Visual Impairment Associated with Heightened Risk of Suicidal Tendencies

Young Kook Kim, MD, PhD

Credit: Seoul National University Hospital

A comprehensive systematic review and meta-analysis identified an association between visual impairment and an elevated risk of suicide and suicidal tendencies, with age serving as a predictive risk factor.¹

The investigation, involving more than 30 studies and nearly 6 million individuals, revealed the association between suicidal behavior and visual impairment was particularly pronounced among adolescents reporting vision struggles.

“This finding emphasizes the importance of eye health to overall mental well-being. It is recommended that clinicians remain attentive to the elevated risk and be ready to implement suitable suicide prevention measures when required, especially when dealing with adolescents,” wrote the investigative team, led by Young Kook Kim, MD, PhD, department of ophthalmology, Seoul National University College of Medicine.

A significant public health concern, a growing body of literature has addressed suicide and suicidal ideation, but the underlying causes can be complex and multifactorial. Risk factors for suicidal ideation can differ from a transition to behavior, where an individual may attempt or complete suicide. Family history, mental disorders, chronic illness, and sociodemographic factors are each known as significant risk factors for suicide.

Nationwide survey data from the United States found that approximately 88% of participants considered eye health a “critical component” of their overall well-being—blindness was ranked as the most severe conceivable health outcome.³ Visual impairment can thus implicate a patient’s health outside the scope of clinical ophthalmology.

Systematic examination has revealed a notable level of impaired quality of life, social isolation, decreased independence, and prevalence of depression in patients with visual impairment, matching many risk factors for suicide.⁴ Owing to variability among available literature, the current systematic review and meta-analysis investigated the association between visual impairment and suicide, with an assessment of risk levels and potential contributing variables.¹

A search was conducted in key medical databases, including PubMed, Embase, Scopus, and the Cochrane Library, from inception to February 2024. All published studies relating to visual impairment and suicide were considered, without restriction in terms of study design, publication date, or language. Numerous meta-regression analyses were performed to identify potential factors contributing to the link between visual impairment and suicide risk.

After identifying 3239 articles in the systematic search, 101 studies were considered potentially relevant, and a full-text review left 31 studies for analysis. The 31 population-based studies comprised 5,692,769 individuals—more than half (52%) of patients were female and the mean age was 48.4 years.

The association between visual impairment and suicidal behavior was investigated in 17 studies (n = 5,602,285). Upon analysis, the summary estimate of visual impairment as a factor for suicidal behavior was an odds ratio (OR) of 2.49 (95% CI, 1.71-3.63), with heterogeneity of I² = 92.8% (P <.001).

Meanwhile, a total of 21 studies (n = 611,899) assessed suicidal ideation. Results showed the pooled OR for the association between visual impairment and suicidal ideation was 2.01 (95% CI, 1.62 - 2.50), with heterogeneity of I² = 89.0% (P <.001).

For the 8 studies (n = 5,067,113) assessing the link between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32 - 2.71), with heterogeneity of I² = 73.6% (P = .002). Overall, suicide death showed moderate heterogeneity, while high heterogeneity was identified for suicidal behavior and suicidal ideation.

After performing random-effects meta-regression analyses, Kim and colleagues pointed to participant age as a potential risk factor. Subgroup analysis comparing effect sizes to mean age revealed the pooled OR for studies with adolescent patients was 9.85 (95% CI, 4.39 - 22.10), the highest value among the age groups. The second highest OR was found among individuals aged ≥65 years at 6.66 (95% CI, 2.95 - 15.00).

Kim and colleagues noted the limited number of studies addressing adolescents with visual impairment and suicide risk suggests the importance of centering additional research on this population.

“Since the etiology of suicidal behavior is complex, and because diverse risk factors are associated with different individual and cultural contexts, further research is warranted to determine which factors may modulate the risk of suicide in patients with visual impairment,” they wrote.

References

1. _{Kim CY, Ha A, Shim SR, Hong IH, Chang IB, Kim YK. Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2024;7(4):e247026. doi:10.1001/jamanetworkopen.2024.7026}
2. _{Favril L, Yu R, Uyar A, Sharpe M, Fazel S. Risk factors for suicide in adults: systematic review and meta-analysis of psychological autopsy studies. Evid Based Ment Health. 2022;25(4):148-155. doi:10.1136/ebmental-2022-300549}
3. _{Scott AW, Bressler NM, Ffolkes S, Wittenborn JS, Jorkasky J. Public Attitudes About Eye and Vision Health. JAMA Ophthalmol. 2016;134(10):1111–1118. doi:10.1001/jamaophthalmol.2016.2627}
4. _{Parravano M, Petri D, Maurutto E, et al. Association Between Visual Impairment and Depression in Patients Attending Eye Clinics: A Meta-analysis. JAMA Ophthalmol. 2021;139(7):753–761. doi:10.1001/jamaophthalmol.2021.1557}