Experiences of Suicide and Suicidal Thoughts Amongst Adults with an Autism Spectrum Condition.

Background: Currently, depression and suicide risk assessment tools are a ‘one size fits all’ design. However, they may need to be adapted for adults with an Autism Spectrum Condition (ASC), due to difficulties such as literal interpretation, identifying and communicating internal emotional states. The clinical implication being that these questionnaires may not accurately measure depression or suicide risk in adults with an ASC. This is worrying given high rates of depression and suicidal ideation in this group.

Objectives: To explore how adults with an ASC interpret questions in current clinical measures of depression and suicide risk, in order to inform development of new tools adapted for this group.

Methods: 15 adults with ASC took part in cognitive interviews while completing the Suicide Behaviour Questionnaire-Revised (SBQ-R), and Patient Health Questionnaire-9 item (PHQ-9). During the cognitive interviews, participants described what they were thinking and reading about when completing these questionnaires. Interviewers subsequently probed participants’ responses to further explore how participants interpreted the questions.

Results: A conversational analysis approach was used to analyse the data. The extracts presented focus on key moments within the interaction when the participants talk about suicide and the future, their ongoing thoughts of suicide, and how they believe these to be autism specific and different from those without autism. These indicate that adults with ASC: 1) interpret the questions literally and in turn provide literal answers which do not always fit the question being asked; 2) find some questions unclear in terms of what information is required to ensure they provide an appropriate answer; and 3) report some questions are describing traits or behaviours typically associated with autism and therefore not appropriate markers of a mental health difficulty for them.

Conclusions: Results suggest that current measures of depression and suicide risk need to be adapted for adults with ASC, in order to accurately identify these difficulties in this group. Results will be used to inform adaptations to these measures, and guidelines for clinicians assessing depression and suicide risk in adults with ASC.