Dr Sarah Cassidy of the Centre for Research in Psychology, Behaviour and Achievement, Coventry University, gives a brief introduction to research and practical suggestions for assessment and prevention of suicide for autistic people.

How common are suicidal thoughts and behaviours in autistic people?

A growing body of research evidence is showing that many autistic people experience mental health problems, such as depression and anxiety, at some point in their lives. Depression is a well-known risk factor for death by suicide in the general population. One large research study showed that over 90% of people who died by suicide were also diagnosed with depression. But what about suicide risk in autistic people? 

In my research, I encounter a lot of concern from clinicians, and carers, who are supporting autistic people experiencing suicidal thoughts and behaviours. However, there has been very little research in this area. Studies have shown high rates of suicidal thoughts (10.9% – 66%), and suicidal behaviours (11% - 30%) in autistic adults and children. Between 7.3% - 15% of people who have been hospitalised for attempted suicide also have an autism diagnosis. This is much higher than the 1% rate of autism diagnosis we would expect in the general UK population. 

These figures show that suicidal thoughts and behaviours are worryingly high in autistic people. However, there is a wide range in these figures, with some studies showing a quite low proportion of autistic people experiencing suicidal thoughts (10.9%), and others very high a very high proportion (66%). This is most likely because of differences in the way the research was carried out; 7.2% of  parents of autistic children report their child has suicidal thoughts, whereas 66% of adults newly diagnosed with Asperger syndrome report having suicidal thoughts at some point in their lives .

It will be very important for future research to explore how many autistic people experience suicidal thoughts and behaviours, the role of factors such as age, time of diagnosis, and how these are measured.

Assessing suicide risk in autistic people 

So how can clinicians effectively assess suicide risk in autistic people  At the moment there are no assessment tools for depression or suicidality which have been developed specifically for autistic people. However, there are important things to consider when assessing suicide risk in these individuals. 

For example, many autistic people also experience mental health problems, and social difficulties such as bullying – both these factors have been shown to increase risk of suicidal thoughts in autistic people. So it is important to be alert to the potential risk factors the person may be experiencing, and gather background information about these.

There are also aspects of autism which must be taken into account when asking these individuals about their suicidal thoughts and behaviours. For example, some autistic people tend to interpret questions literally, such as “have you ever attempted suicide?” This could potentially lead to over-reporting. So it is very important to probe the specific circumstances and check understanding of the questions.

Some autistic people can also have difficulty describing their own internal emotional experiences (known as Alexithymia). This can present a challenge for clinicians when assessing depression or emotional distress in autistic people, who may have difficulty articulating the nature of their feelings and the specific circumstances these occur. Using visual aids to help the individual identify and label their emotions, and describe the situations where they occur, could be beneficial for some autistic people during assessment and treatment.

Our research group is currently exploring these issuesvi, and developing new measures and guidelines for assessing depression and suicide risk in autistic adults.

Preventing suicide in autistic people 

What steps can be taken to reduce suicide risk in autistic people? 

Awareness that many autistic people may experience suicidal thoughts and behaviours is the first step to prevention. Clinicians need to be alert to increased risk, and consider screening for mental health problems and suicidality in adults seeking an autism diagnosis. Also being aware of the fact that many people, and particularly adults, also experience delays in being diagnosed as autistic, alongside lack of support post diagnosis for children and adults, and poor outcomes such as health and social difficulties, social isolation, unemployment and underemployment in autistic adults.

All of these factors could increase risk of secondary depression in autistic people, a key risk factor for suicidal thoughts and behaviours. We also know that strong post diagnostic support improves mental health and quality of life of autistic adults. This means that the secondary depression and suicidality are preventable. Access not only to timely autism diagnosis, but appropriate support post diagnosis are therefore key to reducing suicide risk in autistic people. 

To reduce suicide risk in autistic people, we need to prevent these people from ‘slipping through the net’, and not accessing appropriate timely diagnosis, and appropriate support.