Suicidal Ideation and Suicidal Attempts in Referred Adolescents with High Functioning Autism Spectrum Disorder and Comorbid Bipolar Disorder: A Pilot Study

Abstract

Suicidal ideation and attempts in adolescents are closely associated to bipolar disorders (BD). Growing evidence also suggests that high functioning autism spectrum disorders (HF-ASD) are at increased risk for suicidal ideation and behaviors. Although BD and HF-ASD are frequently comorbid, no studies explored suicidality in these individuals. This exploratory study addressed this issue in a clinical group of inpatient adolescents referred to a psychiatric emergency unit. Seventeen adolescents with BD and HF-ASD and severe suicidal ideation or attempts (BD-ASD-S), were compared to 17 adolescents with BD and HF-ASD without suicidal ideation or attempts (BD-ASD-noS), and to 18 adolescents with BD and suicidal ideation or attempts without ASD (BD-noASD-S), using a structured assessment methodology. Individuals with BD-ASD-S had a higher intelligence quotient, more severe clinical impairment, more lethality in suicide attempts, more internalizing symptoms, less impulsiveness, and lower social competence. Severity of ASD traits in individuals and parents did not correlate with suicidal risk. Some dimensions of resilience were protective in terms of repulsion by life and attraction to death. Main limitations are the small sample size, the lack of a control group of typically developing adolescents. However, a better understanding of the specificities of bipolar HF-ASD individuals with suicidality may improve prevention and treatment strategies.

Investigating the Relationship between Autistic Traits, Ruminative Thinking, and Suicidality in a Clinical Sample of Subjects with Bipolar Disorder and Borderline Personality Disorder

“…These findings may lead to hypothesize a greater load of autism spectrum features and, possibly, of neurodevelopmental alteration severity, in BD than in BPD [ 55 ]. However, in line with previous studies in this field, our results highlighted higher ruminative thinking and suicidality tendencies in both the clinical groups than in the CTL group, without significant differences between BD and BPD subjects [ 16 , 20 , 36 , 37 , 38 ]. Suicidal thoughts seem to be very common among individuals with ASD [ 56 , 57 ].…”

“…Noticeably, a recent study highlighted that also subjects with autistic traits show an increased suicidality risk, without significant differences with respect to the risk reported among individuals with ASD [ 25 ]. Previous studies also reported higher levels of suicidal ideation among both BD and BPD subjects with comorbid autistic traits [ 16 , 20 , 36 , 41 ].…”

“…Moreover, significantly higher rates of anxiety disorders and significantly lower rates of substance use disorders were found in BD subjects with autistic traits [ 20 ]. While BD is also known to be associated with a high risk for suicidality, it has been reported that suicide ideation and behaviors may be markedly increased in individuals with both BD and ASD, and in particular among those with high-functioning ASD [ 36 ]. A recent study highlighted that, among subjects with BD, individuals with autistic traits show a higher suicidality and more severe depressive symptoms [ 20 ].…”

“…Conversely, Anckarsater et al found a 12.2% prevalence of BPD in 74 individuals with ASD [ 44 ]. Another link between autism spectrum and BPD is the shared vulnerability towards traumatic events, which seems to lead in these subjects to higher rates of stress-related symptoms, eventually worsening the clinical picture [ 36 , 45 , 46 , 47 ]. A more recent study highlighted not only a higher presence of autistic traits among individuals with BPD, but also a link between autistic traits and greater suicidality risk in this population [ 16 ].…”

Comportamiento suicida en el trastorno del espectro autista

“…De hecho, los estudios previos señalan como limitante este aspecto no considerado. No obstante, algunas investigaciones mencionan que la red del apoyo social (familiares, amigos y comunidad) y la misma calidad de este apoyo, es un factor de protección en la presencia de pensamientos suicidas (Hedley et al, 2018), como también el apoyo tangible vinculado a la disponibilidad y ayuda sustancial (Hedley et al, 2017); mientras que otro estudio señala que algunas dimensiones de la resiliencia, como las competencias personales (capacidad personal, perseverancia y motivación), los estilos estructurados (capacidad de planificación y organización para los objetivos personales) y los recursos sociales (percepción de la red social de apoyo) son factores protectores en relación al desprecio por la vida y atracción por la muerte (Masi et al, 2020). Aquellos factores de protección son importantes para la adaptación del contexto, puesto que es crucial que las personas con TEA dispongan de recursos suficientes para afrontar los síntomas característicos y los problemas sociales, además de que reducen los comportamientos suicidas y fomentan la adherencia al tratamiento.…”