Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged >=50 years in low/middle-income countries

Lee Smith, Jae Il Shin, Yvonne Barnett, Peter M Allen, Rosie Lindsay, Damiano Pizzol, Louis Jacob, Hans Oh, Lin Yang, Mark A Tully, Nicola Veronese, Ai Koyanagi

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Background There is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged >=50 years from six LMICs and to identify potential mediators.Methods Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted.Results Data on 34 129 individuals aged >=50 years (mean (SD) age, 62.4 (16.0) years; 47.9 were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95.14 to 4.35) and 11.50 (95.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0 9.3 7.2.3severe visual impairment and suicide attempts, respectively.Conclusion Interventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes.Data are available upon reasonable request. Data are available upon reasonable request.
Original languageUndefined
JournalBritish Journal of Ophthalmology
Early online date30 Apr 2021
Publication statusE-pub ahead of print - 30 Apr 2021

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