Safety Planning for Suicidality in Autism: Obstacles, Potential Solutions, and Future Directions

Schwartzman, Jessica M.; Smith, Joshua R.; Bettis, Alexandra H.

doi:10.1542/peds.2021-052958

Cited by 13 publications

(10 citation statements)

References 11 publications

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“…A population-based cohort study on autistic individuals ( n = 27,122) and age- and sex-matched non-autistic individuals ( n = 2,672,185) reported that the odds ratio was higher in autistic individuals who died by suicide (odds ratio: 7.55, 95% CI: 6.04–9.44) than in the age- and sex-matched non-autistic individuals (Hirvikoski et al, 2016). Given the compelling evidence of high suicide risk in autistic individuals and the fact that suicide is the second leading cause of mortality among adolescents in the United States, child and adolescent psychiatrists have implored the US government to develop a safety plan for suicidality in autistic individuals (Ruch et al, 2019; Schwartzman et al, 2021). Considering the similarities in the increased likelihood of suicide mortality between Taiwan (3.67 times in our study) and the United States (3.42 times in the study by Kirby et al, 2019), we recommend that a suicide prevention program specific to autistic individuals or those with autistic traits be implemented in Taiwan.…”

Section: Discussionmentioning

confidence: 99%

All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan

Tsai

Chang

Cheng

et al. 2023

Autism

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Evidence suggests increased mortality rates among autistic individuals. However, risks of mortality, including natural-cause, suicide, and accident mortalities, among autistic individuals remain unclear. Among the entire Taiwanese population ( N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 matched to 181,592 non-autistic individuals based on birth year and sex. All-cause mortality, including natural-cause, accident, and suicide mortalities, was assessed from 2003 to 2017 between the two cohorts. Cox regression models were used to investigate the mortality risk between autistic and non-autistic individuals. Autistic individuals had increased likelihoods (hazard ratio, 95% confidence interval) of all-cause mortality (3.43, 3.00–3.92), natural-cause mortality (4.73, 3.99–5.60), and suicide mortality (3.67, 2.37–5.68) compared with non-autistic individuals. In particular, autistic males were more likely to die by suicide (hazard ratio: 3.81, 95% confidence interval: 2.37–6.13), and autistic females were more likely to die of accident (hazard ratio: 5.07, 95% confidence interval: 2.54–10.13) compared with non-autistic individuals. Appropriate and effective medical and mental health care is recommended for autistic individuals. Lay abstract Our study was the first population-based study in an Asian country to investigate the mortality rates among autistic individuals. Among the entire Taiwanese population ( N = 29,253,529), between 2003 and 2017, 45,398 autistic individuals were identified and 1:4 age-/sex-matched to 181,592 non-autistic individuals. We found that autistic individuals had increased risks of all-cause mortality, natural-cause mortality, and suicide mortality compared with non-autistic individuals. Furthermore, autistic males were more likely to die by suicide, and autistic females were more likely to die of accident compared with the non-autistic individuals.

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Section: Discussionmentioning

confidence: 99%

All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan

Tsai

Chang

Cheng

et al. 2023

Autism

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“…Most clinics that provided a rationale for not accepting autistic youth as patients noted that it was because the clinic did not have clinicians with expertise in autism or specialized programs for the autism population. This is notable as evidence-based treatments for MH conditions within the context of autism are typically adaptations of evidence-based treatments developed for use with the general population (Dickson et al, 2021; Maddox et al, 2021; Schwartzman et al, 2021). Therefore, many non-specialized clinicians, including those employed within settings that deny services to autistic youth, may have the skills to provide MH care in the context of autism (Lake et al, 2014), particularly with additional training and implementation support.…”

Section: Discussionmentioning

confidence: 99%

“…Implementation supports will be needed to ensure that providers have the skills and knowledge about how to coordinate care across these systems. Finally, continued adaptation of evidence-based MH interventions for autistic individuals that can be feasibly implemented by nonspecialized community MH clinicians is essential (Adams & Young, 2021; Camm-Crosbie et al, 2019; Wood et al, 2015), particularly in regard to suicide prevention strategies (Jager-Hyman et al, 2020; Schwartzman et al, 2021). Wide-scale adaptation and implementation of evidence-based services have been accomplished for other populations (e.g.…”

Section: Discussionmentioning

confidence: 99%

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems

Cervantes

Conlon

Seag

et al. 2022

Autism

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Psychiatric conditions are common in autism; however, a multitude of barriers exist in accessing community-based mental health care for autistic youth. Perhaps the first and most formidable barrier is identifying a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. These systems typically function independently of one another, contributing to the complexity of accessing services. To identify gaps caused by New York’s multisystem care model for autistic youth, and as part of a larger quality improvement initiative to advance suicide risk management in several New York City emergency departments, we conducted a telephone survey to identify outpatient mental health service availability for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state’s mental health and developmental disability systems. Results demonstrated that while a greater proportion of clinics in the mental health system compared with agencies in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), there is remarkably limited service availability overall. Efforts to reduce these care inequities through policy reform and improving workforce capacity are urgently needed. Lay abstract Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state’s mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers’ knowledge and confidence in working with autistic youth are improved.

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“…If a patient is felt appropriate for discharge, safety planning should include clear directives to address sources of distress and environmental risks, using reasoning patterns that match patient communication styles. Coping strategies should be tailored to the interests of the child, such as engagement in circumscribed activities, as more social demands may be anxiety provoking 26 . Caregivers should also receive lethal means restriction counseling, a critical aspect of postdischarge safety.…”

Section: Common Behavioral Health Concernsmentioning

confidence: 99%

“…Coping strategies should be tailored to the interests of the child, such as engagement in circumscribed activities, as more social demands may be anxiety provoking. 26 Caregivers should also receive lethal means restriction counseling, a critical aspect of postdischarge safety.…”

Section: Suicidalitymentioning

confidence: 99%

Behavioral Management of Children With Autism in the Emergency Department

Wolpert

Kodish

Kim³

et al. 2023

Pediatr Emer Care

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Autism spectrum disorder (ASD) is characterized by impaired social communication in conjunction with patterned behaviors. Often associated with emotional dysregulation, irritability, aggression, depression, and suicidality, ASD youth frequently present to the emergency department for behavioral and mental health evaluation. Psychiatric comorbidities, agitation, and depression are commonly encountered. During these visits, practitioners must thoughtfully consider organic etiologies for presenting symptoms, formulate plans to address risk of agitation, and understand how to effectively formulate disposition options in this patient population.

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Safety Planning for Suicidality in Autism: Obstacles, Potential Solutions, and Future Directions

Cited by 13 publications

References 11 publications

All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan

All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems

Behavioral Management of Children With Autism in the Emergency Department

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