Autism and autistic traits in those who died by suicide in England

Abstract

Background Autism and autistic traits are risk factors for suicidal behaviour. Aims To explore the prevalence of autism (diagnosed and undiagnosed) in those who died by suicide, and identify risk factors for suicide in this group. Method Stage 1: 372 coroners’ inquest records, covering the period 1 January 2014 to 31 December 2017 from two regions of England, were analysed for evidence that the person who died had diagnosed autism or undiagnosed possible autism (elevated autistic traits), and identified risk markers. Stage 2: 29 follow-up interviews with the next of kin of those who died gathered further evidence of autism and autistic traits using validated autism screening and diagnostic tools. Results Stage 1: evidence of autism (10.8%) was significantly higher in those who died by suicide than the 1.1% prevalence expected in the UK general alive population (odds ratio (OR) = 11.08, 95% CI 3.92–31.31). Stage 2: 5 (17.2%) of the follow-up sample had evidence of autism identified from the coroners’ records in stage 1. We identified evidence of undiagnosed possible autism in an additional 7 (24.1%) individuals, giving a total of 12 (41.4%); significantly higher than expected in the general alive population (1.1%) (OR = 19.76, 95% CI 2.36–165.84). Characteristics of those who died were largely similar regardless of evidence of autism, with groups experiencing a comparably high number of multiple risk markers before they died. Conclusions Elevated autistic traits are significantly over-represented in those who die by suicide.

Clinical Characteristics of Youth with Autism or Developmental Disability during Inpatient Psychiatric Admission

“…Those with ASD/DD had higher rates of externalizing features relative to peers, but lower rates of depression, anxiety, and suicidal ideation and attempts. This contrasts with outpatient data indicating heightened internalizing disorders in ASD (e.g., [ 4 ]), as well as with elevated rates of suicidal ideation and behavior among adults with ASD [ 29 , 30 ].…”

The relevance of the interpersonal theory of suicide for predicting past-year and lifetime suicidality in autistic adults

“…Sample size calculations were based on Pelton et al [ 9 ], who reported effect sizes ( f 2 ) of 0.11 (the upper end of small) and 0.18 (medium) in regression analyses for suicide ideation and attempts in autistic people. For the number of predictors in our own models of suicide ideation [ 5 ] and attempts [ 7 ], with power set at 90% and predicted effect size as small (in order to be conservative), minimum required sample sizes would have been 156 and 174 respectively.…”

“…Suicide ideation, attempts and deaths are unacceptably high in autistic adults without intellectual disabilities [ 1 – 5 ]. Factors associated with suicide ideation and attempts include loneliness and unmet support needs [ 6 , 7 ], self-injury [ 6 , 8 ], psychiatric illnesses and post-traumatic symptoms [ 4 , 9 ], rumination and low self-worth [ 10 ], and the extent to which individuals camouflage their autism [ 6 ].…”

School Distress in UK school children: A story dominated by neurodivergence and unmet needs

“…The current research exposes the very real cost of such policies to autistic, or otherwise neurodivergent, children and young people’s mental health. These findings must also be considered with respect to autistic individuals’ increased vulnerability to severe mental health difficulties, suicidality (110), attempted suicide (142), and death by suicide (111, 112), with rates of suicidal ideation and suicide attempts being significantly higher for autistic children (14%) than for their neurotypical peers (0·5%) (113). In addition to such research showing increased risk of suicide in autistic individuals broadly, Hirvikoski et al’s study using population-level data from Sweden (112) found that autistic people without a co-morbid intellectual disability are more likely to die by suicide (odds ratio = 9.40).…”

“…Such elevated scores are of concern, not least because higher anxiety severity is associated with a lower quality of life in both autistic and non-autistic children with anxiety disorders (108), and in autistic CYP more generally (107,109). Moreover, such scores need to be considered with respect to the high prevalence of suicidality and death by suicide documented in autistic individuals e.g., (110)(111)(112)(113) (see below for further discussion). Hence, supporting individual CYP who are experiencing such levels of anxiety, and their families, should be first and foremost in the minds of the educational and health-care professionals surrounding these CYP.…”