Autistic Traits and Suicidal Thoughts, Plans, and Self-Harm in Late Adolescence: Population-Based Cohort Study

Abstract

ObjectiveTo examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years.MethodWe examined associations between ASD diagnosis and 4 dichotomized ASD traits (social communication, pragmatic language, repetitive behavior, and sociability) with suicidal and nonsuicidal self-harm, suicidal thoughts, and suicidal plans at age 16 years in 5,031 members of the United Kingdom−based birth cohort study the Avon Longitudinal Study of Parents and Children. We assessed whether any associations were explained by depressive symptoms in early adolescence measured by the Short Moods and Feelings Questionnaire at 12 years.ResultsChildren with impaired social communication had a higher risk of self-harm with suicidal intent (relative risk [RR] = 2.14, 95% CI = 1.28–3.58), suicidal thoughts (RR = 1.42, 95% CI = 1.06–1.91), and suicidal plans (RR = 1.95, 95% CI = 1.09–3.47) by age 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and outcomes, although these analyses were imprecise because of small numbers. There was also no evidence of an association between other autism traits and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at 12 years.ConclusionSocial communication impairments are an important autistic trait in relation to suicidality. Early identification and management of depression may be a preventative mechanism, and future research identifying other potentially modifiable mechanisms may lead to interventions against suicidal behavior in this high-risk group.

Association of Autistic Traits With Depression From Childhood to Age 18 Years

“…The lack of a general population group in previous studies makes it difficult to conclude whether the trajectories of depressive symptoms in the autistic population differ from those of the general population, 29 , 30 , 31 , 32 a limitation in the literature that our study attempted to address. Our findings suggesting that difficulties in social communication may have stronger associations with future depression than other autistic traits have also been reported for outcomes of suicidal thoughts and behaviors 33 and are consistent with the concept of fractionation of component features of the autism spectrum. 4 However, although social communication difficulties are an important feature of autism, they may occur independently in the population or within the context of other psychiatric diagnoses.…”

A 20‐year study of suicide death in a statewide autism population

“…Because suicide is a relatively rare occurrence, and ASD affects approximately 2% of the population, some researchers have opted to examine relationships between suicidality and autistic traits within samples of individuals without an ASD diagnosis. For example, Culpin et al [2018] recently identified a significant relationship between social communication impairments and suicidal intent among over 5,000 youth in the U.K. (adjusted RR = 2.14, P = 0.004). In a sample of 163 young adults in the U.K., Pelton and Cassidy [2017] also found that self-reported autistic traits predicted suicidal behavior in mediation models, with significant indirect effects found through both perceived burdensomeness (P = 0.001) and thwarted belonging (P = 0.001).…”

Suicidality in Children with Elevated Autistic Traits

“…Few studies have analyzed pathways leading to an increased suicide risk in autistic children. Culpin et al [2018] reported that approximately one-third of the elevated risk of self-harm with suicidal thoughts in adolescents A B C Figure 2. The mediation effect of anxiety/depression for the association between autistic traits and three suicide outcomes.…”

“…From a public health perspective, exploring whether elevated autistic traits are predictive of suicidality in individuals with or without an ASD diagnosis can be useful for suicide prevention. We identified only one population-based study on suicidality in adolescents with ASD and autistic traits [Culpin et al, 2018]. This UK study revealed that impaired social communication, rather than an ASD diagnosis, was a significant predictor of suicidality.…”