Skip to main content

Brief Report: Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder

Abstract

Adults with autism spectrum disorder (ASD) are at increased risk of suicide compared to the general population. Research has yet to identify the mechanisms underlying this increased risk. This study examined perceived social support as a potential protective factor for depressive symptoms and suicidal ideation in 76 adults with ASD. Twenty-five percent of participants were in the clinical range for depression, and 20% reported recent suicidal ideation. Social support in the form of appraisal and belonging was not associated with depression or ideation; however the perceived availability of tangible (material) support indirectly acted on ideation through depression. The findings suggest that tangible support, but not appraisal or belonging, may act as an indirect protective factor against suicidality in ASD.

This is a preview of subscription content, access via your institution.

Fig. 1

Notes

  1. 1.

    The full SEM was run excluding participants (n = 12) who did not meet the recommended cut-off for ASD (≥65) on the AQ-Short (refer to “Appendix” for the figure). The exclusion of participants who did not meet the recommended cut-off did not affect the model. Result showed that depression had a direct effect on suicidal ideation (β = 0.61, p < .001). ISEL-12 Tangible Support had no direct effect on suicidal ideation (β = 0.046, p = .664), but showed an indirect effect through depression (β = −0.261, p = .037). Therefore, the indirect model was supported.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th edn.). Washington, DC: American Psychiatric Publishing.

    Book  Google Scholar 

  2. Arbuckle, J. L. (2016). Amos (version 24.0) [computer program]. Chicago: IBM SPSS.

    Google Scholar 

  3. Australian Bureau of Statistics (ABS). (2007). National survey of mental health and wellbeing: Summary of results, 2007 (cat. No. 4326.0). Canberra, ACT: Australian Bureau of Statistics.

    Google Scholar 

  4. Australian Bureau of Statistics (ABS). (2014). Autism in Australia, 2012: Labour force participation (cat. No. 4428.0). Canberra, ACT: Australian Bureau of Statistics.

    Google Scholar 

  5. Balfe, M., & Tantam, D. (2010). A descriptive social and health profile of a community sample of adults and adolescents with Asperger syndrome. BMC Research Notes, 3, 300.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17.

    Article  PubMed  Google Scholar 

  7. Barraclough, B., Bunch, J., Nelson, B., & Sainsbury, P. (1974). A hundred cases of suicide: Clinical aspects. The British Journal of Psychiatry, 125, 355–373.

    Article  PubMed  Google Scholar 

  8. Bauminger, N., & Kasari, C. (2000). Loneliness and friendship in high-functioning children with autism. Child Development, 71, 447–456.

    Article  PubMed  Google Scholar 

  9. Bjarnason, T. (1994). The influence of social support, suggestion and depression on suicidal behavior among Icelandic youth. Acta Sociologica, 37, 195–206.

    Article  Google Scholar 

  10. Bryan, C. J., & Rudd, M. D. (2006). Advances in the assessment of suicide risk. Journal of Clinical Psychology, 62, 185–200.

    Article  PubMed  Google Scholar 

  11. Buitelaar, J. K., van Engeland, H., de Kogel, K. H., de Vries, H., & van Hooff, J. A. (1991). Differences in the structure of social behaviour of autistic children and non-autistic retarded controls. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 32, 995–1015.

    Article  PubMed  Google Scholar 

  12. Cameron, I. M., Crawford, J. R., Lawton, K., & Reid, I. C. (2008). Psychometric comparison of PHQ-9 and HADS for measuring depression severity in primary care. British Journal of General Practice, 58, 32–36.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Casey, P., Dunn, G., Kelly, B. D., Lehtinen, V., Dalgard, O. S., Dowrick, C., & Ayuso-Mateos, J. L. (2008). The prevalence of suicidal ideation in the general population: Results from the Outcome of Depression International Network (ODIN) study. Social Psychiatry and Psychiatric Epidemiology, 43, 299–304.

    Article  PubMed  Google Scholar 

  14. Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: A clinical cohort study. Lancet Psychiatry, 1, 142–147.

    Article  PubMed  Google Scholar 

  15. Chioqueta, A. P., & Stiles, T. C. (2007). The relationship between psychological buffers, hopelessness, and suicidal ideation: Identification of protective factors. Crisis, 28, 67–73.

    Article  PubMed  Google Scholar 

  16. Cohen, S., & Hoberman, H. M. (1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13, 99–125.

    Article  Google Scholar 

  17. Cohen, S., Mermelstein, R., Kamarck, T., & Hoberman, H. M. (1985). Measuring the functional components of social support. In I. G. Sarason & B. R. Sarason (Eds.), Social support: Theory, research, and applications. The Hague: Martinus Niijhoff.

    Google Scholar 

  18. Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.

    Article  PubMed  Google Scholar 

  19. Corson, K., Gerrity, M. S., & Dobscha, S. K. (2004). Screening for depression and suicidality in a VA primary care setting: 2 items are better than 1 item. American Journal of Managed Care, 10, 839–845.

