Suicide Rates Higher in Individuals With Sight-Threatening Eye Disease

Suicide rates among patients living in South Korea are higher for individuals with sight-threatening eye diseases (STEDs), according to research published in Ophthalmology.

Researchers conducted a nationwide population-based cohort study to determine whether individuals with STEDs (glaucoma, exudative age-related macular degeneration [AMD], and diabetic retinopathy [DR]) die by suicide more often than individuals without STEDs. Individuals included in the study were identified in the Korean National Health Insurance (NHI) service database, aged 40 years or older, and living in South Korea between 2010 and 2020. 

The investigators used NHI health checkup records and the National Disability Registration to confirm severe visual impairment (VI) and diagnostic codes recorded in the Korea National Statistical Office for death by suicide. They estimated suicide rates using incidence rate ratios (IRRs) adjusted for socio-demographics, comorbidity, psychiatric diagnoses, and VI. They also assessed the temporal relationship between time since first STED diagnosis and suicide risk by identifying patients newly diagnosed between 2010 to 2011.

Of the 2.8 million people registered with NHI and observed for 24,300,969 person-years, 13,205 died by suicide. Of those, 4514 (34%) had an STED diagnosis. The suicide rate was 69 per 100,000 person-years (95% confidence [CI], 67-72) for individuals with STEDs. For individuals without STEDs, the suicide rate was 51 per 100,000 person-years (95% CI, 50-52). 

Those with STEDs, relative to those without STED, had an adjusted IRR of 1.33 (95% CI, 1.26-1.41). The study showed that individuals with DR had the largest excess adjusted IRR of death by suicide (1.40; 95% CI, 1.29-1.52), followed by those with exudative AMD (1.20; 95% CI, 1.04-1.39), and those with glaucoma (1.09; 95% CI, 1.02-1.17). It also demonstrated the adjusted incidence of suicide rate ratio for individuals with any STED and with coexisting severe VI was 1.49 (95% CI, 1.29-1.73). 

The investigators found that the hazard ratio (HR) for death by suicide was the highest between 3 and 6 months following diagnosis (HR, 5.33; 95% CI, 4.59-6.20).

“[O]phthalmologists and primary care physicians should devote more attention to reducing STED patients’ fears of blindness, and providing a focused and detailed discussion of the disease and its implications at diagnosis might reduce some of the initial concern. Special attention might be warranted for patients who suffer accompanying severe VI,” explain the study authors.

Limitations of the study included potential under-recording the suicide rate, a general lack of data for potential confounding factors in claims databases, and lack of generalizability to patients in other countries.