Abstract
ObjectiveTo examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years.MethodWe examined associations between ASD diagnosis and 4 dichotomized ASD traits (social communication, pragmatic language, repetitive behavior, and sociability) with suicidal and nonsuicidal self-harm, suicidal thoughts, and suicidal plans at age 16 years in 5,031 members of the United Kingdom−based birth cohort study the Avon Longitudinal Study of Parents and Children. We assessed whether any associations were explained by depressive symptoms in early adolescence measured by the Short Moods and Feelings Questionnaire at 12 years.ResultsChildren with impaired social communication had a higher risk of self-harm with suicidal intent (relative risk [RR] = 2.14, 95% CI = 1.28–3.58), suicidal thoughts (RR = 1.42, 95% CI = 1.06–1.91), and suicidal plans (RR = 1.95, 95% CI = 1.09–3.47) by age 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and outcomes, although these analyses were imprecise because of small numbers. There was also no evidence of an association between other autism traits and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at 12 years.ConclusionSocial communication impairments are an important autistic trait in relation to suicidality. Early identification and management of depression may be a preventative mechanism, and future research identifying other potentially modifiable mechanisms may lead to interventions against suicidal behavior in this high-risk group.
Highlights
Our research questions were: as follows: (1) Is an autism diagnosis Journal of the American Academy of Child & Adolescent Psychiatry Volume 57 / Number 5 / May 2018 www.jaacap.org and/or are autistic traits associated with suicidal ideation and suicidal behavior by age 16 years? (2) Are any of the observed associations explained by depressive symptoms in early adolescence?
Based on the imputed analyses, a slightly higher proportion (35%) of the total association between impaired social cognition and self-harm was accounted for by the indirect path through depressive symptoms. This is the first large population-based study to investigate the association between an autism diagnosis and traits and suicidal ideation and behavior by late adolescence, as well as examining the mechanisms of this association
Impairments in social communication were associated with an increased risk of suicidal thoughts, suicidal plans, and self-harm with suicidal intent, but not self-harm without suicidal intent
Summary
To examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years. Depression is a strong risk factor for suicidal ideation and selfharm in the general population[13]; whether it could explain a greater risk of suicidal thoughts or behaviors in people with autism has not been studied. Quantifying this relationship is important, as it may inform preventive or intervention strategies, considering that depression is potentially treatable. Journal of the American Academy of Child & Adolescent Psychiatry Volume 57 / Number 5 / May 2018 www.jaacap.org and/or are autistic traits associated with suicidal ideation (suicidal thoughts and plans) and suicidal behavior (self-harm with and without suicidal intent) by age 16 years? Journal of the American Academy of Child & Adolescent Psychiatry Volume 57 / Number 5 / May 2018 www.jaacap.org and/or are autistic traits associated with suicidal ideation (suicidal thoughts and plans) and suicidal behavior (self-harm with and without suicidal intent) by age 16 years? (2) Are any of the observed associations explained by depressive symptoms in early adolescence?
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