Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review

S.A Cassidy,L Bradley,E Bowen,S Wigham,J Rodgers

doi:10.1016/j.cpr.2018.05.002

Abstract

Adults diagnosed with autism are at significantly increased risk of suicidal thoughts, suicidal behaviours and dying by suicide. However, it is unclear whether any validated tools are currently available to effectively assess suicidality in autistic adults in research and clinical practice. This is crucial for understanding and preventing premature death by suicide in this vulnerable group. This two stage systematic review therefore aimed to identify tools used to assess suicidality in autistic and general population adults, evaluate these tools for their appropriateness and measurement properties, and make recommendations for appropriate selection of suicidality assessment tools in research and clinical practice. Three databases were searched (PsycInfo, Medline and Web of Knowledge). Four frequently used suicidality assessment tools were identified, and subsequently rated for quality of the evidence in support of their measurement properties using the COSMIN checklist. Despite studies having explored suicidality in autistic adults, none had utilised a validated tool. Overall, there was lack of evidence in support of suicidality risk assessments successfully predicting future suicide attempts. We recommend adaptations to current suicidality assessment tools and priorities for future research, in order to better conceptualise suicidality and its measurement in autism.

Highlights

Adults diagnosed with Autism Spectrum Conditions (ASC, hereafter autistic adults) are at high risk of experiencing suicidality compared to other clinical groups (Hedley and Uljarević, 2018; Zahid and Upthegrove, 2017; Cassidy et al, 2014; Segers and Rawana, 2014; Hannon and Taylor, 2013)
The search for studies using tools to assess suicidality in autistic adults, identified 672 articles which were screened, none of which were retained for analysis (Figure 1)
A majority of studies in both groups searches had utilised a single item designed for the specific study with no evidence of validity, or a single item or subscale contained within a larger mental health (MINI, SCID) or depression (e.g. PHQ-9, BDI) measure

Summary

Introduction

Adults diagnosed with Autism Spectrum Conditions (ASC, hereafter autistic adults) are at high risk of experiencing suicidality compared to other clinical groups (Hedley and Uljarević, 2018; Zahid and Upthegrove, 2017; Cassidy et al, 2014; Segers and Rawana, 2014; Hannon and Taylor, 2013). In a recent large-scale population study in Sweden, those diagnosed with ASC, without co-occurring ID, were at high risk of dying by suicide compared to the general population (Hirvikoski et al 2016). It is crucial to effectively assess suicidality in autistic adults. It is unclear if there are valid tools available to assess suicidality in autistic adults, or whether existing tools need to be adapted for this group

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Discussion

Conclusion