Investigating Bullying as a Predictor of Suicidality in a Clinical Sample of Adolescents with Autism Spectrum Disorder

Abstract

For typically developing adolescents, being bullied is associated with increased risk of suicidality. Although adolescents with autism spectrum disorder (ASD) are at increased risk of both bullying and suicidality, there is very little research that examines the extent to which an experience of being bullied may increase suicidality within this specific population. To address this, we conducted a retrospective cohort study to investigate the longitudinal association between experiencing bullying and suicidality in a clinical population of 680 adolescents with ASD. Electronic health records of adolescents (13–17 years), using mental health services in South London, with a diagnosis of ASD were analyzed. Natural language processing was employed to identify mentions of bullying and suicidality in the free text fields of adolescents' clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality outcomes. Reported experience of bullying in the first month of clinical contact was associated with an increased risk suicidality over the follow‐up period (hazard ratio = 1.82; 95% confidence interval = 1.28–2.59). In addition, female gender, psychosis, affective disorder diagnoses, and higher intellectual ability were all associated with suicidality at follow‐up. This study is the first to demonstrate the strength of longitudinal associations between bullying and suicidality in a clinical population of adolescents with ASD, using automated approaches to detect key life events within clinical records. Our findings provide support for identifying and dealing with bullying in schools, and for antibullying strategy's incorporation into wider suicide prevention programs for young people with ASD. Autism Res 2020, 13: 988‐997. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. Lay Summary We investigated the relationship between bullying and suicidality in young people with autism spectrum disorder (ASD). We examined the clinical records of adolescents (aged 13–18 years old) with ASD in South London who were receiving treatment from Child and Adolescent Mental Health Services. We found that if they reported being bullied in the first month after they were first seen by mental health services, they were nearly twice as likely to go on to develop suicidal thoughts or behaviors.

Coping, fostering resilience, and driving care innovation for autistic people and their families during the COVID-19 pandemic and beyond

“…The impact of school closure, shift to online schooling, and physical distancing during the COVID-19 pandemic Schools often provide opportunities for interventions including specialized education, mental health care [31], and social interaction; they are critical for regulation of behaviors. On the other hand, school can also be a highly challenging setting for some autistic individuals due to academic difficulties, co-occurring ADHD or anxiety [2], and high risk of school and cyber-bullying from peers [32,33]. All of these factors contribute to trauma, depression, anxiety, and suicidality [32,34].…”

“…On the other hand, school can also be a highly challenging setting for some autistic individuals due to academic difficulties, co-occurring ADHD or anxiety [2], and high risk of school and cyber-bullying from peers [32,33]. All of these factors contribute to trauma, depression, anxiety, and suicidality [32,34]. Thus, closure of schools (and work environments for adults) may result in reduced stress in some autistic individuals and increased stress in others [9].…”

Reviewing a Decade of Research Into Suicide and Related Behaviour Using the South London and Maudsley NHS Foundation Trust Clinical Record Interactive Search (CRIS) System

“…Using a subset of this cohort, Holden et al ( 48 ) used a historical cohort design and applied NLP approaches to extract information on victimisation by bullying and suicidal behaviour. They found those young people with ASD who were bullied were nearly twice as likely to report later suicidal ideation.…”

Social Anxiety in Victimization and Perpetration of Cyberbullying and Traditional Bullying in Adolescents with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

“…Involvement in traditional bullying can compromise the mental health of children and adolescents. For example, traditional bullying victimization prospectively predicts the internalization of mental health problems [ 7 ], school refusal [ 8 ], and suicidality [ 9 ] in children and adolescents with ASD. Both victims and perpetrators of traditional bullying with ADHD are more likely to experience pain, pain-related dysfunction [ 10 ], and depression [ 11 ] than their counterparts with ADHD not involved in bullying are.…”