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      Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: a case–control study

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          Abstract

          Background

          The present study aims to examine if autism spectrum disorder (ASD) is a risk factor for suicide attempts among adult depressed patients and to elucidate the characteristics of suicide attempts in adult depressed patients with ASD.

          Methods

          We conducted a case–control study. Subjects consisted of 336 retrospectively recruited first-time visit patients to our outpatient clinic with a current major depressive episode; 31 of the 336 patients had attempted suicide. The demographic backgrounds (i.e., age, gender, personal/family history of suicidality); specific psychopathology like bipolarity, agitation, and psychotic features; and comorbidity such as physical diseases, alcohol abuse, cluster B personality disorder, and ASD including pervasive developmental disorder not otherwise specified (PDD-NOS) were examined as potential risk factors for suicide attempts. We compared these variables between the suicide attempters and non-attempters. In addition, we compared suicide attempters to non-attempters within the ASD group and non-ASD group. Binary logistic regression analysis was performed using the significant independent variables from the comparisons between the suicide attempters and non-attempters, and the odds ratios (OR) and 95% confidence intervals (CI) were calculated.

          Results

          Logistic regression analysis demonstrated that agitation during a depressive episode (OR = 7.15, 95% CI = 2.88–17.74), past suicidal behaviors (OR = 4.32, 95% CI =1.70–10.98), and comorbid PDD-NOS (OR = 4.04, 95% CI = 1.20–13.54) were significantly associated with suicide attempts. The most prevalent suicidal method was drug overdose (59.1%) among non-ASD attempters while hanging was the most prevalent (44.4%) in ASD attempters.

          Conclusions

          Depressed adults with comorbid atypical autistic traits are at higher risk for suicide attempts and may engage in methods that are more lethal.

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          Most cited references47

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          Twelve-month prevalence of and risk factors for suicide attempts in the World Health Organization World Mental Health Surveys.

          Guilherme Borges, Matthew Nock, Josep Haro Abad … (2010)
          Although suicide is a leading cause of death worldwide, clinicians and researchers lack a data-driven method to assess the risk of suicide attempts. This study reports the results of an analysis of a large cross-national epidemiologic survey database that estimates the 12-month prevalence of suicidal behaviors, identifies risk factors for suicide attempts, and combines these factors to create a risk index for 12-month suicide attempts separately for developed and developing countries. Data come from the World Health Organization (WHO) World Mental Health (WMH) Surveys (conducted 2001-2007), in which 108,705 adults from 21 countries were interviewed using the WHO Composite International Diagnostic Interview. The survey assessed suicidal behaviors and potential risk factors across multiple domains, including sociodemographic characteristics, parent psychopathology, childhood adversities, DSM-IV disorders, and history of suicidal behavior. Twelve-month prevalence estimates of suicide ideation, plans, and attempts are 2.0%, 0.6%, and 0.3%, respectively, for developed countries and 2.1%, 0.7%, and 0.4%, respectively, for developing countries. Risk factors for suicidal behaviors in both developed and developing countries include female sex, younger age, lower education and income, unmarried status, unemployment, parent psychopathology, childhood adversities, and presence of diverse 12-month DSM-IV mental disorders. Combining risk factors from multiple domains produced risk indices that accurately predicted 12-month suicide attempts in both developed and developing countries (area under the receiver operating characteristic curve = 0.74-0.80). Suicidal behaviors occur at similar rates in both developed and developing countries. Risk indices assessing multiple domains can predict suicide attempts with fairly good accuracy and may be useful in aiding clinicians in the prediction of these behaviors. © Copyright 2010 Physicians Postgraduate Press, Inc.
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            Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study.

            Sarah Cassidy, Paul Bradley, Janine Robinson … (2014)
            Asperger's syndrome in adulthood is frequently associated with depression, but few studies have explored the lifetime experience of self-reported suicidal ideation and suicide plans or attempts in this clinical group. We aimed to assess this prevalence in a clinical cohort of patients in the UK.
            Article 0 comments Cited 149 times – based on 0 reviews     Review now
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              Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey.

              Maaike E. Walters, R Kessler, Diogo G. Borges (1999)
              General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied. Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis. Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt. Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.
              Article 0 comments Cited 141 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Kiyoharu Takara: takarakiyo1018@gmail.com
                Tsuyoshi Kondo: kondo@med.u-ryukyu.ac.jp
                Journal
                Journal ID (nlm-ta): Ann Gen Psychiatry
                Journal ID (iso-abbrev): Ann Gen Psychiatry
                Title: Annals of General Psychiatry
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1744-859X
                Publication date (Electronic): 16 October 2014
                Publication date PMC-release: 16 October 2014
                Publication date Collection: 2014
                Volume: 13
                Issue: 1
                Electronic Location Identifier: 33
                Affiliations
                Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215 Japan
                Article
                Publisher ID: 33
                DOI: 10.1186/s12991-014-0033-z
                PMC ID: 4201698
                PubMed ID: 25328535
                SO-VID: 356bb058-2141-45bd-8b86-4163b04b7642
                Copyright © © Takara and Kondo; licensee BioMed Central Ltd. 2014
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 11 August 2014
                Date accepted : 6 October 2014
                Categories
                Subject: Primary Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2014

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: autism spectrum disorder,adult,atypical,depressive episode,suicide attempt,risk factor,pervasive developmental disorder-not otherwise specified,suicide methods
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: autism spectrum disorder, adult, atypical, depressive episode, suicide attempt, risk factor, pervasive developmental disorder-not otherwise specified, suicide methods

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