Teens with social communication issues are twice as likely as their peers to harm themselves with suicidal intentions, new study finds1.
The work is among the first to explore the relationship between autism traits and suicidal behavior.
The results also suggest that social communication problems precipitate depression, which can ultimately lead to suicidal thoughts or behaviors.
“It is well known that depression is associated with suicidal tendency,” says Dheeraj Rai, senior researcher and senior lecturer in psychiatry at the University of Bristol in the UK. “The surprise to me was that this only explains part of the association, so there are certainly other potential mediators out there.” For example, factors such as bullying and poor emotional control may also contribute to the high risk of suicidal behavior in adolescents with social problems.
The study did not find a direct association between suicidal behavior and autism; the sample included only 42 autistic adolescents – too few to draw meaningful conclusions.
Yet it reinforces work showing that suicide and self-harm are alarmingly common among people with the disease.2. People on the spectrum may have few social support networks and may struggle to connect with others, which exacerbates their risk of suicide.
“This is quite an important study in the sense that it highlights the impact that difficulties with social communication can have,” says Jacqui Rodgers, senior lecturer in clinical psychology at Newcastle University in the UK. United, which did not participate in the research. “This again reinforces the potential relationship between autism characteristics and mental health problems.”
The study’s ‘big message’ is a need for suicide and depression screening in people with autism, says Jeremy Veenstra-VanderWeele, professor of psychiatry at Columbia University, who was not involved in the research . “It seems that autism makes these difficulties [in adolescence] more frequent.”
Rai and his colleagues analyzed questionnaires completed by parents of 5,031 children enrolled in the Avon Longitudinal Parent-Child Study. This study is following thousands of women and their children in the UK to investigate genetic and environmental influences on development.
When the children were 7 years old, their parents completed a questionnaire that assesses social communication. Parents also answered questions about three other autism traits – impaired social skills when the children were 3, repetitive behavior when they were 5 and verbal communication when they were 9.
The researchers identified the 10% of children with the most impairment in each of these autistic traits as part of a “high risk” group for autism. They considered the remaining 90% to be “low risk”.
When the children were 12, they completed a depression survey. And at 16, they answered questions about suicidality, as if they were self-harming with the intent to kill themselves.
When researchers looked at self-harm without suicidal intent, they found that an equal proportion of children in the low- and high-risk groups for social communication difficulties — about 11% — had engaged in such behavior. However, 12.5% of people in the high-risk group said they had self-harmed with suicidal intent, compared to around 6% in the low-risk group.
“It’s a pretty worrying finding, really,” says Emily Taylor, senior lecturer in clinical psychology at the University of Edinburgh in Scotland, who was not involved in the research.
People with autistic traits can only harm themselves if they have suicidal intentions, Taylor says. “There is not this intermediate step”, of self-harm without suicidal intention, she says. “It’s more of an active attempt to die.”
The study found no association between other autism traits and suicidal thoughts, plans or behaviors of self-harm. The results were published in May in the Journal of the American Academy of Child and Adolescent Psychiatry.
A new tool identifies suicidal behavior from medical records, rather than relying on clinicians to manually code records. The algorithm accurately identifies suicidal intentions or behaviors in 85% of individuals, according to a study published in April3.
The algorithm can help clinicians estimate how many people with autism are having suicidal thoughts and behaviors, says co-lead researcher Johnny Downs, a clinical researcher at King’s College London. It could also possibly help researchers identify risk factors for suicide in people with autism.