Suicidal Ideation, Plans, and Attempts in Adults with Asperger Syndrome: A Clinic Referral Study

Friday, May 16, 2014
Atrium Ballroom (Marriott Marquis Atlanta)
S. A. Cassidy1, P. Bradley2, J. Robinson3, C. Allison4, M. McHugh3 and S. Baron-Cohen1, (1)Autism Research Centre, University of Cambridge, Cambridge, United Kingdom, (2)Psychiatry of Learning Disability, Hertfordshire Partnership NHS Foundation Trust, Watford, United Kingdom, (3)Cambridge Lifespan Asperger Syndrome Service, Cambridgeshire and Peterborough Foundation NHS Trust, Cambridge, United Kingdom, (4)Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
Background:  Asperger Syndrome (AS) in adulthood is frequently associated with depression but there have been few studies exploring the lifetime prevalence of self-reported suicidal ideation (SI), plans and attempts (P/A) in this clinical group. 

Objectives:  1) To quantify the life-time prevalence of SI in adults who were diagnosed at a clinic specializing in the late diagnosis of AS in comparison to other clinical groups; 2) To explore risk factors associated with life time prevalence of SI and P/A in this clinical group. 

Methods:  n = 374 adults diagnosed with AS at a specialist diagnostic clinic between 2004 and 2013 were screened for history of depression, SI and P/A prior to assessment using a self-report questionnaire, and completed self-report measures of autistic traits and empathizing.  Rate of SI in the current sample was compared to published rates of SI in the general population and other clinical groups. Associations between depression, autistic traits, empathizing and likelihood of SI and P/A were also explored.

Results: Mean age at diagnosis was 31.5 years (range 17-67, SD=10.9). 66% of adults diagnosed with AS reported previous or current SI, 35% had planned or attempted suicide and 31.5% had depression. Adults with AS were 9.6 times more likely to report life time experience of SI than individuals from a general UK population sample (χ²(1)=542.3, p<0.001); 5.8 times more likely to report SI than a sample with one medical illness (χ²(1)=238.5, p<0.001); 3.6 times more likely to report SI than a sample with two or more medical illnesses (χ²(1)=75.2, p<0.001); 1.3 times more likely to report SI than a sample with psychotic illness (χ²(1)=5.5, p<0.001), but were not significantly more likely to report SI than a sample with drug dependency and ADHD (χ²(1)=.001, p=.99). Individuals with AS were 4.3 times more likely to report SI (χ²(1)=27.8, p<0.001) and 2.4 times more likely to report planned or attempted suicide (χ²(1)=14.3, p<0.001) if they also had depression. Those who planned or attempted suicide also had a significantly higher level of self-reported autistic traits than those who did not (t(366)=2.6, p<0.01).   

Conclusions:  Individuals diagnosed with AS later in life are significantly more likely to report SI than other clinical groups. Depression and a high level of self-reported autistic traits are significant risk factors in life-time prevalence of SI and plans or attempts at suicide. This confirms anecdotal reports of increased rates of SI, and depression as a significant potential risk factor for suicidality in adults with AS.  Individuals with AS often experience many risk factors (social isolation/exclusion, bullying in childhood and adolescence, academic underachievement, unemployment, employment difficulties, lack of a close confiding relationship, or no friends) that can cause low self-esteem and secondary depression. Given that many of these risk factors are avoidable, the secondary depression may be preventable. This highlights the need for further research exploring the effect of appropriate service planning and support for adults with AS on the prevalence of secondary depression and suicidality.