Journal Article Annotations
2025, 3rd Quarter

Suicide

Annotations by Sharvari Shivanekar, MD
September, 2025

Risk of Suicide among US Adults with Work Disability.

PUBLICATION #1 — Suicide

Risk of Suicide among US Adults with Work Disability.

Mark Olfson, Candace M Cosgrove, Melanie M Wall, Carlos Blanco.

Abstract: Am J Prev Med. 2025 Sep 22:108131. doi: 10.1016/j.amepre.2025.108131. Online ahead of print.

Introduction:
Prior research has not evaluated whether US adults with federally qualified work disability have an increased risk of suicide. A basic understanding of their suicide risk could help inform preventive interventions.

Methods:
A nationally representative sample, ages 20-61 years, from the 2008 American Community Survey (N=2,403,000) was followed through 2019 to calculate suicide rates with 95% confidence intervals per 100,000 person-years. Cox models estimated hazard ratios of suicide for adults with compared to without work disability controlling for age, sex, race and ethnicity, marital status, education, residence, employment, and income. Separate models were stratified by age, sex, and functional impairment (hearing, visual, cognitive, mobility, self-care, and independent living skills). Data were collected in 2008-2019 and analyzed in 2025.

Results:
Annual suicide rates per 100,000 persons were 34.6 (95%CI=31.0-38.4) for adults with disability and 13.5 (95%CI=13.1-38.4) for those without work disability. After controlling for age, sex, race and ethnicity, marital status, education, residence, employment, and income, the adjusted hazards of suicide for work disability were 1.44 (95%CI=1.26-1.64). In fully adjusted models, hazards of suicide for work disability were 1.90 (95%CI=1.52-2.38) for females and 1.30 (95%CI=1.11-1.52) for males and 1.84 (95%CI=1.46-2.31) for younger adults and 1.29 (95%CI=1.11-1.51) for older adults. Adults with work disabilities and each functional impairment, except hearing, had significantly increased hazards of suicide.

Conclusions:
Relative to US adults without work disability, US adults with work disability were at increased risk of suicide, including especially women, younger adults, and those with a visual, cognitive, mobility, self-care, or independent-living impairment.

Annotation

The findings:
The authors analyzed data from 2,403,000 individuals from the 2008 American Community Survey followed through 2019 to calculate suicide rates to understand if individuals on federally qualified work disability have an increased risk of suicide. They found that relative to US adults without work disability, US adults with work disability were indeed at increased risk of suicide, including especially women, younger adults, and those with a visual, cognitive, mobility, self-care, or independent-living impairment. While financial difficulties related to employment and income contribute to this elevated risk, they do not fully explain it, suggesting that depression, elevated rates of physical pain, social discrimination and low social support may be contributing to the increased risk.

Strength and weaknesses:
Strengths including a large sample size, long follow up period of this exploratory study, and the careful controlling for multiple socio-demographic factors and functional impairment add to the strength of the study. There were several weaknesses. Firstly, information was not available concerning the primary health condition leading to work disability, preventing evaluation of the extent to which the association between work disability and suicide was concentrated among individuals with work disability due to mental health disorders. Secondly, information was not available on work disability onset and newly acquired disability during the follow-up period was not detected and therefore was misclassified. Third, the mortality data, which terminated in 2019, do not reflect suicide risks during the COVID era. Fourth, death data based on ICD-10 codes may not accurately classify all suicide deaths. Finally, information on family income was not adjusted for family size.

Relevance:
CL Psychiatrists frequently manage care for individuals on work disability. Knowledge about the increased risk of suicide in this vulnerable population can help inform comprehensive lethality risk management in clinical practice.