The Link Between Suicide and Autism

New research shows a strong increased risk of suicidality in autism.

Posted Feb 10, 2019

Until recently, suicide in the context of autism spectrum disorder (ASD) was rarely discussed.  Research over the last 5 years is changing this.  Whereas it is common to think of self-injurious behavior occurring in those with ASD who have more cognitive impairments or a younger age, it is now becoming evident that there may be an equal concern of suicide or suicidal behavior in teens with ASD who are more cognitively aware.

In 2014, a study in the United Kingdom found that out of 367 patients with Asperger disorder, 66% reported having suicidal thoughts and 35% reported suicide attempts or suicidal plans.  This rate of suicidality is higher than that seen in those with psychosis.  In this study 31% were depressed.  Depression was found to be a significant predictor of these suicidal thoughts and plans.  Also, those patients that rated their own autism traits as higher were more likely to have suicidal thoughts or behavior. (1)  This may indicate that those with ASD who are more aware of their symptoms or deficits are more likely to be depressed and suicidal.

Another study, using a national Taiwan database, found that 3.9% of those with ASD made a suicide attempt within 3.6 years compared to the 0.7% of the control group (without ASD) who attempted suicide within 6 years.  (2) This would then be a suicide attempt rate almost 10 times higher for those with ASD than for the general population. 

A 2018 study sought to discover if there were specific autism traits that were increasing the risk of suicidal thoughts or behavior.  They broke up autism traits into the four areas of social communication, pragmatic language, repetitive behavior, and sociability.  They found, by age 16, it was the trait of social communication that predicted suicidal thoughts, plans, and attempts.  This was at a rate of about twice that of the general population.  Those at the bottom 10% of social communication were most at risk for suicidal thoughts and behavior.  They also examined depressive symptoms at the age of 12 in these patients and found that depression accounted for about a third of the risk of suicidal thoughts and behavior.  (3) Thus, depression alone did not account for the full risk but it was significant. 

With all of this in mind, it is clear that those with ASD are at a much higher risk for suicide.  Furthermore, it may be that those with ASD who are more cognitively aware and have lower social communication skills may be at the highest risk for suicidal thoughts and behavior.  We can decrease this risk by recognizing and treating depression as early as possible, as well as by trying to improve social relationships and social skills as much as possible.  Social skills groups and even Applied Behavior Analysis can help with social communication.  Although not mentioned in these studies, it is also important to treat social anxiety disorder that is often present in those with ASD.  Social anxiety further impairs social development and leads to avoidance of social situations.  This makes any desire to make friends or improve social skills unbearable and difficult to bring to fruition, causing more feelings of loneliness and frustration.  Bullying must also be addressed as this prevents youth with ASD from developing socially and will also cause avoidance and depression.  If you are a parent, you should seek mental health treatment for your child in the form of therapies and/or medication when appropriate.

References

1.       Cassidy S. Bradley P., Robinson J. et al.  Suicidal ideation and suicide plans in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study.  Lancet Psychiatry.  2014; 1:142-147

2.       Chen MH, Pan TL, Lan WH, et al.  Risk of suicide attempts among adolescents and young adults with autism spectrum disorder:  a nationwide longitudinal follow-up study.  J Clin Psychiatry.  2017; 7: 78:e1174-e1179

3.       Culpin I, Mars B, Pearson RM, et al.  Autistic traits and suicidal thoughts, plans and self-harm in late adolescence:  population-based cohort study.  J Am Acad Child Adolesc Psychiatry.  2018;57:313-320.e6.