Self-Harm Among 17-Year-Old Adolescents With/Without Disabilities in the United Kingdom.

Background: Self-harm is a critical public health issue for adolescents/young adults. Aims: To estimate the prevalence of self-harm among adolescents with/without disabilities in the United Kingdom. Method: Secondary analysis of data collected at age 17 in the UK's Millennium Cohort Study. Results: Prevalence of self-harm was significantly greater among adolescents with disabilities for suicide attempts and six forms of self-harming behaviors. The lifetime prevalence of suicide attempts was 5.3% (4.5-6.3) among adolescents without disabilities, 21.9% (18.2-26.2) among adolescents with less limiting disabilities, and 25.5% (17.2-35.9) among adolescents with more limiting disabilities. Adjusted prevalence rate ratios ranged from 5.13 (3.58-7.36) for those with mental health limitations to 1.48 (0.65-3.35) for those with mobility limitations. Similar patterns were observed for the 12-month prevalence of six self-harming behaviors. Limitations: Further studies are needed to identify potential mediators of the association between disability and self-harm that are potentially modifiable. Conclusion: Adolescents with disabilities are at markedly greater probability of suicide attempts and self-harming behaviors than their peers.

Disability-related inequalities in the prevalence of loneliness across the lifespan: trends from Australia, 2003 to 2020.

BACKGROUND: Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. METHODS: We used annual data (2003-2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). RESULTS: From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. CONCLUSION: This study confirms that people with disability have increased risk of loneliness compared to people without disability. We add to the existing evidence by demonstrating that disability-related inequalities in loneliness have persisted for two decades in Australia without improvement. Our findings indicate that addressing inequalities in loneliness for people with disability is a critical public health concern given that loneliness is associated with a wide range of poor health outcomes.

Disability and loneliness in the United Kingdom: cross-sectional and longitudinal analyses of trends and transitions.

BACKGROUND: Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness. METHODS: Secondary analysis of three waves of data collected between 2017 and 2020 by the UK's annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16-65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated. RESULTS: At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities. CONCLUSION: Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.

Health and wellbeing outcomes associated with loneliness for people with disability: a scoping review.

BACKGROUND: Loneliness is a significant public health concern due to its detrimental impact on health and wellbeing. Despite people with disability reporting higher levels of loneliness than the general population, there has been little research into how this is affecting their health and wellbeing. In light of this, the aim of our study was to scope both the existing evidence about the health and wellbeing outcomes associated with loneliness for people with disability, as well as the conceptual frameworks and measures utilised in this field of research. METHODS: To conduct this scoping review, we followed the methodology outlined by JBI and searched MEDLINE, Scopus, Informit, Embase, and Web of Science for peer-reviewed, English-language articles published between 1 January 2000 and 8 February 2023. Two independent reviewers completed screening, full-text review and data extraction, with consensus sought at each stage. Data were analysed using content analysis and presented both numerically and narratively. RESULTS: Out of the initial 1602 publications identified in the scoping review, only nine were included after duplicate removal, title and abstract screening, and full-text review. This limited number of studies, with the earliest study one published in 2015, represents a key finding. Eight of the nine studies were quantitative, and all were conducted in high income countries. Most of these studies utilised a version of the University of Los Angles Loneliness Scale to measure loneliness and addressed specific impairment groups. Notably, most of the studies identified associations between loneliness and health and wellbeing outcomes for people with disability. CONCLUSIONS: This scoping review highlights the current scarcity of studies examining the effect that loneliness has on the health and wellbeing outcomes of people with disability. As most of the reviewed studies relied on loneliness measures designed for individuals without disability, they potentially overlook the unique life experiences of people with disability. Given that loneliness is an international public health concern, it is imperative that people with disability are not left behind or overlooked in efforts to address the impact of loneliness on health and wellbeing.

Impact of informal care on the mental health of caregivers during the COVID-19 pandemic.

BACKGROUND: Informal care can affect the mental health of caregivers. The COVID-19 pandemic precipitated many people into informal care. Little is known about the longitudinal effect of informal care throughout the pandemic. We investigate changes in mental health in relation to changes in informal care between July 2020 and September 2021. METHODS: Using data from Understanding Society, we applied fixed-effects modelling to assess mental health variations associated with changes in caregiving among 13 557 participants (50 430 observations). Hours of weekly care were categorized as 0, 1-19, ≥20. Mental health was measured using the General Health Questionnaire (GHQ-12) as a continuous score and a binary indicator. Main analyses were stratified by gender. RESULTS: Compared to when delivering 0 hours care/week, the GHQ-12 scores of women providing care for 1-19 hours/week were 0.46 points higher (95%CI: -0.11, 1.09), while their mental health scores were 0.99 higher (95%: 0.08, 1.90) when caring for ≥20 hours/week. Changes on the binary GHQ-12 measure were only evident for women when providing ≥20 hours of weekly care. These changes were not substantial among men. CONCLUSION: Informal care adversely impacted the mental health of women carers during the COVID-19 pandemic. Support programmes for informal carers should focus on alleviating caregiving loads in women.

Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys.

Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.

The wellbeing of women and men with and without disabilities: evidence from cross-sectional national surveys in 27 low- and middle-income countries.

BACKGROUND: Little is known about disability-related inequities in personal wellbeing (PWB) in low- and middle-income countries (LMICs). METHOD: Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) undertaken in 27 LMICs (n = 296,693 women, 66,557 men). Data were aggregated across countries by mixed effects multi-level modelling and meta-analysis. RESULTS: Women and men with disabilities were less likely than their non-disabled peers to report being happy and to be satisfied with their life. These differences were evident in all countries for women and in 18 of 22 countries for men. Aggregated data indicated that: (1) women with disabilities were 14-15% less likely to be happy and 17% less likely to be satisfied with their lives; (2) men with disabilities were 15-17% less likely to be happy and 17-19% less likely to be satisfied with their lives; (3) disability-related inequalities in personal wellbeing were reduced by 22-26% for women and 11-22% for men by adjusting for differences in living conditions. CONCLUSIONS: Future releases of MICS data could prove a valuable resource in monitoring country-level progress to realising Sustainable Development Goal 3 and the extent to which progress is equitable between women and men and between people with/without disabilities. Results also suggest that a significant proportion of the disability-related inequities in wellbeing may be accounted for by modifiable differences in their living conditions and life experiences.

Exposure of Women With and Without Disabilities to Violence and Discrimination: Evidence from Cross-sectional National Surveys in 29 Middle- and Low-Income Countries.

There is a paucity of robust nationally representative data from low- and middle-income countries (LMICs) on the prevalence and risk factors associated with exposure of women with/without disability to either discrimination or violence. We undertook secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) involving nationally representative data from 29 countries with a total sample size of 320,426 women aged 18 to 49 years. We estimated: (1) prevalence rates for exposure to discrimination and violence among women with/without disabilities in the previous year in a range of LMICs; (2) the relative risk of exposure when adjusted for demographic and contextual characteristics; (3) the relative risk of exposure associated with specific functional difficulties associated with disabilities; and (4) the association between country-level estimates and national wealth and human development potential. Our results indicated that women with disabilities were approximately twice as likely as women without disabilities to be exposed to violence and discrimination in the past year, and approximately one-third more likely to feel unsafe in either their home or local neighbourhood and to be at greater risk of domestic violence. Risk of exposure was associated with national characteristics (national wealth, human development potential) and within country factors, especially relative household wealth and level of education. These results must be of concern on two counts. First, they attest to the ongoing violation of the human rights of women with disabilities. Second, they point to increased exposure among women with disabilities to several well-documented social determinants of poorer health.

COVID-19 vaccination coverage and vaccine hesitancy among Australians with disability and long-term health conditions.

ISSUE ADDRESSED: COVID-19 vaccination is the cornerstone of managing Australia's COVID-19 pandemic and the success of the vaccination program depends on high vaccination coverage. This paper examined differences in COVID-19 vaccination coverage and vaccine hesitancy for people with disability, long-term health conditions, and carers - subgroups that were prioritised in Australia's vaccination program. METHODS: Using data from 2400 Australians who participated in two waves of the Taking the Pulse of the Nation survey in April and May 2021, we described vaccination coverage and hesitancy among people with disability, severe mental health conditions, severe long-term health conditions, frequent need for assistance with everyday activities, and carers. RESULTS: Vaccination coverage was estimated to be 8.2% in the population overall and was similar for people with disability, those with frequent need for assistance, and carers. It was higher for people with severe long-term health conditions (13.4%) and lower for people with severe mental health conditions (4.3%). Vaccine hesitancy was high overall (35.6%) and was similarly high across the priority groups, with only small differences for people with disability, severe long-term health conditions and frequent need for assistance. CONCLUSIONS: This study highlights a lack of difference in vaccination coverage for people with disability, long-term health conditions, and carers compared to the general population. So what? Sub-optimal vaccination coverage for people in the priority groups leaves many people at significant risk of serious disease or death if exposed to COVID-19, particularly in light of easing of disease-control restrictions across Australia and the emergence of new variants.

Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis.

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability.

The association between household wealth and the prevalence of child disability and specific functional limitations: Analysis of nationally representative cross-sectional surveys in 40 low- and middle-income countries.

