Abstract
There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.
Highlights
Autism spectrum disorder (ASD) comprises a set of chronic neurodevelopmental disorders with a wide range of symptoms and levels of severity.[1,2] Globally, the prevalence of ASD has been estimated to be 1% to 1.5%,3 with a cumulative incidence up to 2.8% in recent birth cohorts in Denmark.[4]
For individuals with ASD, the adjusted incidence rate ratio (aIRR) for suicide attempt among female individuals was 4.41-fold higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold higher compared with male individuals
When adjusting for sex, age, and period, we found that persons with ASD had a higher rate of suicide attempt compared with those without ASD
Summary
Autism spectrum disorder (ASD) comprises a set of chronic neurodevelopmental disorders with a wide range of symptoms and levels of severity.[1,2] Globally, the prevalence of ASD has been estimated to be 1% to 1.5%,3 with a cumulative incidence up to 2.8% in recent birth cohorts in Denmark.[4]. Little evidence from large-scale studies exists regarding an association between ASD and suicidality.[11,12,13,14,15] A recent population-based case-cohort study from Sweden showed an increased risk of suicide and suicide attempt among those with ASD, especially among those without intellectual disability.[16] It has yet to be determined what factors are associated with suicidal behavior in people with ASD and whether they differ from the factors associated with suicidal behavior in the population without ASD. To make evidence-based decisions and inform the design of intervention studies, there is a need for largescale national cohort studies on the risk of suicide attempts and suicides among persons with ASD. The aims of this retrospective cohort study were to analyze whether people with a diagnosis of ASD had higher rates of suicide attempts and suicides compared with people without ASD, identify risk factors for suicide attempt and suicide among those with ASD, and examine associations with psychiatric comorbid disorders
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
