A nation-wide study of people aged 10 years and over diagnosed with Autism Spectrum Disorder (ASD) in Denmark has linked ASD to a higher risk of suicide attempts.
ASD is a developmental disorder particularly associated with social and communication skills, which can restrict feelings of belonging and fitting in. People with ASD often colloquially refer to themselves as neurodivergent.
An Australian team, led by Kairi Kõlves from the Australian Institute for Suicide Research and Prevention at Griffith University, found that suicide attempts were more than three times higher for people diagnosed with ASD in a Danish population.
Furthermore, they found that 90% of those diagnosed with ASD and who had attempted or died by suicide had a comorbidity – or another simultaneous condition – such as anxiety or affective disorders.
“There is scant evidence showing a link between ASD and suicidality from large-scale studies,” says Kõlves. “Ours is the first to show an elevated rate of suicide attempt and suicide in persons diagnosed with ASD, after adjusting for sex, age and time period, in a nationwide cohort study.”
The study included a nationwide analysis of people diagnosed with ASD between 1995 and 2016, with the exclusion of those below 10 years of age; 35,000 of the 6.56 million individuals were diagnosed with ASD, 73.4% of which were male, although this may be due to differing diagnostic practises over the two-decade time period.
Risk factors associated with suicide attempts and deaths differed between the study groups. For instance, the majority of factors associated with suicide rates in a general population, such as being male or not having a partner, were not found to be associated with the cohort of people diagnosed with ASD.
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Instead, they appeared to face unique risk factors that need extra consideration.
For example, “the self-realisation of rather limited social and problem-solving skills may increase self-imposed pressure to cope with and alter expectations of success,” says Kõlves. “These factors are crucial for assessing suicide risk by practitioners working with people with ASD, particularly for those with other psychiatric comorbidities.”
Women diagnosed with ASD also experienced higher rates of attempted suicide than men in a general population, although the reasons for this require further investigation.
“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,” says Kõlves.
“This might explain their higher rates of suicidal behaviour (4.6 times higher than males) which is supported by findings from Swedish linkage studies where higher risk of suicidal behaviour was noted for females with ASD compared to males.”
The authors emphasise that suicide prevention programmes specifically addressing the issues faced by people diagnosed with ASD may be a more effective preventative.
“A number of risk factors are different from those in the general population which suggests the need for tailored suicide prevention activities such as more robust screening procedures, early interventions to improve social skills of children and adolescents with ASD and the expanding of access to care,” says Kõlves.
The study was published in the Journal of the American Medical Association
Dr Deborah Devis is a science journalist at The Royal Institution of Australia.
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