Exploring risk factors for suicidality in adolescents with autism spectrum disorders

Background: Suicidality, suicidal ideation and suicidal behaviour, is a significant health concern for adolescents with Autism Spectrum Disorders (ASD). Depression and Irritability have been identified as risk factors for suicidality in autistic adolescents. Autistic youth may have higher vulnerability to these factors than typically developing adolescents. No study has compared the relationship between suicidality and different depressive phenotypes, nor used a UK clinical sample. This study aimed depression, irritability, and specific depressive phenotypes as risk factors for suicidality in adolescents with ASD within a UK clinical population.

Method: This clinical cohort study used archival data extracted from an electronic mental health records database. The sample consisted of 1314 adolescents (13+ years) who received an ICD-10 ASD diagnosis between 2008 and 2013. Outcome measure was suicidality, with exposure variables of depression, irritability, and phenotypes (depression with comorbid irritability (DWI), depression without comorbid irritability (DNI), irritability without comorbid depression (IND)).

Results: Cross-sectional analysis found depression to be associated with higher likelihood of suicidality. Irritability was found to be associated with higher likelihood of suicidality, even after controlling for depression. DWI was a more significant predictor of suicidality than IND, but no different from DNI. Psychosis, being female, antidepressant use, and caregiver mental health difficulties were also positively associated with suicidality, but significantly less likely in individuals diagnosed with ID.

Conclusions: Results indicate multiple characteristics of adolescents with ASD at high-risk of suicidality. Early identification of high-risk individuals could help deliver timely intervention, potentially reducing both incidence and progression of suicidality.