Suicidality in autistic youth: A systematic review and meta-analysis

O’Halloran, Laura; Coey, P.; Wilson, Charlotte

doi:10.1016/j.cpr.2022.102144

Cited by 48 publications

(39 citation statements)

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“…Similarly, prevalence of suicidal ideation and suicidal behaviours in autistic samples under the age of 18 is found to range between 11 and 73% [20]. Possible explanations for this variation likely include a combination of diverse study and participant level characteristics, such as differences in sample size, recruitment from clinical or nonclinical settings [21,22], and the way that suicidality is measured, reported, and defined [18]. Moreover age, gender and presence of co-occurring ID in autistic participants also differ greatly across samples as sources of variability [18].…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

et al. 2023

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Background Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. Aims To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. Results Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9–40.5), suicide plans 21.9% (13.4–30.4), and suicidal attempts and behaviours 24.3% (18.9–29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. Conclusions The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.

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Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

et al. 2023

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“…They also show similar trends to LGBTQ+ people in terms of poorer mental health outcomes compared to neurotypical people (e.g. O'Halloran et al, 2022;Tung et al, 2016), and as the neurotype-minority this can be understood through the same Minority Stress framework. This is a particularly prudent lens as research has suggested that neurodivergent people are more likely to identify as gender diverse and/or lesbian, gay, bisexual, or asexual, when compared to the population average (van der Miesen et al, 2016;George & Stokes, 2018) this is potentially related to how neurodivergent people experience and respond to social norms, enabling greater freedom of expression and disclosure (Ehrensaft, 2018).…”

Section: Intersectionality: Neurodiversity and Lgbtq+ Studentsmentioning

confidence: 69%

“…These findings suggest that Queer and neurodivergent students in our sample were more familiar with mental health as a construct, and more aware of their personal mental wellbeing than their neurotypical and cisgender-heterosexual peers. This is a reasonable interpretation given we know that the rate of mental health difficulties among LGBTQ+ and neurodivergent people is much higher than the population average (O'Halloran et al, 2022;King et al, 2008); it may be that students who mentioned their mental wellbeing in their responses had prior experience with mental health difficulties and thus were more attuned to changes in their mental wellbeing during the transition to online/blended learning. Alternatively, the students who exhibited poorer wellbeing in our study may have experienced drops in wellbeing regardless of teaching method over the preceding two years, due to other pandemic-related stressors (O'Connor et al, 2021), or personal predisposition to mental health difficulties as an individual with demographic risk-factors.…”

Section: Implications and Place In Literaturementioning

confidence: 86%

Blended Learning Experiences of LGBTQ+ and Neurodivergent Students: A mixed-methods study

Jarvis¹,

Nordmann²

2022

Preprint

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The COVID-19 pandemic has fundamentally altered teaching and learning practices in higher education, with academic, social, and psychological consequences for students. The pivot to online and blended-learning models across has the potential to impact belongingness and social adjustment in students across identity groups – including students who identify as LGBTQ+, who have previously been shown to have lower perceptions of belongingness and social adjustment in the university context (Sotardi et al., 2021). This partial replication applied a mixed-methods, intersectional lens to investigate student belonging amongst LGBTQ+ and neurodivergent students.We found that belonging and social adjustment were predictors of academic self-efficacy for all students, but particularly LGBTQ+ students, during blended learning. Neurodivergent students demonstrated significantly lower wellbeing and academic self-efficacy than their neurotypical peers. All students we surveyed acknowledged that blended learning was associated with both benefits and challenges in the academic social spheres. These included increased flexibility and accessibility, but also difficulties with engagement, motivation, and socialising. However, the discourse among LGBTQ+ and neurodivergent students differed in that it explicitly referenced negative impacts to mental wellbeing, as well as the distortion of the university experience and student identity. They also referred to the importance of identity-based peer relationships in supporting their wellbeing.Our results suggest that future research should focus on the intersection of LGBTQ+ and neurodivergent students, as well as how universities can implement a hybrid model that offers the benefits of a blended-learning model without detracting from student engagement, motivation, and social opportunities for LGBTQ+ and neurodivergent students.

