Visual Impairment Associated with Significantly Increased Risk of Suicide

Yousif Subhi, MD, PhD

Credit: University of Southern Denmark

A systematic review and meta-analysis of 10 studies reported visual impairment as a significant and important risk factor for suicidal ideation, suicide attempts, and suicide death.

Most studies included in the analysis found that significantly increased risk remained after adjustments for depression and other relevant risk factors, suggesting an important association between eye health and mental health.

“These high increases in risk of suicide from visual impairment underscore the importance of eye health on the overall mental health, and the potential devastating consequences of insufficient access to eye care, lack of treatment possibilities for any reason, or low political priority of eye care,” wrote the investigative team, led by Yousif Subhi, MD, PhD, from the department of ophthalmology at Rigshospitalet.

Data from the United States suggest blindness ranked first in the fear of losing independence and the worst possible health condition. Systematic reviews indicate extremely worrying degrees of impaired quality of life, loss of independence and social status, lower personal income, and a high prevalence of depression.² The risk factors of suicidal behavior can be very similar to those of visual impairment, including low quality of life and loss of independence and social status.²

In fact, prior studies have suggested sensory impairment, including visual impairment, as an important risk factor for suicidal behavior, but the exact association is unclear. To gain a clearer understanding, the investigative team systematically reviewed studies on the association between visual impairment and different aspects of suicidal behavior. A literature search of 11 databases occurred in October 2022, with the investigative team identifying a total of 10 eligible studies with 5.8 million participants.

The estimates obtained from studies were then used for quantitative analyses of the visual impairment-related risk for suicidal behavior, including suicidal ideation, suicide attempt, and suicide death. Within the 10 eligible studies, a total of 7 reported data on suicidal ideation, 5 reported data on suicide attempts, and 3 reported data on suicide death. Subhi and colleagues evaluated suicide ideation and suicide attempt on screening questions, and suicide death was evaluated using death registries.

All pooled summary estimates for use in the meta-analyses were adjusted estimates of association, as the investigative team acknowledged that suicide behavior is a complex behavior with many potential confounders, including depression. A total of 8 studies with 292,121 participants provided eligible data for meta-analyses. Upon analysis, investigators found the summary estimate of visual impairment as a risk factor for suicide ideation was an odds ratio (OR) of 1.83 (95% CI, 1.40 - 2.40; P = .000012).

The analysis revealed the summary estimate of visual impairment as a risk factor for suicide attempts was an OR of 2.62 (95% CI, 1.29 - 5.31; P = .0077). For the analysis of visual impairment as a risk factor for suicide death, only a single study provided eligible data, and investigators observed an association of OR, 7.00 (95% CI, 2.30 - 21.4; P = .000063).

Based on these results, the investigative team suggests the greater impact of visual impairment on mental health, noting the crucial effect on the life of the patients, their families, and society at large.

“Among patients with eye diseases, we recommend that the ophthalmologist is aware of the increased risk and prepare for appropriate suicide prevention measures where necessary, especially in cases in which the physician-patient communication reveals a significant element of crisis or emotion distress,” investigators wrote.

References

1. Palbo A, Roed Rasmussen ML, Hansen MS, Subhi Y. Association between visual impairment and suicide: A systematic review and meta-analysis [published online ahead of print, 2023 Jul 3]. Acta Ophthalmol. 2023;10.1111/aos.15730. doi:10.1111/aos.15730
2. Lee, O.E., Park, D. & Park, J. (2022) Association of vision impairment with suicide ideation, plans, and attempts among adults in the United States. Journal of Clinical Psychology, 78, 2197–2213.
3. Center for Disease Control. (2022). https://www.cdc.gov/suici de/factors/index.html (Accessed July 11, 2022)