Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications
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Purpose of the Review
There is a heightened risk of suicide in Autism Spectrum Disorder (ASD). An up-to-date systematic review was conducted for studies examining suicide in ASD that were published in the past 5 years.
Four previous systematic reviews were identified. The most recent review included studies published between 1995 and 2014. Combining data cross studies, prevalence of suicide attempts in ASD was estimated to be 7 to 47%, and suicidal ideation was 72%.
The current review included 13 studies. Compared to previous reviews, we identified a shift to the use of larger cohorts, including one population-based study. Prevalence rates for suicidal ideation were 11 to 66% and suicidal attempts were 1 to 35%. One study reported that 0.31% of premature deaths in ASD were due to suicide, significantly higher than general population controls. Further theoretical and empirical work is needed to identify causal mechanisms underlying suicidal risk in people with ASD.
KeywordsAutism spectrum disorder Ideation Prevalence Review Suicidal behavior Suicide
Compliance with Ethical Standards
Conflict of Interest
Darren Hedley reports grants from DXC Technology, Australian Government Department of Human Services, and Australian Government Department of Defense.
Mirko Uljarević reports a grant from Autism CRC.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Christensen DL, Baio J, Braun KV, Bilder D, Charles J, Constantino JN, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2012. Centers Dis Control Prev MMWR Surveill Summ. 2016;65(SS-3):1–23.Google Scholar
- 4.Evans DW, Canavera K, Kleinpeter FL, Maccubbin E, Taga K. The fears, phobias and anxieties of children with autism spectrum disorders and Down syndrome: comparisons with developmentally and chronologically age matched children. Child Psychiatry Hum Dev. 2005;36(1):3–26. https://doi.org/10.1007/s10578-004-3619-x.CrossRefPubMedGoogle Scholar
- 7.Uljarevic M, Richdale AL, McConachie H, Hedley D, Cai RY, Merrick H, et al. The Hospital Anxiety and Depression scale: factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism Res. 2017; https://doi.org/10.1002/aur.1872.
- 9.Humphreys JS, Gringras P, Blair PS, Scott N, Henderson J, Fleming PJ, et al. Sleep patterns in children with autistic spectrum disorders: a prospective cohort study. Arch Dis Child. 2014;99(2):114–8. https://doi.org/10.1136/archdischild-2013-304083.
- 16.•• Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S. Premature mortality in autism spectrum disorder. Br J Psychiatry. 2016;208:232–8. Examined all-case and cause-specific mortality in ASD and matched controls from Swedish population-based register. Compared to controls, increased risk of premature death in ASD highest for diseases of the nervous system (OR = 7.49) and suicide (OR = 7.55).CrossRefPubMedGoogle Scholar
- 17.Meyer RE, Salzman C, Youngstrom EA, Clayton PJ, Goodwin FK, Mann JJ, et al. Suicidality and risk of suicide—definition, drug safety concerns, and a necessary target for drug development: a consensus statement. J Clin Psychiatry. 2010;71(08):e1–e21. https://doi.org/10.4088/JCP.10cs06070blu.
- 18.World Health Organization. World Health Statistics 2017: monitoring health for the SDGs, sustainable developmental goals. Geneva: World Health Organization; 2017.Google Scholar
- 19.Casey P, Dunn G, Kelly BD, Lehtinen V, Dalgard OS, Dowrick C, et al. The prevalence of suicidal ideation in the general population: results from the Outcome of Depression International Network (ODIN) study. Soc Psychiatry Psychiatr Epidemiol. 2008;43(4):299–304. https://doi.org/10.1007/s00127-008-0313-5.CrossRefPubMedGoogle Scholar
- 21.• Segers M, Rawana J. What do we know about suicidality in autism spectrum disorders? A systematic review. Autism Res. 2014;7:507–21. High quality systematic review of suicide in ASD. Google Scholar
- 24.Kato K, Mikami K, Akama F, Yamada K, Maehara M, Kimoto K, et al. Clinical features of suicide attempts in adults with autism spectrum disorders. Gen Hosp Psychiatry. 2013;35(1):50–3. https://doi.org/10.1016/j.genhosppsych.2012.09.006.
