Disclosures: The authors report no relevant financial disclosures.
February 12, 2021
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Teens, young adults with ASD three times more likely to attempt suicide

Disclosures: The authors report no relevant financial disclosures.
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Teenagers and young adults with autism spectrum disorder were significantly more likely to attempt suicide and die by suicide than those without ASD, a cohort study from Denmark showed.

“It has yet to be determined what factors are associated with suicidal behavior in people with ASD and whether they differ from the factors associated with suicidal behavior in the population without ASD,” Kairi Kõlves, PhD, a principal research fellow at the Australian Institute for Suicide Research and Prevention, and colleagues wrote in JAMA Network Open.

The adjusted incidence rate ratio for suicide attempt among those with autism spectrum disorder vs. those wihout ASD is 3.19. This same ratio for death by suicide is 3.75.
Reference: Kõlves K, et al. JAMA Netw Open. 2021; doi:10.1001/jamanetworkopen.2020.33565.

The researchers analyzed nationwide register data from Jan. 1, 1995, to Dec. 31, 2016, on 6,559,266 individuals in Denmark aged 10 years or older. Among them, 35,020 individuals had received a diagnosis of ASD (mean age at autism diagnosis, 13.4 years; 73.4% male). Kõlves and colleagues reported that there were 64,109 suicide attempts and 14,197 deaths by suicide among the entire cohort, including 587 attempts and 53 deaths among those with ASD.

Individuals with ASD had a more than threefold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR] = 3.19; 95% CI, 2.93-3.46) and death by suicide (aIRR = 3.75; 95% CI, 2.85-4.92) than those without ASD. For those with ASD, the suicide attempt rate was more than fourfold higher among females (aIRR = 4.41; 95% CI, 3.74-5.19) compared with males. For those without ASD, the rate was almost 1.5 times higher among females than males (aIRR = 1.41; 95% CI, 1.39-1.43). Higher rates of suicide attempt were noted across all age groups for those with ASD.

Also, individuals who only had an ASD diagnosis had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt. However, those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.1) for suicide vs. those without any psychiatric disorders. Among the 587 individuals with ASD who attempted suicide, 542 had at least one other comorbid condition, and of the 53 individuals with ASD who died by suicide, 48 had at least one other comorbid condition.

“Factors, which have been identified as protective against suicide attempt in the general population, such as older age and higher education were not found to have this effect in those with ASD, and some factors such as being married or cohabiting and employed were linked to less impact among those with ASD,” Kõlves said in a press release.

The link between ASD and suicidality, particularly in adults, may be attributable to the combination of social isolation and poor access to care, according to the press release.

“While it is possible that an inability to establish and retain social and intimate relationships may severely affect adult women with ASD, they might also be diagnosed and treated later in the course of the disorder by being able to camouflage their autistic traits,” Kõlves said in the press release. “This might explain their higher rates of suicidal behavior, which is supported by findings from Swedish linkage studies where higher risk of suicidal behavior was noted for females with ASD compared to males.”

The findings indicate a “need for tailored suicide prevention strategies,” among individuals with ASD, the researchers wrote.

Mikle South, PhD, a professor of psychology and neuroscience at Brigham Young University, and colleagues wrote in a related editorial that the findings also “clarify the roadmap for and emphasize the urgency of ongoing research into risk detection and prevention of suicide in autistic people.” The authors also noted funding discrepancies in autism research. Therefore, they urged funding agencies, communities, policymakers and health care systems to devote more resources to investigate “the tragic, pervasive problem of intense mental health difficulties, suicidal thinking and death by suicide in autistic youth and adults.”

References:

Kõlves K, et al. JAMA Netw Open. 2021; doi:10.1001/jamanetworkopen.2020.33565.

South M, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2020.34018.