Premature mortality in autism spectrum disorder

Hirvikoski, Tatja; Mittendorfer‐Rutz, Ellenor; Boman, Magnus; Larsson, Henrik; Lichtenstein, Paul; Bölte, Sven

doi:10.1192/bjp.bp.114.160192

Cited by 699 publications

(702 citation statements)

References 32 publications

Supporting

Mentioning

618

Contrasting

Unclassified

Order By: Relevance

“…The increased ratio of the prevalence of males to females with ASD is well-established (Lai et al 2013) as is the fact that males have a higher rate of suicide than females in the general population (Hawton 2000). However, in contrast to the increased risk of suicide in males in the general population, a recent study reported a loss of this typical sex difference, leading to a higher relative risk in females with ASD compared to those without ASD (Hirvikoski et al 2016). Over the last few years, an increased awareness of sex differences in brain and behaviour studies in ASD is an encouraging trend (Alice et al 2007;Baron-Cohen et al 2011;Lai et al 2013;Mandy et al 2011) that should be extended into the matrix of ASD and suicidality.…”

Section: Developmental-contextual Factors: Sex and Agementioning

confidence: 81%

“…Recent reports have drawn attention to the high prevalence of suicidality in individuals with autism spectrum disorder (ASD) (Cassidy et al 2014) and a sevenfold increase in the number of deaths by suicide in the ASD population compared to the general population (Hirvikoski et al 2016). Along with the increased prevalence of co-occurring mental health problems in individuals with ASD (50-70%; Simonoff et al 2008), it is pressing to understand the interplay of ASD symptomology and suicidality in order to offer better care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Suicidality in Autism Spectrum Disorder: a Commentary

Lai

Rhee

Nicholas

2017

Adv Neurodev Disord

View full text Add to dashboard Cite

Recent studies report a higher prevalence of suicidality (ideation, attempts and deaths by suicide) among individuals with autism spectrum disorder (ASD) than in the general population. Unfortunately, there is little research addressing the conceptualization and management of suicidality in the ASD population. In this commentary, we explore potential modifications in the processes leading to suicidality in individuals with ASD and considerations relevant to clinical support and service development. Specifically, based on a multilevel framework, we highlight individual, contextual and systemic risk factors of suicidality in the ASD population noted in the literature. We discuss how patterns of ASD-related behaviours may modify specific pathways in theories of suicide as developed for the general population. We explore how ASD symptomology may contribute to maladaptive coping strategies and dynamics between those with ASD and their care providers. Considerations for prevention and proactive responses at various levels of practice and implications for support and service development are discussed as future directions in the field.

show abstract

Section: Developmental-contextual Factors: Sex and Agementioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Suicidality in Autism Spectrum Disorder: a Commentary

Lai

Rhee

Nicholas

2017

Adv Neurodev Disord

View full text Add to dashboard Cite

show abstract

“…Their risk of death was still estimated to be twice that of their matched controls without ID (HR 2.2; see Table 23). A doubling of mortality risk with autism spectrum disorder compared with the general population has been shown in several population cohorts worldwide; 131 however, this risk increases in studies that were able to further restrict the comparison to subjects with a co-existing ID 131 or neurological disorders. 132 Although a recent large Swedish case-control study 131 reported an OR of 5.8, the median age of death for the group with co-existing ID (40 years) suggests that insufficient follow-up in our study (3 years) may account for our imprecise findings among the younger subgroup of adults with ID with autism, who had an average age of only 30.5 years at the beginning of follow-up.…”

Section: Mortalitymentioning

confidence: 99%

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

Carey

Hosking

Harris

et al. 2017

Health Serv Deliv Res

View full text Add to dashboard Cite

Background People with intellectual disability (ID) have poorer health than the general population; however, there is a lack of comprehensive national data describing their health-care needs and utilisation. Annual health checks for adults with ID have been incentivised through primary care since 2009, but only half of those eligible for such a health check receive one. It is unclear what impact health checks have had on important health outcomes, such as emergency hospitalisation. Objectives To evaluate whether or not annual health checks for adults with ID have reduced emergency hospitalisation, and to describe health, health care and mortality for adults with ID. Design A retrospective matched cohort study using primary care data linked to national hospital admissions and mortality data sets. Setting A total of 451 English general practices contributing data to Clinical Practice Research Datalink (CPRD). Participants A total of 21,859 adults with ID compared with 152,846 age-, gender- and practice-matched controls without ID registered during 2009–13. Interventions None. Main outcome measures Emergency hospital admissions. Other outcomes – preventable admissions for ambulatory care sensitive conditions, and mortality. Data sources CPRD, Hospital Episodes Statistics and Office for National Statistics. Results Compared with the general population, adults with ID had higher levels of recorded comorbidity and were more likely to consult in primary care. However, they were less likely to have long doctor consultations, and had lower continuity of care. They had higher mortality rates [hazard ratio (HR) 3.6, 95% confidence interval (CI) 3.3 to 3.9], with 37.0% of deaths classified as being amenable to health-care intervention (HR 5.9, 95% CI 5.1 to 6.8). They were more likely to have emergency hospital admissions [incidence rate ratio (IRR) 2.82, 95% CI 2.66 to 2.98], with 33.7% deemed preventable compared with 17.3% in controls (IRR 5.62, 95% CI 5.14 to 6.13). Health checks for adults with ID had no effect on overall emergency admissions compared with controls (IRR 0.96, 95% CI 0.87 to 1.07), although there was a relative reduction in emergency admissions for ambulatory care-sensitive conditions (IRR 0.82, 95% CI 0.69 to 0.99). Practices with high health check participation also showed a relative fall in preventable emergency admissions for their patients with ID, compared with practices with minimal participation (IRR 0.73, 95% CI 0.57 to 0.95). There were large variations in the health check-related content that was recorded on electronic records. Limitations Patients with milder ID not known to health services were not identified. We could not comment on the quality of health checks. Conclusions Compared with the general population, adults with ID have more chronic diseases and greater primary and secondary care utilisation. With more than one-third of deaths potentially amenable to health-care interventions, improvements in access to, and quality of, health care are required. In primary care, better continuity of care and longer appointment times are important examples that we identified. Although annual health checks can also improve access, not every eligible adult with ID receives one, and health check content varies by practice. Health checks had no impact on overall emergency admissions, but they appeared influential in reducing preventable emergency admissions. Future work No formal cost-effectiveness analysis of annual health checks was performed, but this could be attempted in relation to our estimates of a reduction in preventable emergency admissions. Funding The National Institute for Health Research Health Services and Delivery Research programme.

show abstract

“…Many studies originating in Scandinavian and the Nordic countries [20] have previously used hospitalisation rates [21,22], as well as, individual uptake of psychotropic medication to examine a range of factors, including maternal and pre-natal factors related to attention-deficit/hyperactivity disorder in children [23,24], factors related to impaired psychological health in adolescents and younger adults [25], area effects on psychiatric morbidity [26], the effects of working conditions and early retirement [27,28] and the prevalence and differences in poor mental health across refugees and migrants [29]. Medical records have also been used in validity studies of self-reported medication use, with reports of good agreement and specificity being noted between the two measures, especially in chronically used medicines [30].…”

Section: Introductionmentioning

confidence: 99%