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 10
H.
Meltzer et
al.
/ ALTER,
European
Journal
of
Disability
Research 6
(2012)
1–12 Our
finding that
cognitive
tasks
such
as
managing
money and
dealing
with
paperwork
were
the
sole IADL
items
with
an
independent
association with
suicide
attempts
suggests
an
increased tendency
for
people
with
limitations
in
intellectual
functioning to
attempt
suicide although
difficulties in
skills
are
not
necessarily
indicative of
a
cognitive deficit.
Nevertheless,
in
a
previous examination
of the
same
survey
dataset
focusing
on
the
relationship between
borderline
intellectual functioning
and suicidal
behaviour,
people
with
borderline
intellectual functioning
were
found
to
be more
likely
to
report
suicide attempts
than
the
rest
of
the
sample with
normal
intelligence
(
Tanzarella,
Bebbington &
Cooper,
2011 ).
Although this
relationship
was
partially
explained by
the confounding
effect
of
age
and income,
this
was
not
the
case
for
the
relationship
between
difficulties
in
out
financial
and
organisational
matters
and
lifetime
suicidal
attempts.
Impairment of
exec- utive
functioning
beyond
that
typically
found
in
major
depression have
been
reported
in
depressed patients
with
prior
suicide
attempts
( Keilp et
al.,
2001 )
and intellectual
functioning has
been
reported
as
a risk
factor
for
suicidal
behaviour
among
adolescents
(
et
al.,
2006 ).
Among elderly
sui-
cide
attempters the
risk
of
a
repeat attempt
was
found
to
increase
in female
patients
with
memory
disorders
( Lebret,
Perret-Vaille, Mulliez,
Gerbaud
&
Jalenques,
2006 ). Advantages
and
limitations
of
the
study The
main advantages
of
our
study include
the
sampling
procedures
that
provided
a
large
nation- ally
representative community
sample
across
the
age
spectrum,
the
ability
to
control
for important confounding
factors, and
the
use
of
well-validated
instruments and
epidemiological
methods
to
mea- sure
suicide
attempts
and
disability.
The
main
drawback
to
the
study is
the
cross-sectional design,
thereby
limiting the
ability
to
form
aetiological inferences
or
examine
maintaining factors.
Although
the
response rate
of
57%
could potentially
influence
the
results,
very
careful
weighting
procedures were
performed to
reduce
any potential
non-response biases.
Clinical
implications In
summary, specific
disabilities
and
multiple
disabilities
are
key
correlates
of
suicide
attempts. The
clinical implication
of
this
is that
a
full
disability profile
of
individuals
needs to
be
considered – not just
personal
care
but
the
capacity
to
do
household tasks,
practical
activities and
most
importantly their
abilities
both
financial
and
administrative. Appendix
Logistic
regression analysis
has
been
used
in
the
analysis of
the
survey data
to
provide
a measure
of,
for
example, the
effect
of
disability
as well
as
various
sociodemographic variables,
on
the
prevalence of
suicide attempts
in
the
past 12
months. Unlike
crosstabulations,
multiple
logistic
regression
estimates the
effect
of
disability
while adjust-
ing
for the
confounding
effects
of
other
variables in
the
analysis. Logistic
regression produces
an
estimate
of the
probability
of
an
event occurring
when
an
individual is
in
a particular
category
compared
to
a
reference category.
This
effect
is
measured
in terms
of
odds. For
example,
Table
2
shows
that having
a
difficulty
in any
ADL/IADL
increases
the
odds
of
the
person reporting
a suicide
attempt
in
the
past 12
month
compared with
the
reference
category
of
“no
difficulty with
any ADL/IADL
activity”.
The
amount
by
which
the odds
of
a
suicide attempt
actually
increases
is
by
the
figure in
the
unadjusted odds
ratio
(OR)
column.
In
this
case, the
OR
is
4.83 indicating that
a
disability
increases the
odds
of
the
report of
a
suicide attempt
by
nearly
five times.
However
we know
from
Table
1
that
several other
factors
can
influence
the
likelihood
of
a
suicide attempt.
So the
adjusted
odds
ratio
in
the
right hand
part
of
Table
2 shows
that
the
fivefold
increase
in
odds of
having
made a
suicide
attempt reduces
to
a
fourfold increase
once
one
has
controlled
for
the
possible confounding
effects
of
age,
marital status,
employment
status,
physical
illness
and
debt.
The
statistics presented
in
this
paper represent
summary
information
about
a
variable,
e.g., dis-
ability,
based on
the
sample of
people
interviewed in
the
study. However,
extrapolation
from
these
sample
statistics is
required
in order
to
make
inferences about
the
distribution
of
that
particular vari-
Author's personal copy H.
Meltzer
et al.
/
ALTER,
European Journal
of
Disability
Research 6
(2012)
1–12 11 able in
the
population. This
is
done
by calculating
confidence intervals
around
the
statistic
in
question. These
confidence
intervals indicate
the
range
within
which
the
“true”
(or
population)
value
is
likely to
lie.
Where 95%
confidence
intervals are
calculated,
this
simply
indicates
that
one
is
“95%
confident” that
the odds
ratio
lies
within
this
range.
(More
accurately,
it
indicates
that if
repeated
samples were
drawn
from the
population,
the
true
odds
ratio
would
lie
within
this
range
in
95%
of the
samples). For
the
bottom
section
of
Table
4 shows
an
adjusted
odds ratio
of
2.95
for the
association between
in
managing
money such
as
budgeting
for food
or
paying
bills and
making
a
suicide attempt
in
the
past 12
months,
with a
confidence
interval from
1.47
to
5.91,
indicating that
the
“true”
(i.e.,
population) OR
is
likely to
lie
between these
two
values.
If
the
confidence interval
does
not
include
1.00
then the
OR
is
likely to
be
significant – that
is,
the
association
between
the
independent
variable
(type
of disability)
and
the
odds
of
having
made a
suicide
attempt in
the
past year
is
unlikely
to be due to
chance.
If the
interval
includes
1.00,
then
it
is
possible that
the
“true”
OR
is
actually 1.00,
i.e.
no increase in
the
odds of
a
suicide attempt
can
be
attributed
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