Suicidality in Adolescents and Adults with and without an Autism Spectrum Condition

Background: Recent research has shown that adults with Autism Spectrum Conditions (ASC) report significantly increased rates of suicidality compared to the general population and other clinical groups. Self-reported autistic traits and history of depression have been shown to be significant risk factors for suicidal ideation, plans and attempts in this clinical group (Cassidy et al., 2014). However, there is still very little research exploring suicidal ideation, suicide plans, suicide attempts or non-suicidal self-injury in those with ASC and the associated risk factors. It is also unknown whether autistic traits are a risk factor for suicidality in the general population.

Objectives: 1) To compare the rate of suicidality, and non-suicidal self-injury in adolescents and adults with ASC to; a) typically developing (TD) adults, and b) a previous patient sample diagnosed with Asperger Syndrome (AS) in adulthood; 2) To explore risk factors for suicidality and non-suicidal self-injury in adolescents and adults with and without ASC.

Methods: 25 adolescents and adults with ASC were recruited from a Belgium clinic, and 43 adolescents and adults without ASC were recruited from online adverts. Participants completed an online survey including the Autism Spectrum Quotient (AQ), age diagnosed with ASC, lifetime experience of suicidal ideation, suicide plans, suicide attempts, and non-suicidal self-injury. 

Results: Mean age of ASC diagnosis was 21.4 years (range 13-45, SD 10.7). Participants with and without ASC were matched on age (p=0.2) and education status (p=0.6). Self-reported rates of suicidal ideation in the current ASC sample (60%) were not significantly different to rates reported in a UK clinic sample diagnosed with AS in adulthood (66%, p=0.5). Compared to the TD group, participants with ASC were significantly more likely to report lifetime experience of suicidal ideation (60% vs 25.6%, OR 1.8, p<0.01); suicide plans (32% vs 4.7%, OR 3.5, p<0.01); and non-suicidal self-injury (28% vs 7%, OR 2.3, p=0.02); but not suicide attempts (16% vs 4%, p=0.1). In the TD group, self-reported autistic traits were significantly correlated with lifetime experience of suicidal ideation (p=0.01), suicide plans (p<0.001), and suicide attempts (p<0.01), but not non-suicidal self-injury (p=0.26). 

Conclusions: Results confirm consistently high rates of suicidal ideation in adolescents and adults with ASC, in approximately two thirds of patients. Participants with ASC in the current sample were significantly more likely to have experienced suicidality and non-suicidal self-injury than age and education matched controls. Self-reported autistic traits were also a significant risk factor for suicidality in the general population. These results suggest an association between autistic traits, and increased risk of suicidality. This highlights the need for heightened vigilance for suicidality in people with ASC.