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The 1986-1996 National Health Interview Surveys

Byron L. Lam, MD; Sharon L. Christ, MS; David J. Lee, PhD; D. Diane Zheng, MS; Kristopher L. Arheart, EdD

Arch Ophthalmol. 2008;126(7):975-980.

Objective  To examine the relationship between reported visual impairment and suicide mortality.

Methods  From 1986 through 1996, annual cross-sectional multistage area probability surveys of the US civilian noninstitutionalized population living at addressed dwellings were conducted by the National Center for Health Statistics. We performed mortality linkage through 2002 with the National Death Index of 137 479 adults 18 years and older. The relationships between reported visual impairment and suicide were examined using structural equation modeling.

Results  The mean duration of follow-up was 11.0 years, and 200 suicide deaths were identified. After controlling for survey design, age, sex, race, marital status, number of nonocular health conditions, and self-rated health, the direct effect of visual impairment on death from suicide was elevated but not significant (hazard ratio, 1.50; 95% confidence interval, 0.90-2.49). The approximate indirect effect of visual impairment on death from suicide via poorer self-rated health (1.05; 1.02-1.08) or number of nonocular health conditions (1.12; 1.01-1.24) was significant. The total effect of visual impairment on death from suicide was elevated but not significant (1.64; 0.99-2.72).

Conclusions  Visual impairment may be associated with an increased risk of suicide through its effect on poor health. This suggests that improved treatment of visual impairment and factors causing poor health may potentially reduce suicide risk.

Author Affiliations: Bascom Palmer Eye Institute (Drs Lam and Lee) and Department of Epidemiology and Public Health (Dr Lee, Ms Zheng, and Mr Arheart), University of Miami School of Medicine, Miami, Florida; and Odum Institute for Research in Social Science, The University of North Carolina at Chapel Hill (Ms Christ).

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