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      Risk markers for suicidality in autistic adults

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          Abstract

          Background

          Research has shown high rates of suicidality in autism spectrum conditions (ASC), but there is lack of research into why this is the case. Many common experiences of autistic adults, such as depression or unemployment, overlap with known risk markers for suicide in the general population. However, it is unknown whether there are risk markers unique to ASC that require new tailored suicide prevention strategies.

          Methods

          Through consultation with a steering group of autistic adults, a survey was developed aiming to identify unique risk markers for suicidality in this group. The survey measured suicidality (SBQ-R), non-suicidal self-injury (NSSI-AT), mental health problems, unmet support needs, employment, satisfaction with living arrangements, self-reported autistic traits (AQ), delay in ASC diagnosis, and ‘camouflaging’ ASC. One hundred sixty-four autistic adults (65 male, 99 female) and 169 general population adults (54 males, 115 females) completed the survey online.

          Results

          A majority of autistic adults (72%) scored above the recommended psychiatric cut-off for suicide risk on the SBQ-R; significantly higher than general population (GP) adults (33%). After statistically controlling for a range of demographics and diagnoses, ASC diagnosis and self-reported autistic traits in the general population significantly predicted suicidality. In autistic adults, non-suicidal self-injury, camouflaging, and number of unmet support needs significantly predicted suicidality.

          Conclusions

          Results confirm previously reported high rates of suicidality in ASC, and demonstrate that ASC diagnosis, and self-reported autistic traits in the general population are independent risk markers for suicidality. This suggests there are unique factors associated with autism and autistic traits that increase risk of suicidality. Camouflaging and unmet support needs appear to be risk markers for suicidality unique to ASC. Non-suicidal self-injury, employment, and mental health problems appear to be risk markers shared with the general population that are significantly more prevalent in the autistic community. Implications for understanding and prevention of suicide in ASC are discussed.

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          Most cited references31

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          On the ontological status of autism: the ‘double empathy problem’

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            The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples.

            Past suicidal behaviors including ideation and attempts have been identified as significant risk factors for subsequent suicidal behavior. However, inadequate attention has been given to the development or validation of measures of past suicidal behavior. The present study examined the reliability and validity of a brief self-report measure of past suicidal behavior, the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Participants included psychiatric inpatient adolescents, high school students, psychiatric inpatient adults, and undergraduates. Logistic regression analyses provided empirical support for the usefulness of the SBQ-R as a risk measure of suicide to differentiate between suicide-risk and nonsuicidal study participants. Receiver operating characteristic (ROC) analyses indicated that the most useful cutoff scores on the SBQ-R were 7 for nonsuicidal samples, and 8 for clinical samples. Both the single SBQ-R Item 1 and SBQ-R total scores are recommended for use in clinical and nonclinical settings.
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              Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.

              A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death.
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                Author and article information

                Contributors
                Sarah.Cassidy@Nottingham.ac.uk
                Louise.Bradley@Coventry.ac.uk
                Rebecca.Shaw@covwarkpt.nhs.uk
                sb205@cam.ac.uk
                Journal
                Mol Autism
                Mol Autism
                Molecular Autism
                BioMed Central (London )
                2040-2392
                31 July 2018
                31 July 2018
                2018
                : 9
                : 42
                Affiliations
                [1 ]ISNI 0000 0004 1936 8868, GRID grid.4563.4, School of Psychology, , University of Nottingham, ; University Park, Nottingham, NG7 2RD UK
                [2 ]ISNI 0000000106754565, GRID grid.8096.7, Centre for Innovative Research across the Life Course, , Coventry University, ; Coventry, UK
                [3 ]ISNI 0000000121885934, GRID grid.5335.0, Autism Research Centre, , University of Cambridge, ; Cambridge, UK
                [4 ]Coventry and Warwickshire Partnership Trust, Coventry, UK
                [5 ]ISNI 0000 0004 0412 9303, GRID grid.450563.1, Cambridge Lifetime Asperger Syndrome Service (CLASS), , Cambridgeshire and Peterborough NHS Foundation Trust, ; Cambridge, UK
                Author information
                http://orcid.org/0000-0003-1982-3034
                Article
                226
                10.1186/s13229-018-0226-4
                6069847
                30083306
                65f1b220-cdd3-494e-a3e2-5a4242db2b28
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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
                : 22 February 2018
                : 22 July 2018
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000269, Economic and Social Research Council;
                Award ID: ES/N000501/1
                Award Recipient :
                Funded by: Autism Research Trust
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                Neurosciences
                autism spectrum condition,autistic traits,suicidality,non-suicidal self-injury,nssi,sbq-r,nssi-at,risk markers,mental health,depression,anxiety

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