    PubMed  Google Scholar 

  20. Efron, B., & Tibshirani, R. (1993). An introduction to the bootstrap. Boca Raton, FL: Chapman & Hall/CRC.

    Book  Google Scholar 

  21. Gutierrez, P. M. (2006). Integratively assessing risk and protective factors for adolescent suicide. Suicide and Life-Threatening Behavior, 36, 129–135.

    Article  PubMed  Google Scholar 

  22. Hefner, J., & Eisenberg, D. (2009). Social support and mental health among college students. American Journal of Orthopsychiatry, 79, 491–499.

    Article  PubMed  Google Scholar 

  23. Hill, E., Berthoz, S., & Frith, U. (2004). Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229–235.

    Article  PubMed  Google Scholar 

  24. Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry, 208, 232–238.

    Article  PubMed  Google Scholar 

  25. Hoekstra, R. A., Vinkhuyzen, A. A., Wheelwright, S., Bartels, M., Boomsma, D. I., Baron-Cohen, S., … van der Sluis, S. (2011). The construction and validation of an abridged version of the autism-spectrum quotient (AQ-Short). Journal of Autism and Developmental Disorders, 41, 589–596.

    Article  PubMed  Google Scholar 

  26. Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., … Leboyer, M. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9, 1–9.

    Article  Google Scholar 

  27. Horowitz, L. M., Thurm, A., Farmer, C., Mazefsky, C., Lanzillo, E., Bridge, J., … Siegel, M. (2017). Talking about death or suicide: Prevalence and clinical correlates in youth with autism spectrum disorder in the psychiatric inpatient setting. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803-017-3180-7.

    Google Scholar 

  28. Humphrey, N., & Symes, W. (2010). Responses to bullying and use of social support among pupils with autism spectrum disorders (ASDs) in mainstream schools: A qualitative study. Journal of Research in Special Educational Needs, 10, 82–90.

    Article  Google Scholar 

  29. IBM Corp. (2016). IBM SPSS statistics for windows (Version 24.0) [Computer Program]. Armonk, NY: IBM Corp.

    Google Scholar 

  30. Kendler, K. S., Myers, J., & Prescott, C. A. (2005). Sex differences in the relationship between social support and risk for major depression: A longitudinal study of opposite-sex twin pairs. American Journal of Psychiatry, 162, 250–256.

    Article  PubMed  Google Scholar 

  31. Kleiman, E. M., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings from two nationally representative samples. Journal of Affective Disorders, 150, 540–545.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32, 509–515.

    Article  Google Scholar 

  33. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114, 163–173.

    Article  PubMed  Google Scholar 

  35. Lasgaard, M., Nielsen, A., Eriksen, M. E., & Goossens, L. (2010). Loneliness and social support in adolescent boys with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, 218–226.

    Article  PubMed  Google Scholar 

  36. Maenner, M. J., Smith, L. E., Hong, J., Makuch, R., Greenberg, J., & Mailick, M. R. (2013). An evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disability and Health Journal, 6, 8–17.

    Article  PubMed  Google Scholar 

  37. Martin, A., Rief, W., Klaiberg, A., & Braehler, E. (2006). Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population. General Hospital Psychiatry, 28, 71–77.

    Article  PubMed  Google Scholar 

  38. Mayes, S. D., Gorman, A. A., Hillwig-Garcia, J., & Syed, E. (2013). Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders, 7, 109–119.

    Article  Google Scholar 

  39. Mazefsky, C. A., Kao, J., & Oswald, D. P. (2011). Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders, 5, 164–174.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Mazurek, M. O. (2014). Loneliness, friendship, and well-being in adults with autism spectrum disorders. Autism: The International Journal of Research and Practice, 18, 223–232.

    Article  Google Scholar 

  41. Meadows, L. A., Kaslow, N. J., Thompson, M. P., & Jurkovic, G. J. (2005). Protective factors against suicide attempt risk among African American women experiencing intimate partner violence. American Journal of Community Psychology, 36, 109–121.

    Article  PubMed  Google Scholar 

  42. Merz, E. L., Roesch, S. C., Malcarne, V. L., Penedo, F. J., Llabre, M. M., Weitzman, O. B., … Gallo, L. C. (2014). Validation of Interpersonal Support Evaluation List-12 (ISEL-12) scores among English- and Spanish-Speaking Hispanics/Latinos from the HCHS/SOL Sociocultural Ancillary Study. Psychological Assessment, 26, 384–394.

    Article  PubMed  Google Scholar 

  43. Pagliaro, L. A. (1996). Adolescent depression and suicide: A review and analysis of the current literature. Canadian Journal of School Psychology, 11, 191–201.

    Article  Google Scholar 

  44. Poudel-Tandukar, K., Nanri, A., Mizoue, T., Matsushita, Y., Takahashi, Y., Noda, M., … Tsugane, S. (2011). Social support and suicide in Japanese men and women: The Japan Public Health Center (JPHC)-based prospective study. Journal of Psychiatric Research, 45, 1545–1550.

