Gender Differences in the Suicide Attempts of Adolescents in Emergency Departments: Focusing on Individuals with Autism Spectrum Disorder

Abstract

Background: Few studies on gender-based diagnostic characteristics of adolescent suicide attempters in emergency departments (EDs) have included individuals with autism spectrum disorder (ASD). Objective: This study aimed to examine the clinical features of adolescent suicide attempts in EDs, focusing on gender differences and considering individuals with ASD. Method: Ninety-four adolescent patients, aged less than 20 years, who had attempted suicide and had been hospitalized in an emergency department, participated in this study. Psychiatric diagnoses according to DSM-IV criteria and clinical features were compared between male and female patients. Results: The number (%) of males was 15 (16.0), and that of females was 79 (84.0). The mean age (SD) of males was 17.1 (1.5), and that of females was 16.9 (1.6). The attempt methods were more serious, length of stay in the emergency room longer, and rate of outpatient treatment lower in males. In addition, suicide attempters with ASD were significantly more frequent in male. Adjusting for age and gender, adjustment disorder was significantly associated with the presence of suicide attempters with ASD using a multivariable logistic regression. Conclusion: Males were less likely to visit psychiatric service previous to attempting suicides, and may be likely to complete suicides. In addition, suicide attempters with ASD are characteristic in male, and likely to have comorbid adjustment disorder. ED visits offer a window of opportunity to provide suicide prevention interventions for adolescents, and therefore, psychiatrists in EDs have a crucial role as gatekeepers of preventing suicide reattempts, especially in adolescent males including individuals with ASD having adjustment disorder.

Suicide Leap of an 11-Year-Old Girl with Autism Spectrum Disorder

“…To prevent suicide re-attempts, it is critical to reduce risk factors, reinforce the protective function of families, 5,17 and rebuild parent-child relationships so that adolescents can easily seek help from their families. 5 To mitigate the risk caused by her adjustment disorder, we manipulated the environmental factor that triggered the patient's suicide attempts, her interpersonal relationships at school, by enrolling her in a special class in cooperation with the local community. In addition, to reinforce protective factors, it is crucial to utilize a psychiatric treatment method in which the child, family, and therapist carefully intervene with the patient's early developmental history.…”

“…In addition, to reinforce protective factors, it is crucial to utilize a psychiatric treatment method in which the child, family, and therapist carefully intervene with the patient’s early developmental history. 5 We intervened in the parent-child relationship after repeatedly listening to the patient’s personal history and addressing her hesitation to ask for help.…”

“…Case studies of ASD-related suicide attempts by adolescents have reported that background factors such as bullying increase the risk of patients with ASD attempting suicide, 4 that first-time suicide attempts are more likely to be fatal, 3 and that adjustment disorder comorbidity can increase the risk of ultimate suicide completion. 3,5,6 However, there is no information on approaches to prevent re-attempts by elementary school, aged children with ASD who have attempted suicide. Therefore, we report our experience of treating an 11-year-old girl (in the 6th grade of elementary school) with comorbid adjustment disorder and ASD after she was injured in a suicide leap from a great height.…”

Comportamiento suicida en el trastorno del espectro autista

“…La presencia de problemas en la salud mental también son factores de riesgo. La soledad y los trastornos de adaptación han sido descritos en este tipo de población (Jackson et al, 2018;Mikami et al, 2019). Sin embargo, los trastornos afectivos y la ansiedad al parecer son más frecuentes y persistentes.…”

“…Los estudios en personas con TEA informan que los métodos utilizados para intentar suicidarse frecuentemente en población adolescente que presentan ideación suicida son los saltos al vacío de alturas considerables, intoxicación por monóxido de carbono, envenenamiento, ahorcamiento y sobredosis de drogas, siendo este último más particular en mujeres a comparación de los hombres (Mikami et al, 2019); mientras que un estudio en población adulta señala que el ahorcamiento (44,4 %) y los saltos de altura (22,2 %) son métodos más comunes (Takara y Kondo, 2014). Por otro lado, al parecer el método más letal, las armas de fuego, es poco frecuente en personas con TEA.…”