Suicide and non-fatal self-injury-related emergency department visits among individuals with autism spectrum disorder

Abstract

We analyzed the Healthcare Cost and Utilization State Emergency Department (ED) Databases and State Inpatient Databases for all individuals who were 2 years of age or older with at least one ED visit from 2011 to 2016 in New York to estimate the association between suicide and non-fatal injury-related ED visits and autism spectrum disorder (ASD). Our study included 14.4 million individuals with 43.5 million ED visits. Of those, 31,946 (0.2%) individuals had ASD accounting for 162,440 ED visits (0.4%). Compared to those without ASD, individuals with ASD had 2.1 more ED visits on average, higher shares of inpatient ED visits, more years of ED utilization, and higher prevalence of mental health-related comorbidities and diagnoses and self-injury-related ED visits. Among the ASD cohort, 6.1% had at least one self-injury-related ED visit compared to 2.2% among those without ASD. Using multivariable regressions adjusted for sociodemographic, clinical, contextual, and visit-level characteristics, we found that individuals with ASD were significantly more likely to have at least one self-injury-related ED visit compared to those without ASD. Our findings highlight the importance of raising awareness among caregivers and providers about the increased self-injury risk that individuals with ASD face and to tailor care delivery practices towards their needs. Lay abstract This study used data for 14.4 million individuals with 43.5 million emergency department visits from all hospitals in the state of New York to explore the association between suicide and non-fatal self-injury-related (self-injury) emergency department visits and autism spectrum disorder. Overall, we found that individuals with autism spectrum disorder had more emergency department visits and admissions through the emergency department, more years of emergency department utilization, and higher prevalence of mental health-related comorbidities. Individuals with autism spectrum disorder were also significantly more likely to have at least one self-injury-related emergency department visit compared to those without autism spectrum disorder. These results emphasize the need to raise awareness across both family caregivers and healthcare providers on the increased suicide and self-injury risks that individuals with autism spectrum disorder face and to improve care delivery practices. In addition, effort to promote and increase timely access to mental health care is an urgent priority for individuals with autism spectrum disorder.

Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada

“…5 Our findings corroborate these previous observations and highlight the importance of evaluating self-harm events and suicide death separately, stratified by sex, and accounting for confounders informing risk mechanismsparticularly psychiatric illnesses-especially because the latest meta-analyses could not summarize their roles owing to the lack of primary data. 4,8 Our findings of increased self-harm risks among autistic individuals are consistent with population-based findings from Sweden, 15,17 Denmark, 18 Finland, 19 Taiwan, 20 the UK, 22 and the US [11][12][13] that autism diagnosis is independently associated with risk of self-harm or suicide attempts, but the associations of self-harm or suicide attempts with psychiatric diagnoses are substantial and often larger than that of autism. Risks for suicidal behaviors span predisposing factors (eg, genetics, early-life adversity), developmental factors (eg, anxiety, impulsivity, executive dysfunction), and precipitating factors (eg, psychiatric illnesses), as well as social-contextual determinants (eg, social isolation, poor mental health care, access to lethal means).…”

“…Our findings of increased self-harm risks among autistic individuals are consistent with population-based findings from Sweden, Denmark, Finland, Taiwan, the UK, and the US that autism diagnosis is independently associated with risk of self-harm or suicide attempts, but the associations of self-harm or suicide attempts with psychiatric diagnoses are substantial and often larger than that of autism. Risks for suicidal behaviors span predisposing factors (eg, genetics, early-life adversity), developmental factors (eg, anxiety, impulsivity, executive dysfunction), and precipitating factors (eg, psychiatric illnesses), as well as social-contextual determinants (eg, social isolation, poor mental health care, access to lethal means) .…”

“…Population-based studies offer critical insights about suicide risks among autistic people and region-specific variations by sociocultural and health systems factors. So far, there are only a small number of such studies, from the US, [9][10][11][12][13] Sweden, [14][15][16][17] Denmark, 18 Finland, 19 Taiwan, 20,21 and the UK. 22 Suicide risk patterns can be sex-specific, with males more likely to die by suicide than females, and females experiencing more self-harm, suicidal ideation, and suicide attempts than males.…”

“…Population-based studies offer critical insights about suicide risks among autistic people and region-specific variations by sociocultural and health systems factors. So far, there are only a small number of such studies, from the US, 9 , 10 , 11 , 12 , 13 Sweden, 14 , 15 , 16 , 17 Denmark, 18 Finland, 19 Taiwan, 20 , 21 and the UK. 22 …”

European and US Aeromedical Authority Guidance for Neurocognitive Evaluation of Airline Pilots With Mental Disorders

“…However, these skills can degrade due to a range of work-related, mental health, and physiological challenges (Bor, Eriksen, Georgemiller, et al, 2024). The aim of neuropsychological evaluations of commercial pilots is to gauge whether there are cognitive and emotional limitations that may cause a risk to the safety of pilots, passengers, or third parties (Front, 2017). This evaluation is important because cognitive and psychological interaction can be a crucial factor in aircraft accidents (Nidos et al, 2018;Bor, Eriksen, & Vuorio, 2025).…”