Measurement Properties of Tools Used to Assess Suicidality in Adults with and without Autism Spectrum Conditions: A Systematic Review

Background: Recent research has shown significantly increased rates of suicidal thoughts, behaviours and death by suicide among adults with Autism Spectrum Conditions (ASC), and hence a need to effectively assess suicidality in research and clinical practise. However, it is unclear what tools if any are currently available to assess suicidality in people with ASC, or whether tools used in the general population need to be adapted for this group.

Objectives: 1) To identify tools used to assess suicidality in adults with and without ASC; and 2) To evaluate these tools for their appropriateness and measurement properties.

Methods:  Electronic databases including Medline, Psychinfo, Web of Knowledge, Cochrane database and registers were searched for studies of suicidality in a) adults with ASC, and without co-morbid learning disability; and b) adults from the general population, and without any co-morbid conditions. Articles examining the measurement properties of these identified tools were then searched for using a methodological filter in PubMed, and the quality of the evidence for each tool evaluated using the COSMIN checklist.

Results: No studies were identified which utilised a validated tool to assess suicidality in adults with ASC. Twenty-two articles were identified which have utilised 12 tools to assess suicidality in general population adults, 4 of which had been used frequently with evidence of validity. These 4 tools were evaluated for the quality of the evidence of their measurement properties.

Conclusions: Overall 3 tools were found which were robust in their measurement properties; the Beck Scale for Sucide Ideation, the Columbia Suicide Severity Rating Scale, and the Suicide Behaviour Questionnaire Revised. However, none of these scales have yet been used to assess suicidality amongst those with ASC. Future research needs to adapt and validate these tools for adults with ASC. This is key to ensure that suicide risk is properly assessed in this high risk group in future research and clinical practise.