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People with autism are more than 3 times as likely to attempt suicide

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Peer-reviewed: This work was reviewed and scrutinised by relevant independent experts.

Observational study: A study in which the subject is observed to see if there is a relationship between two or more things (eg: the consumption of diet drinks and obesity). Observational studies cannot prove that one thing causes another, only that they are linked.

People: This is a study based on research using people.

Australian-led research looked at rates of suicide attempts and suicide among autistic and non-autistic individuals in more than 6 million Danish people over the age of 10, and say those with a diagnosed autism spectrum disorder had more than 3-fold higher rates of suicide attempt and suicide compared with people without autism. Having an additional mental health issue put autistic people at a particularly high risk of attempting suicide - more than 90 per cent of people with autism who attempted or died by suicide had an additional mental health condition, the researchers say. Tailored suicide prevention strategies could help address the issue, they suggest.

Journal/conference: JAMA Network Open

Link to research (DOI): 10.1001/jamanetworkopen.2020.33565

Organisation/s: Griffith University, The Australian National University

Funder: This study was supported by the Danish Health Foundation and by the Griffith University Research Fellowship.

Media release

From: Griffith University

Danish study finds link between ASD and suicidal behaviour

A study of the Danish population aged 10 years and over has found those diagnosed with autism spectrum disorder (ASD) were over three times more likely to attempt suicide and to die by suicide.

The study analysed whether people with ASD had higher rates of suicide attempt and suicide when compared to people with no ASD using national register data from 1995-2016 and risk factors of suicidal behaviours in those with ASD.

The results showed the incidence rates of suicide attempt were 266.8 per 100,000 people diagnosed with ASD and 63.4 for the rest of the population.

“Lack of social integration, unemployment, and psychiatric disorders are common in adults with ASD, the same factors are traditionally associated with suicidal behavior,” said lead author Dr Kairi Kolves from the Australian Institute for Suicide Research and Prevention.

“But there is scant evidence showing a link between ASD and suicidality from large-scale studies. Ours is the first to show an elevated rate of suicide attempt and suicide in persons diagnosed with ASD, after adjusting for sex, age and time period, in a nationwide cohort study.

“Factors, which have been identified as protective against suicide attempt in the general population, such as older age and higher education were not found to have this effect in those with ASD, and some factors such as being married or cohabiting and employed were linked to less impact among those with ASD.”

The majority of factors associated with suicide in the general population such as being male or not in a relationship, were not associated with suicide among those with ASD.

Psychiatric comorbidity was found to be a major risk factor with over 90% of those with ASD, who attempted or died by suicide, having another comorbid condition, with anxiety and affective disorders being most common.

Dr Kolves said higher levels of cognitive functioning and education could imply a wider exposure to different risk factors.

“But also the self-realisation of rather limited social and problem-solving skills may increase self-imposed pressure to cope with and alter expectations of success.

“These factors are crucial for assessing suicide risk by practitioners working with people with ASD, particularly for those with other psychiatric comorbidities.”

She said the reason for linking ASD to suicidality, particularly in adults, might be a combination of social isolation and poor access to care.

While it is possible that an inability to establish and retain social and intimate relationships may severely affect adult women with ASD, they might also be diagnosed and treated later in the course of the disorder by being able to camouflage their autistic traits.

“This might explain their higher rates of suicidal behavior (4.6 times higher than males) which is supported by findings from Swedish linkage studies where higher risk of suicidal behavior was noted for females with ASD compared to males.

“A number of risk factors are different from those in the general population which suggests the need for tailored suicide prevention activities such as more robust screening procedures, early interventions to improve social skills of children and adolescents with ASD and the expanding of access to care.”

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