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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Author's personal copy 8
H.
Meltzer et
al.
/ ALTER,
European
Journal
of
Disability
Research 6
(2012)
1–12 Table
Type
activities
of
daily
living/instrumental activities
of
daily
living (ADL/IADL)
difficulty correlates
of
suicide
attempts in
past 12
months. Type
of
ADL
difficulty Unadjusted
OR 95%
CI Sig.
(p) Reference
group is
no
difficulty Managing
money such
as
budgeting
for food
or paying bills
9.55
5.40–16.91 <
0.001 Dealing
with paperwork
such
as
writing letters,
sending
cards
or
form-filling 7.14
4.04–12.62 <
0.001 Medical
care such
as
taking
medication or
pills, injections
or
change
of dressings 6.46 2.92–14.32 <
0.001 Going
out or
about
or using
transport 4.62 2.54–8.39 <
0.001 Household
activities such
as
preparing
meals, shopping
laundry or
housework 4.21
2.31–7.66
0.001 Practical
activities such
as
gardening, decorating
or
doing
household repairs
2.74
1.54–4.87 0.001
Personal
care such
as
bathing,
washing or using the
toilet
2.03
0.91–4.57 0.085
Type
of ADL
difficulty
Adjusted
OR a 95%
CI Sig.
(p)
Reference
group is
no
difficulty Managing
money such
as
budgeting
for food
or paying bills
4.79 2.40–9.58 <
0.001 Dealing
with paperwork
such
as
writing letters,
sending
cards
or
form-filling 2.93
1.39–6.18
0.005
Medical
care such
as
taking
medication or
pills, injections
or
change
of dressings. 2.06
0.158
Going
out or
about
or using
transport 2.25
0.092
Household
activities such
as
preparing
meals, shopping
laundry or
housework 1.26
0.41–3.51 0.662
Practical
activities such
as
gardening, decorating
or
doing
household repairs
0.96
0.40–2.31 0.993
Personal
care such
as
bathing,
washing or using the
toilet
0.25
0.09–0.74 0.012
Type
of ADL
difficulty
Adjusted
OR b 95%
CI Sig.
(p)
Reference
group is
no
difficulty Managing
money such
as
budgeting
for food
or paying bills
2.95
1.47–5.91 0.002
Dealing
with paperwork
such
as
writing letters,
sending
cards
or
form-filling 2.94
1.43–6.06
0.003
Medical
care such
as
taking
medication or
pills, injections
or
change
of dressings 1.86
0.230
Going
out or
about
or using
transport
2.14
0.82–5.65
0.125
Household
activities such
as
preparing
meals, shopping
laundry or
housework 1.02
0.35–2.92
0.978
Practical
activities such
as
gardening, decorating
or
doing
household repairs
1.02
0.39–2.64 0.971
Personal
care such
as
bathing,
washing or using the
toilet
0.28
0.09–0.85 0.024
OR:
odds ratio.
a Adjusted
by
other
disability domains.
b Adjusted
by
other
disability domains
and
age,
marital
status,
employment
status,
debt
and
physical
health.
The
increased likelihood
of
suicide
attempts identified
among
particular
sociodemographic groups
in
this study
has
been
reported
in
many
previous studies:
females
( Kessler, Borges
&
Walters,
1999; Ma et al.,
2009;
Scocco,
de
Girolamo,
Vilagut &
Alonso,
2008; Weissman
et
al.,
1999 ),
unmarried individuals ( Kessler,
Borges
&
Walters,
1999; Ma
et
al., 2009;
Weissman
et
al.,
1999 ),
younger age
groups
( Joe, Baser,
Breeden, Neighbors
&
Jackson,
2006; Kessler,
Borges
&
Walters,
1999; Ma
et
al., 2009;
Scocco,
Author's personal copy H.
Meltzer
et al.
/
ALTER,
European Journal
of
Disability
Research 6
(2012)
1–12 9 de Girolamo,
Vilagut
&
Alonso,
2008 ),
physical health
problems
( Ma et
al.,
2009 )
and debt
( Meltzer et
al., 2011
).
A recent
summary
of
12-month
prevalence estimates
of
suicide
attempts from
the
WHO
world
mental health
surveys
( Borges et
al.,
2010 )
present rates
of
0.3%,
and 0.4%
for
developed
and
developing
countries respectively.
