The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea.
Br J Ophthalmol. 2022 Nov;106(11):1610-1616. doi: 10.1136/bjophthalmol-2021-318864. Epub 2021 Apr 30.
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.
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.
Data on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) 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% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 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% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively.
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.
目前，关于视力障碍与自杀意念和行为之间的关联的文献有限，尤其是在来自中低收入国家（LMICs）的老年人中。因此，我们旨在调查 6 个 LMIC 中年龄≥50 岁的成年人中客观测量的远距离视力障碍与自杀意念和自杀企图之间的关联，并确定潜在的中介因素。
使用 WHO 全球老龄化和成人健康研究的横断面、基于社区、具有全国代表性的数据进行分析。使用滚动 E logMAR 图表测量客观距离视力，将视力障碍分为无、轻度、中度和重度。还收集了过去 12 个月内自杀意念和自杀企图的自我报告信息。进行了多变量逻辑回归和中介分析。
分析了 34129 名年龄≥50 岁的个体（平均（SD）年龄 62.4（16.0）岁；47.9%为男性）的数据。在调整了潜在的混杂因素后，与无视力障碍相比，严重视力障碍与自杀意念显著相关（OR=9.50；95%CI=2.47 至 36.52）。中度和重度视力障碍与自杀企图的几率分别显著增加 2.22（95%CI=1.14 至 4.35）和 11.50（95%CI=1.44 至 91.88）倍。残疾、自我报告的健康状况差、行动不便和孤独感分别解释了中度/重度视力障碍与自杀企图之间关联的 14.0%、9.3%、7.2%和 6.3%。
需要在 LMIC 中针对视力障碍的老年人群采取干预措施，以减少自杀意念和自杀企图，针对已确定的中介因素，并在 LMIC 中使用经过测试的自杀预防策略本身可能会产生有益的结果。
