Suicidality In Patients with Autism Spectrum Disorders

Background:  Autism spectrum disorders are known to be associated with deficits in social interaction, lack of empathy and poor emotional regulation which might render them vulnerable to self destructive behaviors, especially suicide. Although self mutilating behaviors are not uncommon in patients with autism spectrum disorders, suicidal behaviors and ideation have not been studied in this group.

Objectives:  The present study aimed a) to assess the prevalence of suicidal behaviors in individuals with a diagnosis of high functioning autism spectrum disorder, b) to evaluate the risk factors associated with suicidality in this group and c) to define the characteristics of suicidal ideation and behaviors in this group.

Methods:  Fifty-five individuals, 49 of which were  male and 6 were  female, and were aged between 7-20 years old, with the diagnoses of Asperger’s disorder (n=26, 47.3%), high functioning autism (n=24, 43.6%) and pervasive developmental disorder-not otherwise specified (n=5, 9.1%) were included in our study. All were verbal individuals with IQ in non-retarded range. Participants were patients of Autism Spectrum Disorders Clinic of Child Psychiatry Department in Istanbul School of Medicine whom were at regular psychiatric follow-up. They were evaluated with Beck Depression Inventory, Suicide Probability Scale and Suicidal Ideation Scale and K-SADS-PL Affective Disorders- Depression Supplement. As all participants were regular patients of our clinic, any lack of clarity was eliminated by reviewing patients’ charts. Statistical analyses were performed with SPSS version 16.0.

Results:  Sixteen patients (29.1%) were suicidal, with 7 (12.7%) having only suicidal ideation and 9 (16.4%) showing suicidal behaviors. Suicidal patients were not different from non-suicidal patients in terms of age and gender, as well as rates of suicide among autism spectrum disorder subgroups. Scores of Beck Depression Inventory (p=0.001), Suicide Probability Scale (p=0.005) and Suicidal Ideation Scale (p=0.01) were all significantly higher in the suicidal group, whereas in contrary to expected, rates of depression, bipolar disorder and attention deficit hyperactivity disorder were not different between the two groups.  Yet interestingly the rate of psychosis, both due to a primary psychotic disorder or a mood disorder, was significantly higher in the suicidal group (p=0.02). Finally there was a trend towards significance between the suicidal and non-suicidal groups in terms of completed suicide in first and second degree family members (p=0.069).

Conclusions:  In this group, suicidality – and especially suicidal behaviors – was found to be higher than healthy population rates in our community. Suicidality should be kept in mind in autism spectrum disorders, particularly in psychotic patients with depressive symptoms.