These
results
are
based
on
over
100,000 adults
from
21
countries from
2001–2007.
The
rate
for
developed
countries rate
is
similar
to that
found
in
Great
Britain in 2000 (0.5%).
The
sociodemographic
risk
factors
reported
from
this
compilation
of
studies
for suicide
attempts
– female sex,
younger
age,
lower
education
and
income,
unmarried
status,
unemployment
–
all
of
those
characteristics, which
emerged
from
our
study.
Number
of activities
of
daily
living difficulties
and
likelihood
of
suicide
attempts Although
the presence
of
any
ADL/IADL difficulty
was
associated
with
a
fourfold
increase in attempted suicide
in
the
past year,
those
with
three
or
more
types of
ADL
limitation had
an
almost eightfold
increase. It
would
have been
preferable
to
look
at the
number
of
ADL/IADL
as a
continuous variable
but
there
were
too
few
cases
overall,
49,
who
had
attempted
suicide
in
the
past 12
months
to carry
out this
analysis.
There
may
be
a
cumulative risk
as
has
been found
when
looking
at
disability in
relation
to suicidal
ideation
( Dennis et
al.,
2009 ).
Nevertheless, the
grouped
analysis
indicates
a
effect
at
three
ADL/IADL. The
role of
depression Although
disability
has
been
shown
to
have
a direct
effect
on
the
likelihood of
suicide
attempts, there
is also
a
strong
indirect effect
through
depression.
This
can
be
regarded
as a
partial
mediation. Both
cross-sectional and
longitudinal
studies
have
clearly
shown
that
medical
illness
and
physical
dis-
ability
are strongly
associated
with
depression
(
Raue,
Meyers
&
Bruce,
2009 ).
Although there
is considerable
evidence
that
physical
disability
increases the
likelihood
of
depression
( Chang et
al.,
2009 )
depressive symptoms
themselves
may
independently
have
a
direct
effect on
the
devel- opment
of disability
(
et
al.,
2010 ).
It has
also
been
suggested
that
disability
and
psychiatric symptoms
are related
in
the
general population
because
they
have
common
factors
in
their
origin but
that
there are
also
aetiological
differences ( Bebbington et
al.,
2000 ). There
are
many
other
potential
mediating variables,
which
can
link
disability
with
depression
and
suicidal
attempts. Stigma
may
play
a
key
role –
not
just the
stigma
of
the
disability but
the
stigma
of depression. Bahm
and
Forchuk
(2009)
reported
that
people
with
a
self-reported
psychiatric disability and
self-reported
comorbid
physical
disability
faced
more
overall
perceived
discrimination and
stigma
than those
with
a
psychiatric
disability alone.
The
mediating effect
of
loneliness
between disability
and
suicide
attempts
has
been
reported
in
a study
of
elderly
suicide attempters.
These
have
been
characterised
as
most
likely to
be
a wid-
owed
woman suffering
from
social
isolation,
loneliness and
depression
(
Perret-Vaille,
Mulliez,
Gerbaud
& Jalenques,
2006
). Activities
of
daily
living/instrumental activities
of
daily
living difficulties
and
likelihood
of
suicide attempts
There
is far
less
published
data
on
disability
as a
risk
factor for
suicidal
behaviour
than
for
depres-
sion.
A notable
exception
has
been
data
from
the
US
1986–1994
National Health
Interview
Survey
linked
to the
1986–1997
National
Death
Index,
which
has
been
used
to
analyse
the effects
of
chronic physical
illness
and
functional
limitations on
suicide
deaths. After
controlling
for
potential
confounders at
baseline, functional
limitations were
shown
to
be
a significant
predictor of
suicide.
Chronic condi-
tions
alone were
not
predictive
of
suicide
completion when
functional
limitation was
added
to
the model
( Kaplan et
al.,
2007a )
implying that
it
is
disability rather
than
disease
or
impairment,
which is
the main
correlate
of
suicide
attempts. A
study
of US
veterans
also found
that
those
with
activ-
ity
limitations (after
adjusting
for
medical
and
psychiatric
morbidity) were
also
at
a
greater risk
for
completing
suicide ( Kaplan et
al.,
2007b ). |