- 26.Shtayermman O. Peer victimization in adolescents and young adults diagnosed with Asperger's Syndrome: a link to depressive symptomatology, anxiety symptomatology and suicidal ideation. Issues Compr Pediatr Nurs. 2007;30(3):87–107. https://doi.org/10.1080/01460860701525089.CrossRefPubMedGoogle Scholar
- 28.•• Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry. 2014;1:142–7. Reported lifetime suicidal ideation (66%) and suicide plans or attempts (31%) in large sample of adults from the UK recently diagnosed with Asperger’s syndrome. Identified depression as important risk factor for suicidal behavior. CrossRefPubMedGoogle Scholar
- 29.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339(jul21 1):b2700. https://doi.org/10.1136/bmj.b2700.CrossRefPubMedPubMedCentralGoogle Scholar
- 30.Croen LA, Zerbo O, Qian Y, Massolo ML, Rich S, Sidney S, et al. The health status of adults on the autism spectrum. Autism. 2015;19(7):814–23. https://doi.org/10.1177/1362361315577517.
- 32.• Horowitz LM, Thurm A, Farmer C, Mazefsky C, Lanzillo E, Bridge JA, et al. Talking about death or suicide: prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. J Autism Dev Disord. 2017; https://doi.org/10.1007/s10803-017-3180-7. One of the few studies to report suicidal ideation (parent reported presence of talk about death or suicide) in youth with ASD with non-verbal IQ > 55. Identifed need for developmentally and ASD appropriate suicide risk screening instruments.
- 34.Paquette-Smith M, Weiss J, Lunsky Y. History of suicide attempts in adults with Asperger syndrome. Crisis. 2017;34:34–43.Google Scholar
- 35.Storch EA, Sulkowski ML, Nadeau J, Lewin AB, Arnold EB, Mutch P, et al. The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders. J Autism Dev Disord. 2013;43(10):2450–9. https://doi.org/10.1007/s10803-013-1795-x.CrossRefPubMedGoogle Scholar
- 36.Takara K, Kondo T. Autism spectrum disorder among first-visit depressed adult patients: diagnostic clues from backgrounds and past history. Gen Hosp Psychiatry. 2014;36(6):737–42. https://doi.org/10.1016/j.genhosppsych.2014.08.004.CrossRefPubMedGoogle Scholar
- 38.Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E. The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001;31(1):5–17. https://doi.org/10.1023/A:1005653411471.CrossRefPubMedGoogle Scholar
- 41.Rutter M, Bailey A, Lord C. The social communication questionnaire. Los Angeles: Western Psychol Serv; 2003.Google Scholar
- 43.Lord C, Rutter M, DiLavore PC, Risi S. Autism diagnostic observation schedule. Los Angeles: Western Psychological Services; 1999.Google Scholar
- 44.Lord C, Rutter M, DiLavore PC, Risi S, Gotham K, Bishop SL. Autism diagnostic observation schedule, second edition (ADOS-2) manual (part I): modules. Torrance: Western Psychological Services; 2012. p. 1–4.Google Scholar
- 45.Rutter M, Le Couteur A, Lord C. Autism diagnostic interview-revised. Torrance: Western Psychological Services; 2003.Google Scholar
- 47.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Glod M, Creswell C, Waite P, Jamieson R, McConachie H, South MD, et al. Comparisons of the factor structure and measurement invariance of the Spence Children's Anxiety Scale–Parent version in children with Autism Spectrum Disorder and typically developing anxious children. J Autism Dev Disord. 2017;47(12):3834–46. https://doi.org/10.1007/s10803-017-3118-0.CrossRefPubMedPubMedCentralGoogle Scholar
- 50.Jitlina K, Zumbo B, Mirenda P, Ford L, Bennett T, Georgiades S, et al. Psychometric properties of the Spence Children's Anxiety Scale: parent report in children with autism spectrum disorder. J Autism Dev Disord. 2017;47(12):3847–56. https://doi.org/10.1007/s10803-017-3110-8.
- 51.Magiati I, Lerh JW, Hollocks MJ, Uljarevic M, Rodgers J, McConachie H, et al. The measurement properties of the Spence Children's Anxiety Scale–Parent version in a large international pooled sample of young people with autism spectrum disorder. Autism Res. 2017;10(10):1629–52. https://doi.org/10.1002/aur.1809.
- 53.Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMedGoogle Scholar
- 54.Office of the Surgeon General and the National Action Alliance for Suicide Prevention. National strategy for suicide prevention: goals and objectives for action: a report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Strategic Direction 3: Treatment and Support Services. Washington, DC: US Department of Health & Human Services; 2012.Google Scholar
- 55.Hedley D, Uljarević M, Wilmot M, Richdale A, Dissanayake C. Understanding depression and thoughts of self-harm in autism: a potential mechanism involving loneliness. Res Autism Spectr Disord. 2018;46:1-7. https://doi.org/10.1016/j.rasd.2017.11.003.
- 56.Hedley D, Uljarević M, Foley K-R, Richdale A, Trollor J. Risk and protective factors underlying suicidal ideation in Autism Spectrum Disorder. Manuscript submitted for publication.Google Scholar