Suicide Prevention in the Disability Community: The Current State of Research and Practice and Future Directions

Body of Abstract:

Introduction:
People with disabilities represent 28% of the US population (Centers for Disease Control and Prevention, 2024) and exhibit over two times greater odds of suicidal ideation, planning, and attempts compared to people without disabilities (Marlow et al., 2021). Despite the heightened prevalence of suicide-related outcomes in the disability community, this populations remains underrepresented in suicidology (Khazem, 2018). Traditionally, the limited research base focused on suicide in the disability community has conceptualized disability itself as a contributor to suicide risk (e.g., Meltzer et al., 2012). However, more recent findings indicate that disability itself may not be as salient of a contributor to suicide risk as previously believed. Internalized societal views and negative beliefs about disability consistently demonstrate associations with suicidal ideation and related outcomes in the disability community and will be highlighted (e.g., Lund et al., 2016'; Khazem et al., 2015; Khazem et al., 2017; Khazem et al., 2021). This shift in conceptualizing the link between disability and suicide has implications for suicide prevention assessment and intervention for the disability community.

In the works:
As part of this presentation, preliminary findings from an ongoing trial of Brief Cognitive Behavioral Therapy or Suicide Prevention (BCBT; Rudd et al., 2016)—the first test of any suicide prevention intervention in the disability community with empirical support—will be presented to demonstrate the effectiveness of suicide prevention interventions that are accessible to the disability community. Aims from the study include:

1) Establish the preliminary effectiveness of BCBT for suicide prevention for people with vision, hearing, dexterity, mobility, and neurological conditions

2) Integrate feedback from the disability community to systemically refine BCBT.

Methods:
In addition to describing the strengths and limitations of methodologies of previous studies, methods from the ongoing within-subjects pilot trial of BCBT will be discussed. Forty-seven of 60 individuals have completed at least one session of telehealth-administered BCBT, weekly assessments of suicidal ideation (Scale for Suicide Ideation; Beck et al., 1997 ), and assessments of suicide-related cognitions (e.g., Interpersonal Needs Questionnaire and Suicide Cognitions Scale-Revised; Bryan et al., 2022; Van Orden et al., 2012) associated with suicide risk in the disability community (e.g., perceived burdensomeness; Khazem et al., 2015; Khazem et al., 2017). Fixed effects models assessing changes in these outcomes during treatment were conducted, accounting for the autoregressive structure of assessments. Participant feedback was systematically collected and implemented to improve BCBT.

Results:
To date, significant differences in all suicidal ideation and suicide-related cognitions occur, with significant changes from baseline occurring at by Session 6 (approximately halfway through treatment; p<.05 for all outcomes, with total decreases of 3.66 points for suicidal ideation scores, 11.09 points for suicide cognitions scores, and a 6.61-point decrease for perceived burdensomeness scores. Changes to the BCBT protocol based on participant feedback will be discussed.

Conclusions:
Suicide-focused interventions may be adapted to meet the varied accessibility needs of the disability community while maintaining effectiveness. Further, interventions targeting beliefs maintaining suicidal ideation (including those that are disability-related, e.g., "My disability makes me a burden to others") may be particularly promising for reducing suicide risk and fostering a healthy disability identity. Next steps for increasing suicide prevention efforts for the disability community will be discussed, including tailoring interventions to increase their brevity, digital-assisted interventions, and one-session interventions.

Learning Objectives:

• 1. Summarize the state of the literate focused on suicide prevention in the disability community
• 2. Discuss how disability-related beliefs are related to suicidal ideation among the disability community
• 3. Summarize ongoing research focused on suicide prevention int he disability community