Measurement Properties of the Suicidal Behaviour Questionnaire-Revised in Autistic Adults

Sarah A Cassidy,Erica Bowen,Simon Baron-Cohen,Louise Bradley,Heather Cogger-Ward,Rebecca Shaw,Jacqui Rodgers,Magdalena Glod

doi:10.1007/s10803-020-04431-5

Abstract

We explored the appropriateness and measurement properties of a suicidality assessment tool (SBQ-R) developed for the general population, in autistic adults—a high risk group for suicide. 188 autistic adults and 183 general population adults completed the tool online, and a sub-sample (n = 15) were interviewed while completing the tool. Multi-group factorial invariance analysis of the online survey data found evidence for metric non-invariance of the SBQ-R, particularly for items three (communication of suicidal intent) and four (likelihood of suicide attempt in the future). Cognitive interviews revealed that autistic adults did not interpret these items as intended by the tool designers. Results suggest autistic adults interpret key questions regarding suicide risk differently to the general population. Future research must adapt tools to better capture suicidality in autistic adults.

Highlights

Adults diagnosed with Autism Spectrum Conditions (ASC; hereafter autistic adults) are significantly more likely to report suicidal thoughts and suicidal behaviours (Cassidy et al 2014, 2018c; Hedley and Uljarević 2018; Zahid and Upthegrove 2017) and to die by suicide (Hirvikoski et al.Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK2016; Kirby et al 2019) compared to the general population
The current study aimed to explore the appropriateness and measurement properties of a widely used suicidality assessment tool validated for use in general population research, the Suicidal Behaviours Questionnaire-Revised (SBQ-R) (Osman et al 2001) in autistic adults
Despite a growing body of research showing increased risk of suicidal thoughts and suicidal behaviours in autistic adults (Cassidy et al 2014, 2018c), there is no suicidality assessment tool yet validated for this group (Cassidy et al 2018a; Hedley and Uljarević 2018)

Summary

Introduction

Adults diagnosed with Autism Spectrum Conditions (ASC; hereafter autistic adults) are significantly more likely to report suicidal thoughts and suicidal behaviours (Cassidy et al 2014, 2018c; Hedley and Uljarević 2018; Zahid and Upthegrove 2017) and to die by suicide (Hirvikoski et al.Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK2016; Kirby et al 2019) compared to the general population. There are few studies exploring why autistic people are more likely to contemplate and attempt suicide than the general population, to inform suicide prevention strategies for this group (Cassidy in press; Cassidy and Rodgers 2017; Hedley and Uljarević 2018) Addressing this crucial knowledge gap will require further research, but a key barrier is lack of validated research tools available to accurately capture suicidal thoughts and suicidal behaviours in autistic adults (Cassidy et al 2018a; Hedley and Uljarević 2018). This study aimed to explore the appropriateness and measurement properties of a widely used and validated suicidality assessment tool originally developed for the general population, in autistic adults This will in turn inform potential adaptations to better capture suicidal thoughts and suicidal behaviours in autistic adults in future research

Objectives

Results

Conclusion