Adults with Asperger’s syndrome at increased risk for suicidal thoughts and behaviors

1. Suicidal ideation in Asperger’s syndrome was found to be more than nine times higher than in the general population. 

2. Two-thirds (66%) of adults with Asperger’s syndrome had contemplated suicide and one-third (35%) had planned or attempted suicide during their lifetime. 

Evidence Rating Level: 2 (Good) 

Study Rundown: Asperger’s syndrome is a subgroup on the autism spectrum- a set of neurodevelopmental conditions characterized by unusually narrow interests and difficulties in social communication. Asperger’s syndrome can be challenging due to social isolation and lack of support services. This study compared lifetime experience of suicidal ideation in patients with Asperger’s syndrome with that in the general population. Association between suicidal plans or attempts with depression and autistic traits was also assessed. Adults with Asperger’s syndrome were significantly more likely to have contemplated suicide compared to the average population (66% vs. 17% in the general population). High levels of autistic traits and depression were identified as significant risk factors for suicidal thoughts and behaviors. One limitation of this study is that the results cannot be generalized to those who have not sought diagnosis, as the cohort was a self-selected group who actively sought diagnosis. A strength of this study was its relatively large sample size in comparison to previous studies.

The study was funded by the Three Guineas Trust, the Baily Thomas Foundation, the Medical Research Council, NIHR-CLAHRC-EoE, Cambridgeshire and Peterborough NHS Foundation Trust, and the Autism Research Trust.

Click to read the study, published today in The Lancet

Relevant Reading: Presentation of depression in autism and Asperger syndrome

In-Depth [retrospective cohort]: This study compared lifetime self-reported suicidal ideation in 374 adults with Asperger’s syndrome (256 men and 118 women) with that in the general British population as well as other clinical subgroups (i.e. patients with multiple medical diagnoses, psychotic illness). Patients diagnosed with Asperger’s syndrome at a specialist clinic in England between 2004 and 2013 completed a self-report questionnaire that assessed lifetime experience of depression, suicidal ideation, and suicide plans or attempts. Patients also completed self-report forms to measure level of autistic traits and empathy.

Adults with Asperger’s syndrome were more likely to report lifetime experience of suicidal ideation than were those from the general UK population sample (odds ratio [OR] 9.6, 95% confidence interval [CI] 7.6-11.9; p<0.0001), people with one medical illness (OR 5.8, 95% CI 4.6-7.4; p<0.0001), two or more medical illness (OR 3.6, 95% CI 2.7-4.9; p<0.0001), or psychotic illness (OR 1.3, 95% CI 1.0-1.7; p<0.019). Individuals with history of depression were more likely to report suicidal ideation (OR 4.3, 95% CI 2.4-7.7; p<0.0001) and suicide plans or attempts (OR 2.4, 95% CI 1.5-3.8; p<0.0001). Self-reported lifetime experience of suicidal ideation, depression, and suicide plans or attempts did not differ significantly between men and women. That reported lifetime experience of suicidal ideation (66%) was greater than those who were depressed (31%) could stem from under-reporting of depression due in part to the characteristic alexithymia of Asperger’s syndrome (difficulties in verbally describing subjective emotional experience). This could also reflect a difference in processing for suicidal ideation in Asperger’s than for other clinical groups.

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