Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder

Chen, Mu Hong; Pan, Tai‐Long; Lan, Wen Hsuan; Hsu, Ju Wei; Huang, Kou‐Yuan; Su, Tung Ping; Li, Cheng Ta; Lin, Wei Chen; Wei, Han Ting; Chen, Tzeng Ji; Bai, Ya Mei

doi:10.4088/jcp.16m11100

Cited by 90 publications

(96 citation statements)

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“…While autism is often and should be diagnosed in childhood, increasing research has focussed on the long-term mental and physical health of autistic individuals throughout adulthood. Specifically, a growing body of research has identified that autistic adults are at higher risk for SSBI [1][2][3][4][5][6] and life-long vulnerability [91]. These studies are all limited in that they have tested relatively small cohorts, and have typically relied on clinical groups.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism

Warrier¹,

Baron‐Cohen²

2019

Mol Psychiatry

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Autistic individuals experience significantly elevated rates of childhood trauma, self-harm and suicidal behaviour and ideation (SSBI). Is this purely the result of negative environmental experiences, or does this interact with genetic predisposition? In this study we investigated if a genetic predisposition for autism is associated with childhood trauma using polygenic scores (PGS) and genetic correlations in the UK Biobank (105,222 < N < 105,638), and tested potential mediators and moderators of the association between autism, childhood trauma and SSBI. Autism PGS were significantly associated with childhood trauma (max R 2 = 0.096%, P < 2 × 10 −16), self-harm ideation (max R 2 = 0.108%, P < 2 × 10 −16), and self-harm (max R 2 = 0.13%, P < 2 × 10 −16). Supporting this, we identified significant genetic correlations between autism and childhood trauma (r g = 0.36 ± 0.05, P = 8.13 × 10 −11), self-harm ideation (r g = 0.49 ± 0.05, P = 4.17 × 10 −21) and self-harm (r g = 0.48 ± 0.05, P = 4.58 × 10 −21), and an over-transmission of PGS for the two SSBI phenotypes from parents to autistic probands. Male sex negatively moderated the effect of autism PGS on childhood trauma (β = −0.023 ± 0.005, P = 6.74 × 10 −5). Further, childhood trauma positively moderated the effect of autism PGS on self-harm score (β = 8.37 × 10 −3 ± 2.76 × 10 −3 , P = 2.42 × 10 −3) and selfharm ideation (β = 7.47 × 10 −3 ± 2.76 × 10 −3 , P = 6.71 × 10 −3). Finally, depressive symptoms, quality and frequency of social interactions, and educational attainment were significant mediators of the effect of autism PGS on SSBI, with the proportion of effect mediated ranging from 0.23 (95% CI: 0.09-0.32) for depression to 0.008 (95% CI: 0.004-0.01) for educational attainment. Our findings identify that a genetic predisposition for autism is associated with adverse lifetime outcomes, which represent complex gene-environment interactions, and prioritizes potential mediators and moderators of this shared biology. It is important to identify sources of trauma for autistic individuals in order to reduce their occurrence and impact.

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Section: Discussionmentioning

confidence: 99%

“…Autistic individuals have elevated rates of self-harm (with or without suicidal intent) and suicidal behaviour and ideation (SSBI) [1][2][3][4][5][6]. In addition, there is a positive association between autistic traits (subclinical manifestation of autism features) and SSBI [3,7].…”

Section: Introductionmentioning

confidence: 99%

Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism

Warrier¹,

Baron‐Cohen²

2019

Mol Psychiatry

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“…The SBQ-ASC has 5 scored items (Table 2). Item 1 assesses lifetime experience of suicidal thoughts and behaviours from "Never" (0) to "I have attempted to end my life" (4). Item 2 assesses frequency of intense suicidal thoughts in the last 12 months from "Never" (0) to "1 or more times a day" (6).…”

Section: Methodsmentioning

confidence: 99%

“…People diagnosed with autism (henceforth autistic people [1]) are at signi cantly increased risk of experiencing suicidal thoughts and behaviours [3][4][5] and death by suicide [6][7], compared to non-autistic people. Autistic people who have experienced delay in autism diagnosis until adulthood show the highest estimates of lifetime suicidal thoughts (66%), and suicide attempt(s) (35-36%) [8][9].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Cassidy

Bradley

Cogger-Ward

et al. 2020

Preprint

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Background: Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups.Methods: A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults. The adapted tool was refined through 9 interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups.Results: There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales.Limitations: The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which is not representative of the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm.Conclusions: The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.

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“…Traits characteristic of autism are also significantly associated with suicidality in those with [ 2 ], and without ASC diagnosis [ 16 – 18 ]. ASC diagnosis has also 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 – 22 ] or social isolation [ 23 , 24 ], which have been associated with increased risk of suicidality in ASC [ 2 , 15 , 17 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Risk markers for suicidality in autistic adults

et al. 2018

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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.

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Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder

Cited by 90 publications

References 0 publications

Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism

Childhood trauma, life-time self-harm, and suicidal behaviour and ideation are associated with polygenic scores for autism

Development and Validation of the Suicide Behaviours Questionnaire – Autism Spectrum Conditions in Autistic, Possibly Autistic and Non-Autistic Adults.

Risk markers for suicidality in autistic adults

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