Article in Alter European Journal of Disability Research/Revue Européenne de Recherche sur le Handicap · March 2012 doi: 10. 1016/j alter. 2011. 11. 004 Citations 18 reads 367 8 authors
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The influence of disability on suicidal behaviour(1)
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Instruments Suicide
attempts
The
question used
to
assess
suicide attempts,
based
on
the
work of
Paykel,
Myers, Lindenthal
and
Tanner,
1974 and
of
Salmons
and Harrington
(1984)
was:
“Have
you
ever
made
an
attempt
to take
your
life by
taking
an overdose
of
tablets
or in
some
other way?”.
A
positive
response was
followed
up
with a
question
on whether
this
last
occurred
in
the
last week,
last
year
or
longer
ago. Disability Disability
was
assessed
from
respondents’
answers
to
a
set of
questions,
which established
whether
they
had any
difficulties
in
seven
domains. Personal
care
is
commonly
regarded as
comprising
ADL – washing, dressing,
feeding
and
toileting
oneself
-
and
the remaining
domains
are
usually
described as
The
selection
of
activities
was influenced
by
the
MRC needs
for
assessment
(
&
Wing, 1989
)
and was
incorporated
in
the
national survey
of
disability
in Great
Britain
( Martin, Meltzer
& Elliot, 1988
).
The seven
domains
were:
Author's personal copy H.
Meltzer
et al.
/
ALTER,
European Journal
of
Disability
Research 6
(2012)
1–12 5 • personal care
(such
as
dressing,
bathing, washing,
or
using
the toilet);
• getting
out and
about
or
using
transport; • medical
care (such
as
taking
medicines or
pills,
having injections
or
changes
of dressing); • household
activities (like
preparing
meals,
shopping,
laundry
and
housework); • practical
activities (such
as
gardening,
decorating, or
doing
household repairs); • paperwork
(such as
writing
letters, sending
cards,
or
filling
in forms);
• managing
money (budgeting
for
food
or
paying
bills). These
topics have
been
used
over
the
past
40
years
to measure
functional
limitations among
adults
( Duckworth,
1983
).
To explore
whether
the
risk
associated
with
limitation
in
ADL/IADL
was cumulative rather
specific
to
individual
difficulties we
created
a variable
which
grouped
the
sum
of
ADL/IADL limitations
into
four
categories:
0,
1–2,
3–4, 5
or
more. Depression Diagnoses
of
common
mental disorders
including depression
were
derived
from
responses
to
the revised
Clinical
Interview
Schedule
( Lewis, Pelosi,
Araya
&
Dunn,
1992 ).
Diagnostic algorithms
were
applied
to the
data
to
identify
six categories
of
common
mental disorder:
generalised anxiety
disorder, depression,
obsessive-compulsive disorder,
phobia,
panic
disorder
and
mixed
anxiety
and
depressive disorder. Physical
health
Respondents
were asked
if
they
had any
physical
health
problems
since
the
age
of
16
years, and
were
asked to
choose
from a
list
of conditions
covering
all
body
systems
including
arthritis, stroke,
epilepsy,
diabetes, asthma
among
others.
For
each
reported
health
condition,
respondents had
to mention whether
it
was
diagnosed by
a
doctor or
health
professional, the
age
of
onset,
if it
had
been active
in the
past
year
and
if
they
were receiving
any
treatment
for
the
condition.
Self-reported physical
conditions
have been
shown
to
have
good validity
in
large-scale
health surveys
in
other
countries ( Heliövaara
et
al.,
1993 ). Personal,
family
and
household
characteristics Information
on gender,
age
and
marital
status
of
all
household members
was
collected,
as
well
as the
socioeconomic circumstances
of
the
household: educational
level
and
employment
status
of
the respondent,
tenure
and
debt
status.
Results About
one
in
150
adults in
England
had made
a
suicide
attempt in
the
past 12
months
in 2007
–
6.7 per
1000
population.
Women
were
twice
as
likely
as men
to
have
reported an
attempted
suicide in
the past
twelve
months:
8.7
compared
with
4.4
per
1000
population.
The
prevalence
of
suicide
attempts among
men was
highest
in
the
35–54 aged
group
(8.5/1000)
and
highest
among
women
in
the
16–34 group
(14.1/1000) followed
by
the
35–54 age
group
(9.8/1000).
There
were
no
cases
reported by
those aged
75
or
older by
either
men or
women. Based
on
univariate
logistic regression
analysis, several
sociodemographic,
socioeconomic and
health
factors were
found
to
increase
the odds
of
suicide
attempts: youth,
female
sex,
being
single
or widowed, divorced
or
separated,
physical ill-health,
being
unemployed
or
economically
inactive, and
being
in debt
( Table 1 ). When
all of
these
factors were
entered
into
a
multivariable
logistic regression
model,
sex
and
tenure
were the
only
variables
not
retained
as
a
significant correlates
(
1 ). The
largest
odds
ratios
among
the independent
significant correlates
were
being
unemployed
(OR
=
5.44,
95% CI
1.97
– 15.81,
p
= 0.002),
or
economically
inactive (OR
=
4.82,
95% CI
2.34
– 9.94,
p
=
0.001) and
having
a
physical health
problem
(OR
=
4.13,
95% CI
1.44
– 11.86,
p
<
0.008). Author's personal copy 6
H.
Meltzer et
al.
/ ALTER,
European
Journal
of
Disability
Research 6
(2012)
1–12 Table
Significant
sociodemographic, socioeconomic
and
physical
health
correlates
of
suicidal
attempts in
the
past 12
months. Unadjusted
OR
CI p-value Adjusted
OR 95%
CI p-value
Sex Male
1.00
– – 1.00
– – Female 2.03
1.08–3.82 0.028
0.86–3.18 0.133 Age
16
–34 1.00
–
–
1.00 –
– 35
–54
0.99 0.54–1.83 0.996
0.69–3.00 0.337 55
– 74
0.16 0.04–0.59 0.006
0.03–0.58 0.007 75+
–
–
– –
–
– Marital
Status Married
or cohabiting 1.00
–
1.00
– – Single 3.97
2.01–7.84 <
0.001 2.59
1.19–5.63 0.017 Widowed,
separated
or
divorced
3.20 1.43–7.14
0.005
2.66
1.12–6.31
0.217
Employment
status Employed
1.00 –
–
1.00 –
– Unemployed 9.42
<
0.001 5.44
1.97–15.81
0.002
Economically
inactive 3.55
1.82–6.93 <
0.001 4.82
2.34–9.94
0.001 Tenure Owns
outright
or
buying
with mortgage
1.00
–
–
1.00 –
– Renting
4.24
2.29–7.82
0.001 1.50
0.74–3.07
0.263
Debt
status Not
in debt
1.00
–
–
1.00 –
– In
debt
6.35 3.44–11.74
0.001 2.52
1.28–4.94
0.007
Physical
ill-health No
problem 1.00
– –
1.00 –
– Has
problem
3.06
1.09–8.58 0.033
4.13 1.44–11.86
0.008
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