University of Gothenburg
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We need to talk about suicide

Adam Helles's latest blog

[Posted on 21 November, 2017 by Adam Helles]

In this blog post I will address a serious and important subject: suicide and suicidal thoughts among adults with autism spectrum disorders (ASD). A recently published registry study found that people with ASD had a heightened suicide risk [1] and another study reported that many suffer from recurring suicidal thoughts [2]. In spite of this, there is very little information about why some people with ASD commit suicide and how we might be able to prevent it. I find myself seeing many examples of how little people generally know about how aspects like poor mental health and suicide risk manifest in adults with ASD. Moreover, many clinicians in adult psychiatric services seem very insecure about how to assess the potential suicide risk.

People with ASD are significantly more likely to suffer from poor mental health and especially depression, one of the most important risk factors for suicide (three out of four people with Asperger’s syndrome suffer from depression at some point in their lives) [3]. Many with ASD additionally have several comorbid conditions [4] that increase the risk even further. Factors like loneliness and unemployment are well-known risk factors for suicide and people with ASD are more vulnerable in this respect as well, as many of them are lonely and/or unemployed [5].

Are people with ASD more likely to commit suicide, the more difficulties they have? Logically speaking, this should be the case. If someone with ASD also suffers from depression, anxiety, unemployment and loneliness, maybe ASD is just the added burden that makes them want to give up and take their own life. On the other hand, there are research findings indicating that some people with Asperger’s syndrome consider their quality of life to be high even though they are lonely and unemployed.

There are some indications that the suicide process is different for people with ASD, that people with ASD get suicidal thoughts even with only a few symptoms of depression [2]. Another important thing to bear in mind is that many with ASD will not mention their suicidal thoughts unsolicited, but will answer if asked about the issue.

There is currently not a lot of information about how to treat poor mental health in people with ASD, and this is a major problem. The available literature emphasises that treatment must be tailored, but does not provide many answers on how this tailoring should be done. There is also insufficient scientific evidence available regarding what kind of traditional pharmacological treatment actually helps for people with ASD and poor mental health. Even though there is so little information available, people in psychiatric care work every day to try to help adults with ASD and poor mental health. Lots of studies are being done to try to find the answer to why ASD occurs, and also a great deal of research on children and early intervention for people with ASD, but almost no research at all on adults with ASD and treatment of poor mental health among people with ASD. Fundamental research is certainly important, but there is a need for more research on treatment and on poor mental health in adults with ASD.

There are no simple answers to the question of suicide, but we have to dare to ask more questions about suicidal thoughts and suicide plans among people with ASD, whether it be in everyday clinical situations or in research projects. We have to improve our knowledge about suicidal thoughts and suicide among individuals with ASD. People’s lives are depending on it.

[This is a blog. The purpose of the blog is to provide information and raise awareness concerning important issues. All views and opinions expressed are those of the writer and not necessarily shared by the GNC.]

Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study. The Lancet, 1, 142-147.

Gillberg, I.C., Helles, A., Billstedt, E., & Gillberg, C. (2016). Boys with Asperger Syndrome Grow Up: Psychiatric and Neurodevelopmental Disorders 20 Years After Initial Diagnosis. Journal of Autism and Developmental Disabilities, 46, 74-82.

Helles, A., , Gillberg, I.C., Gillberg, C., & Billstedt, E. (2017). Asperger syndrome in males over two decades: Quality of life in relation to diagnostic stability and psychiatric comorbidity. Autism. 21, 458-469

Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016). Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208, 232-238.

Lugnegård, T., Hallerbäck, M.U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32, 1910-1717.