Skip to main content

Advertisement

SpringerLink
Log in

Mental Health Clinicians’ Screening and Intervention Practices to Reduce Suicide Risk in Autistic Adolescents and Adults

  • S.I. : Suicidality and Self-harm in Autism
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Autistic individuals experience elevated risk for suicide ideation, attempts, and deaths. Little is known about how clinicians assess risk or intervene with suicidal autistic individuals. We surveyed 121 clinicians about use of suicide prevention practices with autistic and non-autistic clients. Clinicians reported greater self-efficacy in screening for suicide risk among non-autistic clients (p = 0.01). There were no statistically significant differences in whether they used standardized screening measures or in their reported normative pressure or attitudes towards screening. Clinicians reported similar rates of use of Safety Planning, an evidence-based suicide-prevention strategy, across groups, but greater acceptability for non-autistic clients (p < 0.001). These findings have implications for strategies to increase clinicians’ adoption of these tools for autistic individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Ahmedani, B. K., Simon, G. E., Stewart, C., Beck, A., Waitzfelder, B. E., Rossom, R., et al. (2014). Health care contacts in the year before suicide death. Journal of General Internal Medicine, 29, 870–877.

    Article  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the BDI-II. San Antonio: The Psychological Corporation.

    Google Scholar 

  • Bongiovi-Garcia, M. E., Merville, J., Almeida, M. G., Burke, A., Ellis, S., Stanley, B. H., et al. (2009). Comparison of clinical and research assessments of diagnosis, suicide attempt history and suicidal ideation in major depression. Journal of Affective Disorders, 115, 83–88.

    Article  Google Scholar 

  • Brown, G. K., Currier, G., Jager-Hyman, S., & Stanley, B. S. (2015). Detection and classification of suicidal and nonsuicidal self-injury behavior in emergency departments. Journal of Clinical Psychiatry, 76, 1397–1403.

    Article  Google Scholar 

  • Bryan, C. J., Mintz, J., Clemans, T. A., Leeson, B., Burch, T. S., Williams, S. R., et al. (2017). Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial. Journal of Affective Disorders, 212, 64–72.

    Article  Google Scholar 

  • Carter, G., Milner, A., McGill, K., Pirkis, J., Kapur, N., & Spittal, M. (2017). Predicting suicidal behaviours using clinical instruments: Systematic review and meta-analysis of positive predictive values for risk scales. British Journal of Psychiatry, 210, 387–395.

    Article  Google Scholar 

  • 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  Google Scholar 

  • Cassidy, S., Bradley, P., Shaw, R., Bowen, E., Glod, M., Baron-Cohen, S., et al. (2019). Measurement properties of the Suicide Behaviors Questionnaire- Revised in autistic adults. Paper presented at the International Society for Autism Research, Montreal, Quebec, Canada.

  • Cassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018). Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review. Clinical Psychology Review, 62, 56–70.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2005). Web-based Injury Statistics Query and Reporting System (WISQARS). Retrieved June 1, 2019 from www.cdc.gov/injury/wisqars.

  • Chen, M.-H., Pan, T.-L., Lan, W.-H., Hsu, J.-W., Huang, K.-L., Su, T.-P., et al. (2017). Risk of suicide attempts among adolescents and young adults with autism spectrum disorder: A nationwide longitudinal follow-up study. Journal of Clinical Psychiatry, 78, e1174–e1179.

    Article  Google Scholar 

  • Chesin, M. S., Stanley, B., Haigh, E. A., Chaudhury, S. R., Pontoski, K., Knox, K. L., et al. (2017). Staff views of an emergency department intervention using safety planning and structured follow-up with suicidal veterans. Archives of Suicide Research, 21, 127–137.

    Article  Google Scholar 

  • Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., et al. (2015). The health status of adults on the autism spectrum. Autism, 19, 814–823.

    Article  Google Scholar 

  • de Beurs, D. P., Fokkema, M., & O'Connor, R. C. (2016). Optimizing the assessment of suicidal behavior: The application of curtailment techniques. Journal of Affective Disorders, 196, 218–224.

    Article  Google Scholar 

  • Fishbein, M., & Ajzen, I. (2010). Predicting and changing behavior: The reasoned action approach. New York: Psychology Press.

    Google Scholar 

  • Fishman, J., Lushin, V., Lawson, G., Seidman, M., Beidas, R. S., & Mandell, D. S. (2019). A theory for implementation prediction (TIP): Applying causal models of behavior change to specific evidence-based practices. Manuscript submitted for publication.

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

    Article  Google Scholar 

  • Horowitz, L. M., Bridge, J. A., Teach, S. J., Ballard, E., Klima, J., Rosenstein, D. L., et al. (2012). Ask Suicide-Screening Questions (ASQ): A brief instrument for the pediatric emergency department. Archives of Pediatrics & Adolescent Medicine, 166, 1170–1176.

    Article  Google Scholar 

  • Horowitz, L. M., Thurm, A., Farmer, C., Mazefsky, C., Lanzillo, E., & Bridge, J. A. (2018). 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, 48, 3702–3710.

    Article  Google Scholar 

  • The Joint Commission. (2019). National patient safety goal for suicide prevention. R3 Report: Requirement, Rationale, Reference, 18 update.

  • Kerns, C. M., Roux, A. M., Connell, J. E., & Shattuck, P. T. (2016). Adapting cognitive behavioral techniques to address anxiety and depression in cognitively able emerging adults on the autism spectrum. Cognitive and Behavioral Practice, 23, 329–340.

    Article  Google Scholar 

  • Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019). A 20-year study of suicide death in a statewide autism population. Autism Research, 12, 658–666.

    Article  Google Scholar 

  • Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., et al. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36, 849–886.

