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A new study found that autistic people have different risk factors for suicide and are at 3 times greater risk than the general population. Eclipse Images/Getty Images
  • A new study says that autistic people have more than three-fold higher rates of suicide and suicide attempt than the general population.
  • Autistic females as well as people with additional psychiatric conditions are disproportionately affected.
  • The study highlights gaps in care for autistic people, especially when it comes to diagnosis and resources for autistic adults.

Autistic people have more than three-fold higher rates of suicide and suicide attempt than the general population, according to new research.

The study also found that autistic girls and women had a notably higher risk, as did people with additional psychiatric conditions.

“This study out of Denmark is an important step forward in understanding the risk for suicide in people with autism,” said Donna Murray, PhD, vice president of clinical programs and head of the Autism Treatment Network (ATN) at Autism Speaks.

Most of the research on suicidality have been focused on smaller populations rather than a national dataset.

“This gives us a much more realistic understanding of how common this is for autistic people versus the general population, and by looking at the correlation with different risk factors, helps to pinpoint what we might be able to do to reduce suicide risk,” Murray said.

Dr. Sarah Mohiuddin, a child and adolescent psychiatrist at Michigan Medicine C.S. Mott Children’s Hospital who specializes in treating children with autism spectrum disorder (ASD), said the research shines a light on an under-recognized risk and mirrors what she sees in her practice.

“For a long time it was thought that individuals with autism could not experience this severity of illness,” she said. “So it’s nice to see a study replicating and describing in a systematic way what many of us who treat this population have been seeing for decades in clinic.”

According to the Centers for Disease Control and Prevention (CDC), about 1 in 54 children have ASD.

The prevalence of ASD has risen steadily in recent years, though experts say that has more to do with better monitoring and diagnosis rather than an actual increase in the number of autistic children.

For the study, researchers used a nationwide database to analyze data of more than 6 million people ages 10 and older living in Denmark from 1995 to 2016.

More than 35,000 of these individuals had a diagnosis of ASD. The results were published in JAMA Network Open.

In addition to rates of suicide and attempted suicide, the researchers looked at the risk in different populations within the autism community.

“The importance of our study lies not only in identifying the link between the ASD and suicidal behavior, but also in identifying risk factors, as this will help clinicians in the treatment of people with ASD,” study author Kairi Kõlves, PhD, of Griffith University in Brisbane, Australia, told Healthline.

Autistic girls and women were disproportionately affected, with a four-fold higher risk of suicide attempt compared to men.

Females also had a significantly higher rate of suicide than autistic males. “Higher risk of a suicide attempt in females is not unusual, however, the magnitude of it was rather surprising,” Kõlves said.

One potential reason for this higher risk may be that autistic females are typically diagnosed and treated later in life than males.

“There’s a lot of ongoing work looking at why that is,” Mohiuddin said. “It may be that their symptoms present differently at younger ages. They’re more social, have more in-tact nonverbal communication skills so that may make it confusing for clinicians to identify them.”

Additionally, females are more likely to experience anxiety and affective disorders, like depression, which, as the study demonstrated, are strong risk factors of suicide in autistic people.

In fact, the study found more than 90 percent of autistic people who attempted suicide or died by suicide had a co-occuring psychiatric condition.

Another important finding is that unlike the general population, risk of suicide doesn’t decrease with age for autistic people.

This makes sense, experts say, when taking into account the lack of support autistic people have once they finish school and begin early adulthood.

“Reaching social milestones can be more challenging in the ASD population,” Mohiuddin said. “I see many patients who describe a lot of distress in watching their peers and siblings have a romantic partner or get their first job while this can be very difficult for them.”

Mohiuddin pointed out that some autistic people are able to be successful in a K-12 environment with support from school and their parents.

However, things can become more challenging for them once they’re on their own and need to begin navigating scenarios that require more subtle social situations with more unsaid social rules.

This can also lead to feelings of sadness and loss that they’re missing out on these experiences.

“And you can see how that could be a driver for something like suicidality,” Mohiuddin said.

The researchers also found that high functioning autistic people are at higher risk of suicide, as they’re more likely to get less support.

Experts said the study’s findings highlight the need to address gaps in care for autistic people, especially when it comes to diagnosis and resources for autistic adults.

“The high rates in females with ASD suggest a need to improve diagnostic tools to avoid delays in required treatment,” Kõlves said. “There is need to improve social skills in children with ASD, where early intervention may lower risks of suicidal behavior later in life.”

Kõlves said it’s also essential to expand the support and services for autistic adults, especially those with psychiatric comorbidity, considering the elevated risk of suicide attempt throughout their lives.

Mohiuddin also calls for more training in frontline workers.

“Given the rising rates of ASD overall in the population, physicians, healthcare providers, schools, and colleges do need to have more formalized training in assessment and treatment of ASD,” she said. “As of right now it’s not a required part of many people’s training and it seems like it should be.”

Parents and loved ones can also play an important role in recognizing warning signs of suicide in autistic people.

“Signs and symptoms of depression and anxiety can look different for autistic people because of challenges with communication, and especially for those who have limited language,” Murray said.

“Often, parents and loved ones will need to look for clues like lack of appetite, low energy, and changes in sleep patterns or social interactions that are typical for them,” she said.

Mohiuddin said to watch out for increased statements of hopelessness like “I’m never going to achieve anything” or “nothing ever goes right for me,” social withdrawal, and not doing the things they once enjoyed.

“More urgent signs include making statements like ‘my life isn’t worth living’ or ‘I wish I was dead,’ and taking any kind of preparatory actions like giving away things that are meaningful to them or looking like they’re saying goodbye,” she said.

It’s also important for loved ones to know that they shouldn’t be afraid to ask about suicide.

“People have this misunderstanding that if they ask about it, it’s going to become real or somehow make someone do something,” Mohiuddin said. “But a lot of times people will say they feel relieved that a family member or loved one recognized the depth of what they were feeling and were able to ask about it.”

If you’re concerned about a loved one’s mental health, talk with them about seeking help from a mental health provider or their primary care physician.

If you think someone is at immediate risk of self-harm or suicide call 911 or your local emergency room.

The National Suicide Prevention Lifeline provides free and confidential support 24/7 at 1-800-273-8255.