Suicide among disabled people is an important issue because people with a disability are more likely to think about, plan, and attempt suicide. But it can be difficult for people with a disability to get medical help for suicide because medical providers often do not screen disabled people for suicidality, and the screening tools providers use may not be effective for people with different disabilities. In addition, providers often lack awareness of the needs and experiences of disabled people. This exploratory study begins with a synthesis of evidence on facilitators and barriers to screening for suicidality among disabled adults. We then describe what is known about the effectiveness of screening tools and describe research gaps.
WHY THIS MATTERS
Despite the increased risk for suicide among people with a disability and the knowledge that effective screening can identify people at risk of suicide and facilitate help, little attention is paid to the barriers and facilitators of effective suicide screening among disabled people. Policy changes that impact barriers and facilitators to effective suicide screening can lower suicide rates. Strategic research in collaboration with disabled people with diverse experiences has the potential to identify effective screening tools by type of disability and identify policies that minimize barriers and maximize facilitators for people with a disability.
WHAT WE FOUND
Barriers to effective suicide screening include barriers experienced by nondisabled people (e.g., fear of involuntary commitment) plus inaccessible health care facilities, lack of validated and accessible screening tools, and insufficient provider awareness of the needs and experiences of people with a disability (e.g., assuming disabled people have a low quality of life and suicidality is normal).
Facilitators include adapting screeners and screening processes for different types of disabilities, increasing the share of providers with a nuanced understanding of the experiences and needs of disabled people (including by recruiting providers with a disability), using text messaging to encourage self-disclosure, and conducting voluntary cognitive screenings during intake to improve identification of risk factors for suicide.
Little empirical information exists about the effectiveness of suicide screening tools for people with different types of disabilities. While some screening tools, like the Patient Health Questionnaire-9, include components for assessing suicidal ideation, their performance varies across people with different types of disabilities.
Research gaps identified include the need for validated screening tools tailored, as necessary, to people with different types of disability and the investigation of unique risk factors (e.g., fear of being a burden on loved ones). Gaps noted also include the lack of a comprehensive framework, like the Zero Suicide approach, for pivoting health care systems towards effective screening and treatment that accounts for the experiences (e.g., where they seek health and social services) and needs (e.g., autonomy) of disabled people, Additionally, studying the intersection of disability, suicidality, and substance use disorders is crucial for developing more effective screening and treatment methods.
HOW WE DID IT
We conducted a rapid review of the literature and interviews of technical experts and individuals with lived expertise.
