Intellectual Disability and Suicide Risk

The fields of suicide prevention and intellectual disability (ID) share a common myth. Many in both fields believe that this disability acts as a buffer to suicidality. There is no evidence that this is so. As is the case with mental illness and other conditions, those with ID have much the same exposure to suicide risk as the general population. Individuals with ID are at risk along the entire spectrum of suicidal behavior from ideation to threats to attempts. Here we will look at possible sources of suicidality in this population.

Persons with almost any level of ID are vulnerable to psychosocial and environmental factors linked to suicidal behavior. They may have problems with intellectual functioning and everyday social skills. Suicidal intent has been found in individuals with IQs below 50 who made suicide attempts by hanging, stabbing, jumping, or drowning. Research reports serious attempts by individuals with ID who had major depressive episodes and recent significant social losses. In one study, one-third of respondents with ID felt “life is not worth living.”

Adolescents with ID may endure rejection and stigma in school, the community, and at home. Like most young people they want to be accepted by their peers and not be seen as “different.” Those with mild to moderate ID may be at highest risk, they may recognize the detrimental aspects of their disability. At every age they are at increased risk of being victimized. Adults may be exposed to interpersonal stressors, depression and other psychiatric disorders, substance abuse, serious financial and legal issues, loss and bereavement, other traumas, and job and housing problems. They may have fewer protective factors such as resilience and good skills in coping, problem solving, and help-seeking.

A suicide attempt may occur if there is an extremely strong desire to die and the capability for lethal self-harm. A desire for death can come from believing one is a burden to others and/or that one does not belong. Individuals with ID may see themselves as having a negative impact on their families. A belief of being a burden may begin early and be amplified by school or job problems. Difficulty with social norms may lead to feeling disconnected from peers and family. A sense of being trapped by one’s situation adds to risk. A history of self-injury and physical abuse creates a capability for potentially lethal self-harm.

Suicide risk is a reality in intellectually disabled persons. Family members, schools, and providers must be educated regarding suicide risk and protective factors, recognizing possible warning signs, and be trained in basic suicide crisis intervention. Police, other emergency responders, and corrections staffs should be better informed about nature and prevalence of ID and possible suicide risk in this population. Suicide prevention must be put on the intellectual disabilities agenda and the risk inherent to ID must be acknowledged in suicide prevention plans.

Tony Salvatore