Risk markers for suicidality in autistic adults

Sarah Cassidy,Simon Baron-Cohen,Rebecca Shaw,Louise Bradley

doi:10.1186/s13229-018-0226-4

Abstract

BackgroundResearch has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies.MethodsThrough consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and ‘camouflaging’ ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online.ResultsA majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality.ConclusionsResults confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.

Highlights

Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case
ASC diagnosis has recently been found to be an independent risk marker for suicide attempts independent of demographic characteristics and co-occurring diagnoses [19]. These findings suggest that ASC explains additional variance in suicidality, not accounted for by other well-known risk markers in the general population which are more prevalent in ASC, such as depression [20,21,22] or social isolation [23, 24], which have been associated with increased risk of suicidality in ASC [2, 15, 17, 25, 26]
We explore for the first time a potentially unique risk marker for suicidality and Non-suicidal self-injury (NSSI) in ASC males and ASC females—camouflaging ASC in order to cope in social situations—as well as age of ASC diagnosis, and unmet support needs

Summary

Introduction

Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. It is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies. There are elevated rates of suicidality in adults diagnosed with autism spectrum conditions (ASC) [1,2,3,4,5]. Non-suicidal self-injury (NSSI) is a risk factor for Suicidal thoughts and behaviours are significantly increased in autistic adults compared to the general population and other clinical groups. One study has ever explored whether autistic people are more at risk of dying by suicide than the general population; this population study in Sweden showed that autistic people were significantly more likely to die by suicide (0.31%) compared to the general population (0.04%) [15]

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