Autism and psychosis: Clinical implications for depression and suicide

Abstract

There is increasing recognition of the co-occurrence of autism and schizophrenia spectrum disorders. However, the clinical significance of this on outcomes such as depression and suicidal thinking has not been explored. This study examines the association of autism spectrum traits, depressive symptoms and suicidal behaviour in individuals with psychotic experiences. In two cross sectional studies, individuals from a non-help seeking university student sample and patients with first episode psychosis (FEP) service completed standardized measures of autism spectrum traits, psychotic experiences, depressive symptoms and suicidal thinking. In healthy non-help seeking students, increased autism traits and increased subclinical psychotic experiences were significantly associated with depressive symptoms; a significant interaction effect suggests their combined presence has a greater impact on depression. In FEP, high autism traits and positive symptoms were associated with increased depression, hopelessness and suicidality, however there was no significant interaction effect. In FEP a multiple mediation model revealed that the relationship between autism traits and risk for suicidality was mediated through hopelessness. Young people with subclinical psychotic experiences and all patients with FEP should be screened for autism spectrum traits, which may have significant impact on clinical outcomes. Tailored interventions for patients with high levels of autistic spectrum co-morbidities in FEP should be a priority for future research.

Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality

“…CAPEp and CESD-R measures appeared consistent with previous findings (Ruzich et al, 2015;Upthegrove et al, 2018;Van Dam & Earleywine, 2011), levels of self-harm and suicidality were both higher in our sample than in previously published data (Meltzer H, 2002), which may have biased our results. Finally, traits and symptoms in our study were measured at one time-point only.…”

“…For example, studies found that co-occurrence of autistic and psychotic traits was associated with less impaired executive and social functioning in undergraduate students in China (Shi et al, 2017), and better perspective taking abilities in university students in the UK (Abu-Akel, Wood, Hansen, & Apperly, 2015). On the other hand, a study involving 381 university students undertaken in the UK suggested that co-occurrence of autistic and psychotic traits was associated with significantly increased levels of depression (Upthegrove et al, 2018). The conduct of these studies in student populations may limit the applicability of their findings to the general population.…”

Autistic Symptoms in Schizophrenia Spectrum Disorders: A Systematic Review and Meta-Analysis

“…Three studies included only children and adolescents (18, 38, 39). Four studies were undertaken in Japan (36, 37, 42, 45), four in Europe (35, 40, 41, 46), three in the U.S. (18, 39, 43), and two in China (38, 44). Most of the studies included a high percentage of males, with the exception of three studies (40, 42, 45).…”

Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample

“…Self-reported autistic traits measured by the AQ accurately distinguish over 80% of autistic and non-autistic people (Baron-Cohen et al 2001) and predict who will later go on to obtain a diagnosis of autism (Woodbury-Smith et al 2005). However, self-reported autistic traits are also elevated in a number of other groups, such as those with psychosis (Upthegrove et al 2018) and borderline personality disorder (Dudas et al 2017). Hence, some have argued that the AQ does not specifically measure autistic traits, but more general social skills and social interest, regardless of the underlying condition (Lugnegård et al 2015).…”