Are people with autism more at risk of suicidality?

With the rise of suicide among children and adolescents, there’s been a push to understand who might be at increased risk of suicide. A recent investigation published in JAMA Network Open examined whether people who have autism spectrum disorder are at increased risk of both suicide attempts and suicide when compared to those without autism spectrum disorders.¹

The researchers used nationwide register data from January 1995 to December 2016 to find information on Danish citizens aged 10 years and older. The inclusion age of 10 or older was selected because both suicide attempts and death by suicide are relatively rare for children who are younger. Suicide attempts were identified when a person went to an emergency department or psychiatric hospital and were given the following codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes: X60 to X84 or Y87.0 or a care provider noted the reason for the visit was self-harm. Death by suicide was noted when there was a record of the same ICD-10 codes or manner of death was noted as suicide.

From a population of 6,559,266 people, 35,020 were given a diagnosis of autism spectrum disorder, a majority of which were male. Within the whole population, 64,109 suicide attempt incidents and 14,197 death by suicides were found, with 587 attempts and 53 deaths occurring in people with autism spectrum disorder. Overall there was a 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) in people who had autism spectrum disorder than those who didn’t have the disorder. When compared to male individuals with autism spectrum disorder, the aIRR for a suicide attempt was 4.41-fold (95% CI, 3.74-5.19) higher in females and even among those without autism spectrum disorder, females had a 1.41-fold (95% CI, 1.39-1.43) higher aIRR than their male counterparts. All age groups of people with autism spectrum disorder had increased rates of suicide attempts. Additionally, the researchers that noted an increase in attempts and death by suicide in participants with autism spectrum disorder who had at least 1 other comorbid disorders, with 542 of the individuals with autism spectrum disorder who attempted suicide having at least 1 and 48 of the individuals with autism spectrum disorder who died by suicide also having at least 1 comorbid diagnosis.

The researchers concluded that people with autism spectrum had a higher rate of death by suicide and suicide attempt and that psychiatric comorbidity was a major risk factor. Because the risk factors for this population are different from those in the general population, a tailored suicide prevention program should be used.

Reference

1. Kõlves K, Fitzgerald C, Nordentoft M, Wood S, Erlangsen A. Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Netw Open. 2021;4(1):e2033565. doi:10.1001/jamanetworkopen.2020.33565