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“…Anxiety and depressive disorders also co-occur more frequently in people with ASD than those without ASD (20% vs 7% for anxiety disorder and 11% vs 5% for depressive disorders) . In older children, adolescents, and adults, coexistent mood disorders and related behaviors (eg, depression and suicidality) may greatly contribute to reduced quality of life and increased mortality . Severe behaviors, such as aggression and self-injury, may occur with ASD .…”

Section: Discussionmentioning

confidence: 99%

“…3 In older children, adolescents, and adults, coexistent mood disorders and related behaviors (eg, depression and suicidality) may greatly contribute to reduced quality of life and increased mortality. 41 Severe behaviors, such as aggression and selfinjury, may occur with ASD. 42 People with ASD are at increased risk of specific medical conditions, such as epilepsy (21% in people with ASD and intellectual disability and 8% in those without intellectual disability vs 0.8% in a general population sample), 43,44 feeding problems (eg, focus on specific foods, sensitivity to textures), 45 motor coordination difficulties such as trouble coordinating movements between the left and right side of the body or problems maintaining their posture (37% vs 5%), 46,47 gastrointestinal conditions (eg, constipation [22%]), 48 and sleep difficulties (13% vs 5%) 3 compared with those without ASD.…”

Section: Clinical Presentationmentioning

confidence: 99%

Autism Spectrum Disorder

Hirota

King

2023

JAMA

193

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ImportanceAutism spectrum disorder (ASD), characterized by deficits in social communication and the presence of restricted, repetitive behaviors or interests, is a neurodevelopmental disorder affecting approximately 2.3% children aged 8 years in the US and approximately 2.2% of adults. This review summarizes evidence on the diagnosis and treatment of ASD.ObservationsThe estimated prevalence of ASD has been increasing in the US, from 1.1% in 2008 to 2.3% in 2018, which is likely associated with changes in diagnostic criteria, improved performance of screening and diagnostic tools, and increased public awareness. No biomarkers specific to the diagnosis of ASD have been identified. Common early signs and symptoms of ASD in a child’s first 2 years of life include no response to name when called, no or limited use of gestures in communication, and lack of imaginative play. The criterion standard for the diagnosis of ASD is a comprehensive evaluation with a multidisciplinary team of clinicians and is based on semistructured direct observation of the child’s behavior and semistructured caregiver interview focused on the individual’s development and behaviors using standardized measures, such as the Autism Diagnostic Observation Schedule-Second Edition and the Autism Diagnostic Interview. These diagnostic measures have sensitivity of 91% and 80% and specificity of 76% and 72%, respectively. Compared with people without ASD, individuals with ASD have higher rates of depression (20% vs 7%), anxiety (11% vs 5%), sleep difficulties (13% vs 5%), and epilepsy (21% with co-occurring intellectual disability vs 0.8%). Intensive behavioral interventions, such as the Early Start Denver Model, are beneficial in children 5 years or younger for improvement in language, play, and social communication (small to medium effect size based on standardized mean difference). Pharmacotherapy is indicated for co-occurring psychiatric conditions, such as emotion dysregulation or attention-deficit/hyperactivity disorder. Risperidone and aripiprazole can improve irritability and aggression (standardized mean difference of 1.1, consistent with a large effect size) compared with placebo. Psychostimulants are effective for attention-deficit/hyperactivity disorder (standardized mean difference of 0.6, consistent with a moderate effect size) compared with placebo. These medications are associated with adverse effects including, most commonly, changes in appetite, weight, and sleep.Conclusions and RelevanceASD affects approximately 2.3% of children aged 8 years and approximately 2.2% of adults in the US. First-line therapy consists of behavioral interventions, while co-occurring psychiatric conditions, such as anxiety or aggression, may be treated with specific behavioral therapy or medication.

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Suicidality in autistic youth: A systematic review and meta-analysis

Cited by 48 publications

References 125 publications

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability

Blended Learning Experiences of LGBTQ+ and Neurodivergent Students: A mixed-methods study

Autism Spectrum Disorder

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