Suicide behavior in persons with intellectual disability

Mental Health Concerns in Individuals With Developmental Disabilities: Improving Mental Health Literacy Trainings for Caregivers

Although approximately a third of individuals with intellectual and developmental disabilities (IDD) also experience a mental health concern, caregivers often miss early identification of these issues. In this perspective piece, we present an outline for a mental health literacy program that can enhance existing training approaches for caregivers of individuals with IDD. We describe three processes of the Mental Health Awareness and Advocacy (MHAA) curriculum and detail how it provides a strong preventative model to train caregivers to increase their mental health literacy. In describing these processes, we provide illustrative examples and conclude by providing a brief vignette that highlights how this process could be used by caregivers to help reduce mental health concerns in individuals with IDD.

Suicidality in individuals with Prader-Willi syndrome: a review of registry survey data

INTRODUCTION

Prader-Willi syndrome (PWS) is a rare, genetic, neurodevelopmental syndrome associated with hyperphagia and early onset obesity, growth and sex hormone insufficiencies, mild-to-moderate intellectual disability, and behavioral challenges such as compulsivity, anxiety, skin picking, social skills deficits and temper outbursts. Given high rates of psychiatric comorbidity and potential risk factors for suicide in PWS, this study sought a first estimate of the prevalence of suicidal ideation (SI) and attempts (SA) in the PWS population and any characteristics associated with suicidality in this population.

METHODS

Using the Global Prader-Willi Syndrome Registry, we included all participants who had answered a question about SI. We examined the most recent data from the surveys about social, economic, and demographic factors, genetic subtype, and psychiatric symptoms and treatments. A chi-square analysis was used to compare registry participants who reported SI to those without reported SI.

RESULTS

From 750 included survey respondents, 94 (12.5%) endorsed some history of SI. Of these, 25 (26.6%) also reported a history of SA, with an average age of 16.25 years at their first attempt. Those with a history of SI were predominantly male and adult age, and had higher rates of aggression and psychiatric comorbidities, therapies, and medications.

CONCLUSIONS

This study indicates that the rate of SI and SA in PWS is comparable to the general population, and that suicide attempts in PWS typically begin in middle-teenage years. Despite unique challenges, individuals with PWS and their caregivers should be included in screens and psychoeducation for suicide and mental health concerns.

Prevalence and predictors of suicidal behaviour in a sample of adults with estimated borderline intellectual functioning: results from a population survey

BACKGROUND

We aimed to investigate, for the first time, rates of suicidal behaviour (ideation and acts) in people with borderline intellectual functioning in a general population sample, and to compare these to rates in people with normal functioning.

METHODS

We used data from the third Adult Psychiatric Morbidity Survey, carried out in England in 2007. It was designed to be representative of people living in private households. The analyses are based on 6872 individuals.

RESULTS

1053 (16.1%) participants met criteria for borderline intellectual functioning. People with borderline intellectual functioning were more likely to report ever having made a suicidal attempt or to have harmed themselves without the intention of taking their own life (Odds Ratio for both 1.7, 95% Confidence Interval 1.3-2.2). These associations were no longer significant after controlling for income and age.

LIMITATIONS

Our sample did not include people living in segregate environments, who were likely to display challenging behaviours, and have higher rates of self harm.

CONCLUSION

The increased rates of suicidal behaviour found in people with borderline intellectual functioning were explained by younger age and socioeconomic disadvantages, although the association is likely to be complex. Our findings would strongly support targeting those at the lower range of intelligence with interventions for suicide prevention.

Mood disorders in intellectual disability

PURPOSE OF REVIEW

This article examines reviews and research on the diagnosis and treatment of mood disorders in people with intellectual disability published from September 2004 to December 2005.

RECENT FINDINGS

Patients with intellectual disability have limitations in verbal ability, and with increasing levels of disability may have an atypical clinical presentation. Thus, methods to diagnose mood disorders were a major research focus. Informant-rating scales and two self-report instruments provided data on thought patterns, aberrant behavior, appetite, and suicidality. Behavioral symptoms such as aggression were frequently associated with mood disorders. Pharmacotherapy and electroconvulsive therapy were found to be effective treatments. Mood disorders were frequently identified in people with intellectual disability, although suicide was still quite rare.

SUMMARY

Patients with milder levels of disability can use self-report measures and can be diagnosed using standard criteria with little modification. For those with more severe disability, diagnosis is challenging and often requires the use of residual categories. Atypical clinical presentation, including maladaptive behaviors, lent support for 'behavioral equivalent' substitutes of standard criteria. Typical pharmacological agents were effective for depression and electroconvulsive therapy for treatment-resistant bipolar disorder.