BACKGROUND: It is commonly stated that people with disabilities are at significantly greater risk of living in poverty than their non-disabled peers. However, most evidence supporting this assertion is drawn from studies in high-income countries and studies of adults. There is relatively little robust evidence on the association between poverty/wealth and the prevalence of child disability in low- and middle-income countries (LMICs). OBJECTIVE/HYPOTHESIS: To estimate the strength of association between an indicator of wealth (household assets) and the prevalence of disability among children in a range of LMICs. METHODS: Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys. Nationally representative data were available for 40 countries with a total sample size of 473,578 children aged 2-17. Disability was ascertained by responses to the Washington Group for Disability Statistics module on functional limitations. RESULTS: There were significant dose-dependent relationships between household wealth quintile and the prevalence of disability and 13 of the 15 specific functional difficulties associated with disability. Children living in the poorest 20% of households were 35% more likely to have a disability than children living in the most affluent 20% of households. The strength of the association between household wealth and the prevalence of child disability was markedly lower in low-income countries than in middle-income countries. r CONCLUSIONS: Our results provide robust evidence that in LMICs the prevalence of child disability is disproportionately concentrated in poorer households. Further research is required to better understand why this association appears to be weaker in low-income countries. c.

Do Area-Level Environmental Factors Influence Employment for People with Disability? A Scoping Review.

Employment is an important social determinant of health and wellbeing. People with disability experience labour market disadvantage and have low labour force participation rates, high unemployment rates, and poor work conditions. Environmental factors are crucial as facilitators of or barriers to participation for people with disability. Understanding how the physical, social, and economic characteristics of local areas influence employment for people with disability can potentially inform interventions to reduce employment inequalities. We conducted a scoping review of research investigating associations between area-level environmental factors and employment for people with disability. Eighteen articles published between 2000 and 2020 met the inclusion criteria, and data were extracted to map the current evidence. Area-level factors were categorised into six domains relating to different aspects of environmental context: socioeconomic environment, services, physical environment, social environment, governance, and urbanicity. The urbanicity and socioeconomic environment domains were the most frequently represented (15 and 8 studies, respectively). The studies were heterogeneous in terms of methods and data sources, scale and type of geographic units used for analysis, disability study population, and examined employment outcomes. We conclude that the current evidence base is insufficient to inform the design of interventions. Priorities for future research are identified, which include further theorising the mechanisms by which area-level factors may influence employment outcomes, quantifying the contribution of specific factors, and interrogating specific factors underlying the association between urbanicity and employment outcomes for people with disability.

The prevalence of disability among Roma and non-Roma children in four West Balkan countries.

BACKGROUND: Very little is known about the prevalence of disability among Roma children. OBJECTIVE: To estimate the prevalence of disability and significant cognitive delay among Roma and non-Roma children aged from 2 to 17 years in four West Balkan countries. METHODS: Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicators Cluster Surveys. Nationally representative samples of 6290 Roma and 13,005 non-Roma children in Kosovo, Montenegro, the Republic of North Macedonia, and Serbia. RESULTS: Roma children were twice as likely to have a disability, a less severe disability, multiple disabilities, and severe cognitive delay than their peers and were more likely to have functional limitations in all but one of the domains investigated. CONCLUSIONS: Disability is significantly more prevalent among Roma children aged 2-17 years than among their non-Roma peers in four Western Balkan countries. Future research should focus on the extent to which differences in disability may be attributable to differential rates of exposure to a range of social determinants.

The impact of the COVID pandemic on working age adults with disability: Meta-analysis of evidence from four national surveys.

Concern has been expressed about the extent to which people with disabilities may be particularly vulnerable to negative impacts of the 2020 COVID-19 pandemic. However, to date little published research has attempted to characterise or quantify the risks faced by people with/without disabilities in relation to COVID-19. We sought to compare the impact of the early stages of the COVID-19 pandemic and associated government responses among working age adults with and without disabilities in the UK on; COVID-19 outcomes, health and wellbeing, employment and financial security, health behaviours, and conflict and trust. We undertook secondary analysis of data collected in four UK longitudinal surveys; the Millennium Cohort Study, Next Steps, the British Cohort Study and the National Child Development Study. Combining analyses across surveys with random effects meta-analysis, there was evidence that people with disabilities were significantly more likely to report having had COVID-19 and had significantly increased levels of stress, less exercise, poorer sleep patterns, more conflict with their partner and others in their local area, and to have less trust in the government. While most outcomes did not differ significantly between participants with and without disability, the findings suggest that in the early days of COVID-19 a detrimental impact emerges for those with disabilities which is more pronounced among older people with disabilities. Future research is needed to determine the longer-term impact of the pandemic.

Mental health problems in children with intellectual disability.

Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.

Disability among Women and Men Who Married in Childhood: Evidence from Cross-Sectional Nationally Representative Surveys Undertaken in 37 Low- and Middle-Income Countries.