    Article  PubMed  Google Scholar 

  45. Qualtrics. (2017). Qualtrics (version 2.16) [computer program]. Provo, UT: Qualtrics.

    Google Scholar 

  46. Raja, M. (2014). Suicide risk in adults with Asperger’s syndrome. The Lancet Psychiatry, 1, 99–101.

    Article  PubMed  Google Scholar 

  47. Roberts, R. K., Roberts, C. R., & Chen, Y. R. (1998). Suicidal thinking among adolescents with a history of attempted suicide. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1294–1300.

    Article  PubMed  Google Scholar 

  48. Santomauro, D., Sheffield, J., & Sofronoff, K. J. (2016). Depression in adolescents with ASD: A pilot RCT of a group intervention. Journal of Autism and Developmental Disorders, 46, 572–588.

    Article  PubMed  Google Scholar 

  49. Sarason, I. G., Sarason, B. R., Shearin, E. N., & Pierce, G. R. (1987). A brief measure of social support: Practical and theoretical implications. Journal of Social and Personal Relationships, 4, 497–510.

    Article  Google Scholar 

  50. Segers, M., & Rawana, J. (2014). What do we know about suicidality in autism spectrum disorders? A systematic review. Autism Research, 7, 507–521.

    Article  PubMed  Google Scholar 

  51. Seltzer, M. M., Shattuck, P., Abbeduto, L., & Greenberg, J. S. (2004). Trajectory of development in adolescents and adults with autism. Mental Retardation and Developmental Disabilities Research Reviews, 10, 234–247.

    Article  PubMed  Google Scholar 

  52. Shattuck, P. T., Narendorf, S. C., Cooper, B., Sterzing, P. R., Wagner, M., & Taylor, J. L. (2012). Postsecondary education and employment among youth with an autism spectrum disorder. Pediatrics, 129, 1042–1049.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Simon, G. E., Rutter, C. M., Peterson, D., Oliver, M., Whiteside, U., Operskalski, B., & Ludman, E. J. (2013). Do PHQ depression questionnaires completed during outpatient visits predict subsequent suicide attempt or suicide death? Psychiatric Services, 64, 1195–1202.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th edn.). Needham Heights, MA: Allyn & Bacon.

    Google Scholar 

  55. Uebelacker, L. A., German, N. M., Gaudiano, B. A., & Miller, I. W. (2011). Patient health questionnaire depression scale as a suicide screening instrument in depressed primary care patients: A Cross-sectional study. The Primary Care Companion to CNS Disorders, 13, PCC.10 m01027.

    Google Scholar 

  56. Vilhjalmsson, R. (1993). Life stress, social support and clinical depression: A reanalysis of the literature. Social Science and Medicine, 37, 331–342.

    Article  PubMed  Google Scholar 

  57. Whitehouse, A. J. O., Durkin, K., Jaquet, E., & Ziatas, K. (2009). Friendship, loneliness and depression in adolescents with Asperger’s Syndrome. Journal of Adolescence, 32, 309–322.

    Article  PubMed  Google Scholar 

  58. Wigham, S., Barton, S., Parr, J. R., & Rodgers, J. (2017). A systematic review of the rates of depression in children and adults with high-functioning autism spectrum disorder. Journal of Mental Health Research in Intellectual Disabilities. doi:10.1080/19315864.2017.1299267.

    Google Scholar 

Download references

Acknowledgments

DH and MW were supported by funding from DXC Technology and the Australian Government Department of Human Services and Department of Defence.We would like to thank the individuals who participated in this study.

Funding

This research was funded by DXC Technology and the Australian Government Department of Human Services and Department of Defence. The funding sources were provided a copy of the manuscript prior to submission but had no involvement in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Author Contributions

DH, MU, AR and CD designed the study. DH and MW collected the data. DH and MU conceived of the report. DH, MU and MW analyzed the data and drafted the manuscript. All authors reviewed and approved the final submitted version of the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Darren Hedley.

Ethics declarations

Conflict of interest

The authors declare no other actual or potential conflicts of interest.

Ethical Approval

This research was approved by La Trobe University Human Ethics Committee No. 14–101 and the Australian Defence Human Research Ethics Committee No. 825-16. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Appendix

Appendix

See Fig. 2.

Fig. 2
figure2

Structural equation modelling analysis of the indirect effect of tangible support on suicidal ideation through depressive symptoms for participants who met the recommended cut-off for ASD (≥65) on the AQ-short (n = 64) only. Values provided are standardized beta coefficients. *p < .05, **p < .001

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hedley, D., Uljarević, M., Wilmot, M. et al. Brief Report: Social Support, Depression and Suicidal Ideation in Adults with Autism Spectrum Disorder. J Autism Dev Disord 47, 3669–3677 (2017). https://doi.org/10.1007/s10803-017-3274-2

Download citation

Keywords

  • Autism spectrum disorder
  • Depression
  • Mechanisms
  • Social support
  • Suicide
  • Suicidal ideation