title: Reported visual impairment and risk of suicide: the 1986-1996 national health interview surveys.
abstract: 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.
authors.affiliation: Bascom Palmer Eye Institute, University ofMiami School of Medicine, Miami, FL 33136, USA. blam@med.miami.edu
authors.forename: Byron L
authors.initials: BL
authors.lastname: Lam
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Christ
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
authors.forename: D Diane
authors.initials: DD
authors.lastname: Zheng
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D006302:Health Services Research; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009309:National Center for Health Statistics, U.S.; D016016:Proportional Hazards Models; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000401:mortality*; D019987:Persons with Visual Disabilities / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*