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Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications

  • Autism Spectrum (A Richdale and L Hollier, Section Editor)
  • Published:
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Abstract

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.

Recent Findings

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%.

Summary

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.

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Notes

  1. Although the term “suicidality” is sometimes used as an umbrella term to refer to the array of behaviors associated with suicide [15], more specific terminology is recommended as the term suicidality lacks clinical usefulness and can cause confusion across studies [17].

References

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 

  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC: American Psychiatric Publishing; 2013.

    Google Scholar 

  3. Bellini S. The development of social anxiety in adolescents with autism spectrum disorders. Focus Autism Other Dev Dis. 2006;21(3):138–45. https://doi.org/10.1177/10883576060210030201.

    Article  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.

    Article  PubMed  Google Scholar 

  5. Hofvander B, Delorme R, Chaste P, Nydén A, Wentz E, Ståhlberg O, et al. Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry. 2009;9:1–9.

    Article  Google Scholar 

  6. Lever AG, Geurts HM. Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. J Autism Dev Disord. 2016;46(6):1916–30. https://doi.org/10.1007/s10803-016-2722-8.

    Article  PubMed  PubMed Central  Google 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.

  8. van Steensel FJ, Bogels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–17. https://doi.org/10.1007/s10567-011-0097-0.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  10. Richdale AL, Schreck KA. Sleep problems in autism spectrum disorders: prevalence, nature, & possible biopsychosocial aetiologies. Sleep Med Rev. 2009;13(6):403–11. https://doi.org/10.1016/j.smrv.2009.02.003.

    Article  PubMed  Google Scholar 

  11. Barraclough B, Bunch J, Nelson B, Sainsbury P. A undred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125(4):355–73. https://doi.org/10.1192/bjp.125.4.355.

    Article  PubMed  CAS  Google Scholar 

  12. Pagliaro LA. Adolescent depression and suicide: a review and analysis of the current literature. Can J Sch Psychol. 1996;11(2):191–201. https://doi.org/10.1177/082957359601100223.

    Article  Google Scholar 

  13. Hedley D, Uljarević M, Wilmot M, Richdale A, Dissanayake C. Social support, depression and suicidal ideation in adults with autism spectrum disorder. J Autism Dev Disord. 2017;47(11):3669–77. https://doi.org/10.1007/s10803-017-3274-2.

    Article  PubMed  Google Scholar 

  14. Lai JKY, Rhee E, Nicholas D. Suicidality in autism spectrum disorder: a commentary. Adv Neurodev Disord. 2017;1(3):190–5. https://doi.org/10.1007/s41252-017-0018-4.

    Article  Google Scholar 

  15. • Zahid S, Upthegrove R. Suicidality in autistic spectrum disorders: a systematic review. Crisis. 2017;38:237–46. Recent systematic review of suicide in ASD, includes prevalence of suicidal attempts and ideation and identifies significant risk factors.

    Article  PubMed  Google Scholar 

  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).

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  20. Raja M, Azzoni A, Frustaci A. Autism spectrum disorders and suicidality. Clin Pract Epidemiol Ment Health. 2011;7(1):97–105. https://doi.org/10.2174/1745017901107010097.

    Article  PubMed  PubMed Central  Google 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.

  22. Hedley D, Uljarević M, Cameron L, Halder S, Richdale A, Dissanayake C. Employment programmes and interventions targeting adults with autism spectrum disorder: a systematic review of the literature. Autism. 2017;21(8):929–41. https://doi.org/10.1177/1362361316661855.

    Article  PubMed  Google Scholar 

  23. Hannon G, Taylor EP. Suicidal behaviour in adolescents and young adults with ASD: findings from a systematic review. Clin Psychol Rev. 2013;33(8):1197–204. https://doi.org/10.1016/j.cpr.2013.10.003.

    Article  PubMed  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.

  25. Richa S, Fahed M, Khoury E, Mishara B. Suicide in autism spectrum disorders. Arch Suicide Res. 2014;18(4):327–39. https://doi.org/10.1080/13811118.2013.824834.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  27. Mayes SD, Gorman AA, Hillwig-Garcia J, Syed E. Suicide ideation and attempts in children with autism. Res Autism Spectr Disord. 2013;7(1):109–19. https://doi.org/10.1016/j.rasd.2012.07.009.

    Article  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

  31. Demirkaya SK, Tutkunkardas MD, Mukaddes NM. Assessment of suicidality in children and adolescents with diagnosis of high functioning autism spectrum disorder in a Turkish clinical sample. Neuropsychiatr Dis Treat. 2016;12:2921–6. https://doi.org/10.2147/NDT.S118304.

    Article  Google Scholar 

  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.

  33. Mayes SD, Calhoun SL, Baweja R, Mahr F. Suicide ideation and attempts in children with psychiatric disorders and typical development. Crisis. 2015;36(1):55–60. https://doi.org/10.1027/0227-5910/a000284.

    Article  Google Scholar 

  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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  37. Takara K, Kondo T. Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: a case-control study. Ann Gen Psychiatry. 2014;13(1):33. https://doi.org/10.1186/s12991-014-0033-z.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  CAS  Google Scholar 

  39. Hoekstra RA, Vinkhuyzen AA, Wheelwright S, Bartels M, Boomsma DI, Baron-Cohen S, et al. The construction and validation of an abridged version of the autism-spectrum quotient (AQ-Short). J Autism Dev Disord. 2011;41(5):589–96. https://doi.org/10.1007/s10803-010-1073-0.

    Article  PubMed  Google Scholar 

  40. Kurita H, Koyama T, Osada H. Autism spectrum quotient Japanese version and its short forms for screening normally intelligent persons with pervasive developmental disorders. Psychiatry Clin Neurosci. 2005;59(4):490–6. https://doi.org/10.1111/j.1440-1819.2005.01403.x.

    Article  PubMed  Google Scholar 

  41. Rutter M, Bailey A, Lord C. The social communication questionnaire. Los Angeles: Western Psychol Serv; 2003.

    Google Scholar 

  42. Mayes SD. Checklist for autism spectrum disorder. Wood Dale: Stoelting; 2012.

    Book  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 

  46. Langmann A, Becker J, Poustka L, Becker K, Kamp-Becker I. Diagnostic utility of the autism diagnostic observation schedule in a clinical sample of adolescents and adults. Res Autism Spectr Disord. 2013;7:109–19.

    Article  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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. • Wigham S, Barton S, Parr JR, Rodgers J. A systematic review of the rates of depression in children and adults with high-functioning Autism Spectrum Disorder. J Ment Health Res Intellect Disabil. 2017;10:1–21. Recent good quality systematic review of depression rates in ASD.

    Article  Google 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.

    Article  PubMed  PubMed Central  Google 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.

  52. White SW, Oswald D, Ollendick T, Scahill L. Anxiety in children and adolescents with autism spectrum disorders. Clin Psychol Rev. 2009;29(3):216–29. https://doi.org/10.1016/j.cpr.2009.01.003.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  CAS  Google 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.

  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.

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Authors and Affiliations

  1. Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia

    Darren Hedley & Mirko Uljarević

  2. Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, 94305, USA

    Mirko Uljarević

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  1. Darren Hedley
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Correspondence to Darren Hedley.

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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.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Autism Spectrum

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Hedley, D., Uljarević, M. Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. Curr Dev Disord Rep 5, 65–76 (2018). https://doi.org/10.1007/s40474-018-0133-6

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