Review Article
Understanding suicide and disability through three major disabling conditions: Intellectual disability, spinal cord injury, and multiple sclerosis

https://doi.org/10.1016/j.dhjo.2009.09.001Get rights and content

Background

Disability is not a category of disease but rather relates to the physical, sensory, cognitive, and/or mental disorders that substantially limit one or more major life activities. These functional limitations have been found to be predictive of suicide, with psychiatric comorbidities increasing the risk for suicide. Enormous gaps exist in the understanding of the relationship between disability and suicide.

Objective

We reviewed the current literature addressing the prevalence of and risk factors for suicide among persons with three major disabling conditions and identify priorities for future research.

Methodology

We performed a literature review investigating the relationship between three major disabilities (intellectual disability, spinal cord injury, multiple sclerosis) and suicide. To ensure thorough evaluation of the available literature, we searched PubMed, the Cochrane Library, and Google Scholar with terms including “suicide,” “disability,” “intellectual disability,” “spinal cord injury,” “multiple sclerosis,” and permutations thereof. By this method we evaluated 110 articles and included 21 in the review.

Results

Suicide rates are significantly higher among persons with multiple sclerosis and spinal cord injury than in the general population. A more nuanced picture of suicide rates and risk factors exists for the intellectual disability population, in which it appears that rates of suicide risk factors are higher than among the general population while suicide rates may be lower. The highest rates of suicide are reported among study populations of persons with multiple sclerosis, followed by persons with spinal cord injury, and then individuals with intellectual disability.

Conclusions

Suicide among persons with disabilities is a complex and pressing public health concern. Urgent research priorities include (1) valid estimates of suicide rates among persons with disabilities by age cohort; (2) assessment of the predictive importance of suicide risk factors; and (3) determination of best practices in preventing suicide. Working toward these objectives will reduce the unacceptable burden of this preventable cause of death and help children and adults with disabilities to lead happier, healthier, and longer lives.

Section snippets

Method

The literature review was performed from 2006 to 2009 with search terms including “disability,” “suicide,” intellectual disability,” “spinal cord injury,” “multiple sclerosis,” and permutations thereof in PubMed (www.pubmed.gov), the Cochrane Library (www.cochrane.org), and Google Scholar (www.scholar.google.com). One hundred ten published investigations addressing suicide and the three aforementioned disabling conditions were evaluated for relevance and scientific rigor with the understanding

Suicide in the U.S general population

Among the general U.S. population, reported suicide rates decreased from 1990 to 2003 [4]. Over this time, age-adjusted suicide rates fell from 12.5 per 100,000 in 1990 to 10.4 per 100,000 in 2000 and have remained relatively stable since, with a rate of 10.8 per 100,000 in 2003 [3]. Despite this decline, which was seen across races and genders, suicide still accounted for 31,655 deaths in 2002, at a rate of 10.9 deaths per 100,000 [5]. Reports from the National Institute of Mental Health

Conclusions

As demonstrated by this review of U.S. and international medical literature, suicide among persons with disabilities is a complex and pressing public health concern. Suicide rates are significantly higher among persons with MS and SCI than in the general population, while a more nuanced picture of suicide rates and risk factors has emerged for the ID population. The highest rates of suicide are reported among study populations of persons with MS, followed by persons with SCI, and then

Acknowledgments

The authors would like to thank Michael Marge, Ed.D. for his invaluable insight and steadfast support of this project, as well as his remarkable record of service and dedication to the health and wellness of persons with disabilities.

References (31)

  • Anderson RN, Smith BL. 2005. Deaths: leading causes for 2002. National Vital Statistics Reports. 2002;52. Hyattsville,...
  • National Institute of Mental Health. Suicide in the U.S.: Statistics and Prevention (2003). Available at:...
  • S.A. Walters et al.

    Suicidal behavior in children and adolescents with developmental disorders

    Res Dev Disabil

    (1999)
  • B.J. Kemp et al.

    Depression and life satisfaction among people ageing with post-polio and spinal cord injury

    Disabil Rehabil

    (1999)
  • K. Patja et al.

    Suicide mortality in mental retardation. A 35-year follow-up study

    Acta Psychiatr Scand

    (2001)
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    Financial disclosure: The authors have no conflicts of interest to declare.

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