Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years in low/middle-income countries

Lee Smith, Jae Il Shin, Yvonne Barnett, Peter M. Allen, Rosie Lindsay, Damiano Pizzol, Louis Jacob, Hans Oh, Lin Yang, Mark A. Tully, Nicola Veronese, Ai Koyanagi

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Background 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. Methods 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. Results 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. Conclusion 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.

Original languageEnglish
Pages (from-to)1610-1616
Number of pages7
JournalBritish Journal of Ophthalmology
Issue number11
Publication statusPublished - 2021 Apr 30

Bibliographical note

Funding Information:
1The Cambridge Centre for Sport and Exercise Science, Anglia Ruskin University— Cambridge Campus, Cambridge, UK 2Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea 3Faculty of Science and Engineering, Anglia Ruskin University—Cambridge Campus, Cambridge, UK 4Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK 5Italian Agency for Development Cooperation, Khartoum, Sudan 6Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France 7School of Social Work, University of Southern California, Los Angeles, California, USA 8Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Calgary, Alberta, Canada 9Institute of Mental Health Sciences, Ulster University, Coleraine, UK 10Department of Medicine, University of Palermo, Palermo, Italy 11Research and development unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain Acknowledgements This article uses data from WHO’s Study on global AGEing and adult health (SAGE). SAGE is supported by the US National Institute on Aging through Interagency Agreements OGHA 04034785, YA1323-08-CN-0020, and Y1-AG-1005-01 and through research grants R01-AG034479 and R21-AG034263.

Publisher Copyright:

All Science Journal Classification (ASJC) codes

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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