Visual impairment may be associated with an increased risk of suicide through its indirect negative effect on health, according to a report in the July issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Eye conditions that lead to visual impairment often have psychosocial and health consequences including impaired activities of daily living, social isolation, mental impairment, increased dependency on others, increased motor vehicle crashes, falls and fractures, depression and poor self-rated health, according to background information in the article. "Increased mortality risks also have been noted in adults with visual impairment and disabling eye disease."

Byron L. Lam, M.D., of Bascom Palmer Eye Institute, University of Miami School of Medicine, and colleagues reviewed data from national health surveys of 137,479 participants conducted between 1986 and 1996. Participants reported demographic information along with details about visual impairment and other health conditions. Researchers then verified deaths of participants up until 2002 through the National Death Index.

During an average 11 years of follow-up, 200 suicide deaths were identified. "After controlling for survey design, age, sex, race, marital status, number of non-ocular health conditions and self-rated health, the direct effect of visual impairment on death from suicide was elevated (increased by 50 percent) but not significant," the authors write. The indirect effect of visual impairment on suicide through poor self-rated health or number of non-ocular health conditions was considerable (5 percent and 12 percent, respectively). "The combined indirect effects of reported visual impairment operating jointly through poorer self-rated health and a higher number of reported non-ocular conditions increased the risk of suicide significantly by 18 percent."

"In summary, we observed that reported visual impairment increased suicide risk, particularly indirectly via reported health status and health conditions," the authors conclude. "Our results suggest improved treatments of visual impairment and factors causing poor health could potentially reduce suicide risk."