Child marriage, which the UN's Sustainable Development Goal seeks to eliminate by 2030, represents a violation of the human rights of children. These concerns are driven by the negative impact of child marriage on the health of children married in childhood and their children. Little is known about the association between child marriage and disability. We sought to estimate the strength of association between disability and child marriage among women and men in middle- and low-income countries (LMICs). Secondary analysis was undertaken of nationally representative samples involving 423,164 women in 37 LMICs and 95,411 men in 28 LMICs. Results were aggregated by random effects meta-analysis and mixed effects multilevel multivariate modelling. The prevalence of disability was significantly greater among women and men who were married in childhood, especially among those married under the age of 16. The strength of these associations varied by age group and age at first marriage. Further research is required to understand the causal pathways responsible for the increased likelihood of disability among women and men married in childhood. National initiatives to eliminate child marriage may need to consider making reasonable accommodations to policies to ensure these are equally effective for women and men with disabilities.

Health and healthcare for people with disabilities in the UK during the COVID-19 pandemic.

BACKGROUND: While emerging evidence shows increased mortality from COVID-19 among people with disability, evidence regarding whether there are disability-related inequalities in health during the pandemic is lacking. OBJECTIVE: This study compares access to COVID-19 and non-COVID-19 related health care and mental health of people with and without disability. METHODS: Longitudinal analysis of 12,703 adults (16-64 years) who participated in W9 (2017-2019) and the April and/or May COVID-19 special surveys of the UK Understanding Society study. Descriptive analyses and Poisson regression (adjusted for age, gender, ethnicity and financial stress) were conducted to estimate associations between disability (measured at Wave 9) and a number of different COVID-19-related health and health care outcomes (COVID-19 symptoms, testing and hospitalisation), mental health and loneliness, and non-COVID-19 related health care (e.g. outpatient and inpatient hospital care, prescription medications). RESULTS: Results from the fully-adjusted regression models found that people with disability were more likely: to be hospitalised if symptomatic (adjusted PRR 3.0 95% 1.07-8.43); to experience current symptoms of psychological distress (PRR 1.15, 95% CI 1.05-1.26) and to report being lonely (PRR 1.75, 95% CI 1.46-2.09) compared to non-disabled people. People with disability reported much higher levels of comorbidities than people without disability. However, inability to access health care and treatment were similar. CONCLUSIONS: As the UK opens up, it is important that health care services and social policy address the poor mental health and social isolation of people with disability so that the inequalities occurring early in the pandemic do not become further entrenched.

The association between disability and risk of exposure to peer cyber victimisation is moderated by gender: Cross-sectional survey.

BACKGROUND: Little is known about the exposure of youth with disability to cyber victimisation. OBJECTIVE: /Hypothesis: To estimate the prevalence of peer cyber and non-cyber victimisation in a nationally representative sample of 14-year-old adolescents with and without disability and to determine whether gender moderates the relationship between disability and exposure to victimisation. METHODS: Secondary analysis of data collected in Wave 6 of the UK's Millennium Cohort Survey on 11,726 14-year-old adolescents living in the UK. RESULTS: Adolescents with disability had higher prevalence of cyber and non-cyber victimisation than those with no disability. For cyber victimisation there was a statistically significant interaction between gender and disability, with evidence of increased cyber victimisation for adolescents with disability compared to those with no disability among girls, but not boys. For non-cyber victimisation there was no evidence of an interaction between gender and disability. CONCLUSIONS: The prevalence of both cyber and non-cyber victimisation was higher among adolescents with disability than those with no disability. The association between disability and risk of exposure to peer cyber victimisation appears to be moderated by gender.

Disability, Loneliness and Health in the UK: cross-sectional survey.

BACKGROUND: Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. METHODS: Secondary analysis of data collected in waves 8 and 9 of Understanding Society, the UK's main annual household panel study. RESULTS: Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5-27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3-17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1-14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5-7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. CONCLUSION: Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability.

Policy Implications, Eligibility, and Demographic Characteristics of People With Intellectual Disability Who Access Self-Directed Funding in the United States.

This study identifies factors (state of residence, personal characteristics, and living situation) associated with access to self-directed funding (SDF) for adults with intellectual disability in the United States. Data from 10,033 participants from 26 states in the 2012-2013 National Core Indicators Adult Consumer Survey were analyzed. We examined state, age group, residence type, disability diagnoses, mental health status, and type of disability support funding used. Availability of SDF for people with ID varied by state and aligned mostly with state-by-state policy data on SDF eligibility and availability. The results of a logistic regression analysis demonstrated that access to SDF was lower in older adults and higher for people who lived in their parents' or relatives' home, an independent home, and with certain personal characteristics. Potential influences from policy and practice, and approaches to increase access to SDF are discussed.