    Article  Google Scholar 

  • Louzon, S. A., Bossarte, R., McCarthy, J. F., & Katz, I. R. (2016). Does suicidal ideation as measured by the PHQ-9 predict suicide among VA patients? Psychiatric Services, 67, 517–522.

    Article  Google Scholar 

  • Madan, A., Frueh, B. C., Allen, J. G., Ellis, T. E., Rufino, K. A., Oldham, J. M., et al. (2016). Psychometric reevaluation of the Columbia-Suicide Severity Rating Scale: Findings from a prospective, inpatient cohort of severely mentally ill adults. The Journal of Clinical Psychiatry, 77, e867–e873.

    Article  Google Scholar 

  • Malone, K. M., Szanto, K., Corbitt, E. M., & Mann, J. J. (1995). Clinical assessment versus research methods in the assessment of suicidal behavior. American Journal of Psychiatry, 152, 1601–1607.

    Article  Google Scholar 

  • Nock, M. K., Holmberg, E. B., Photos, V. I., & Michel, B. D. (2007). Self-injurious thoughts and behaviors interview: Development, reliability, and validity in an adolescent sample. Psychological Assessment, 19, 309–317.

    Article  Google Scholar 

  • Quinlivan, L., Cooper, J., Meehan, D., Longson, D., Potokar, J., Hulme, T., et al. (2017). Predictive accuracy of risk scales following self-harm: Multicentre, prospective cohort study. The British Journal of Psychiatry, 210, 429–436.

    Article  Google Scholar 

  • Quinlivan, L., Steeg, S., Elvidge, J., Nowland, R., Davies, L., Hawton, K., et al. (2019). Risk assessment scales to predict risk of hospital treated repeat self-harm: A cost-effectiveness modelling analysis. Journal of Affective Disorders, 249, 208–215.

    Article  Google Scholar 

  • Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8, 443–454.

    Article  Google Scholar 

  • Posner, K., Brown, G. K., Stanley, B. S., Yershova, K. V., Oquendo, M. A., et al. (2011). The Columbia-Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168, 1266–1277.

    Article  Google Scholar 

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

    Article  Google Scholar 

  • Simon, G. E., Coleman, K. J., Rossom, R. C., Beck, A., Oliver, M., Johnson, E., et al. (2016). Risk of suicide attempt and suicide death following completion of the Patient Health Questionnaire depression module in community practice. The Journal of Clinical Psychiatry, 77, 221–227.

    Article  Google Scholar 

  • Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ Primary Care Study. Journal of the American Medical Association, 282, 1737–1744.

    Article  Google Scholar 

  • Stanley, B. S., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19, 256–264.

    Article  Google Scholar 

  • Stanley, B. S., Brown, G. K., Brenner, L. A, Hanga, G. C., Currier, G. W., Knox, K., et al. (2018) Comparison of the Safety Planning Intervention with follow-up vs usual care of suicidal patients treated in the emergency department. JAMA Psychiatry, 75, 894–900.

    Article  Google Scholar 

  • Stanley, B. S., Chaudhury, S. R., Chesin, M., Pontoski, K. P., Bush, A. M., Knox, K. L., et al. (2016). An emergency department intervention and follow-up to reduce suicide risk in the VA: Acceptability and effectiveness. Psychiatric Services, 67, 680–683.

    Article  Google Scholar 

  • Wang, Y., Bhaskaran, J., Sareen, J., Bolton, S.-L., Chateau, D., & Bolton, J. M. (2016). Clinician prediction of future suicide attempts: A longitudinal study. The Canadian Journal of Psychiatry, 61, 428–432.

    Article  Google Scholar 

  • White, S. W., Conner, C. M., & Maddox, B. B. (2017). Behavioral treatments for anxiety in adults with autism spectrum disorder. In C. M. Kerns, P. Renno, E. A. Storch, P. C. Kendall, & J. J. Wood (Eds.), Anxiety in children and adolescents with autism spectrum disorder: Evidence-based assessment and treatment (pp. 171–192). London: Elsevier.

    Chapter  Google Scholar 

  • White, S. W., Simmons, G. L., Gotham, K. O., Conner, C. M., Smith, I. C., Beck, K. B., et al. (2018). Psychosocial treatments targeting anxiety and depression in adolescents and adults on the autism spectrum: Review of the latest research and recommended future directions. Current Psychiatry Reports, 20, 82.

    Article  Google Scholar 

  • World Health Organization. Suicide fact sheet. Retrieved May 20, 2019 from https://www.who.int/mediacentre/factsheets/fs398/en/.

Download references

Acknowledgments

This project was supported by funding from the FAR Fund (PI: Jager-Hyman).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA

    Shari Jager-Hyman, Brenna B. Maddox, Samantha R. Crabbe & David S. Mandell

Authors
  1. Shari Jager-Hyman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brenna B. Maddox
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Samantha R. Crabbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David S. Mandell
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SJH, BMM, and DSM conceived of the study. SRC, SJH, BMM, and DSM developed and reviewed the survey questions. SRC participated in the coordination of the study and data collection. SJH performed the statistical analyses. SJH and BMM drafted the manuscript. All authors read and revised earlier drafts of the manuscript. All authors approved the manuscript for publication.

Corresponding author

Correspondence to Shari Jager-Hyman.

Ethics declarations

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee [redacted to maintain masked review] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

figure a
figure b
figure c
figure d

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jager-Hyman, S., Maddox, B.B., Crabbe, S.R. et al. Mental Health Clinicians’ Screening and Intervention Practices to Reduce Suicide Risk in Autistic Adolescents and Adults. J Autism Dev Disord 50, 3450–3461 (2020). https://doi.org/10.1007/s10803-020-04441-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-020-04441-3

Keywords

Search

Navigation