • Office of the Assistant Secretary for Planning and Evaluation, HHS
        HHS implementation guidance on data collection standards for race, ethnicity, sex, primary language, and disability.
        Office of the Assistant Secretary for Planning and Evaluation, HHS, Washington, DCPublished October 30, 2011
        • Han B
        • McKeon R
        • Gfroerer J
        Suicidal ideation among community-dwelling adults in the United States.
        Am J Public Health. 2014; 104: 488-497https://doi.org/10.2105/AJPH.2013.301600
        • Szanto K
        • Lenze EJ
        • Waern M
        • et al.
        Research to reduce the suicide rate among older adults: methodology roadblocks and promising paradigms.
        Psychiatr Serv. 2013; 64: 586-589https://doi.org/10.1176/appi.ps.003582012
        • Gerst-Emerson K
        • Jayawardhana J
        Loneliness as a public health issue: the impact of loneliness on health care utilization among older adults.
        Am J Public Health. 2015; 105: 1013-1019https://doi.org/10.2105/AJPH.2014.302427
        • Substance Abuse and Mental Health Services Administration
        2018 National Survey on Drug Use and Health: methodological summary and definitions.
        Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MDPublished August 2019