Temperament and character as risk factor for suicide ideation and attempts in adults with autism spectrum disorders

Mortality and Autism: Suicide and Elopement

Autistic children and youth are at risk for premature mortality. Two preventable causes of that increased risk are elopement and suicide. Pediatricians should educate themselves and caregivers about strategies that could prevent tragic situations involving autistic youth.

Risk and Protective Factors Associated with Self-Cutting Behavior Among Adolescents at First Contact with the Juvenile Court

Adolescents involved in juvenile legal system are at increased risk for self-cutting behavior, however, correlates associated with elevated risk remain underresearched, particularly among youth with first involvement with the court. This study utilized an epidemiological two-year longitudinal study involving 401 adolescents at first contact with the court (Mage = 14.47; SDage = 1.94 years; 43% female; 42% Latinx/Hispanic) and an involved caregiver. Study aims examined key prospective psychosocial correlates of self-cutting behavior. Baseline assessments captured individual and family level risk and protective factors; self-cutting behavior was assessed longitudinally every four months post-baseline for 24 months. Psychosocial correlates of self-cutting behavior included adolescent affect dysregulation, post-traumatic stress disorder symptoms, impulsive decision making, anxiety and depression symptoms. Significant protective factors included positive communication with caregiver and family, higher self-esteem, and having a caring and supportive family. These findings suggest that internalizing symptoms as well as difficulties with emotion regulation and impulsive decision making are correlated with heightened risk for self-cutting behavior among adolescents involved in the juvenile legal system. The findings also suggest that individual and family level protective factors, like positive communication and a supportive family, are associated with decreased risk for self-cutting behavior among adolescents at first contact with the court.

[Anton Bruckner: the Linz cathedral organist, university teacher, symphonic musician : Could modern intensive care medicine have helped him and his illnesses?]

BACKGROUND

Anton Bruckner was a famous cathedral organist, university teacher, and symphonic composer, but his life, illnesses, death and dying are little or not known to many.

OBJECTIVES

Which illnesses determined Bruckner's life and did lifestyle and illnesses influence his compositional work? From today's perspective, could modern intensive care medicine have helped him?

MATERIALS AND METHODS

A detailed analysis of Bruckner's diseases was carried out using the scientific databases PubMed® and MEDLINE®. All published articles were evaluated and examined in detail. In addition, data from a concert tour of the author to Linz and the St. Florian Abbey Basilica were collected.

RESULTS

Anton Bruckner was born on 4 September 1824 in Ansfelden, Austria. As a child he received piano and organ lessons. After his father's death, he devoted himself to playing the organ and became in 1855 cathedral organist in Linz. His further career took him to Vienna, where he became a professor at the conservatory and turned to composition. His symphonies, his masses, and his Te Deum are his most famous works. During the first 40 years of his life, Bruckner suffered from psychopathological illnesses, including depression, delusions of persecution, and neuroses. Later, he suffered from chronic heart failure with recurrent right and left heart decompensation up to the development of cardiac cachexia, possibly caused by dilated cardiomyopathy due to alcohol toxicity. He died on 11 October 1896 in Vienna.

CONCLUSION

Bruckners life was marked by a wide variety of illnesses. His penchant for death and the dead was also striking. Modern medicine would probably have improved his quality of life through consequent heart failure therapy; an implantable automatic defibrillator with resynchronization therapy would probably have prolonged his life.

A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor

Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.

The association of personality polygenic risk score, psychosocial protective factors and suicide attempt in mood disorder

Some personality traits, especially neuroticism, has been found to be associated with suicide attempt (SA) in mood disorder patients. The present study explored the association between personality traits and SA using polygenic risk scores (PRS) for personality among patients with mood disorders. We also investigated the effects of a variety of psychosocial variables on SA. Patients with bipolar disorder (BPD, N = 841) and major depressive disorder (MDD, N = 710) were recruited from hospitals in Taiwan. Lifetime SA and information on psychosocial factors was collected. We calculated the PRS of neuroticism and extraversion. A trend test for SA was performed across quartiles of the PRS for neuroticism and extraversion, and logistic regression analyses were performed to examine the associations between psychosocial factors and SA, accounting for the PRS of personality traits. The prevalence of SA was higher in MDD than in BPD patients. The risk of SA was elevated in MDD patients with a higher quintile of PRS in neuroticism and a lower quintile of PRS in extraversion. The multiple regression analysis results demonstrated that later age of onset, higher family support and resilience, and lower overall social support were protective factors against SA. From the perspective of suicide prevention efforts, strengthening family support and conducting resilience training for patients with mood disorders may be beneficial interventions in clinical settings.

Brief Report: Risk and Protective Factors Associated with Depressive Symptoms among Autistic Adults

Autistic individuals are at risk for developing depression though the risk and protective factors for co-occurring depression in autistic individuals are not yet fully characterized. In this retrospective medical chart review study, we explored factors associated with self-reported depressive symptoms (Patient Health Questionnaire-9) in autistic adults (N = 58). For autistic adults, engagement in one or more activities (recreational, educational and/or vocational) was associated with less severe depressive symptoms (Mann-Whitney U test, p = 0.006); and reported family history of depression/anxiety was associated with increased likelihood of suicidal ideation (Chi-square test, p = 0.027). Promotion of community-based activities and family support systems may be an integral part of creating effective treatment plans for depressive symptoms in autistic adults.

Suicide Risk Screening in Pediatric Outpatient Neurodevelopmental Disabilities Clinics

OBJECTIVE

The purpose of this study was to describe the implementation of universal suicide risk screening in pediatric neurodevelopmental disabilities (NDD) medical clinics, analyze demographic and clinical characteristics of eligible patients, describe outcomes of positive screenings, and describe factors that influenced participation in screenings.

METHODS

A suicide risk screening protocol was developed and implemented for medical clinic patients aged 8 to 18 years. Registered nurses screened patients using the "Ask Suicide-Screening Questions" tool during triage. Positive screenings were referred for further assessment and mental health management. Demographics and clinical data were extracted from medical records using retrospective chart reviews.

RESULTS

During the 6-month study period, 2961 individual patients presented for 5260 screening eligible patient visits. In total, 3854 (73.3%) screenings were completed with 261 (6.8%) positive screenings noted. Screenings were declined in 1406 (26.7%) visits. Parents of children with cognitive impairments were more likely to decline screening. Clinics serving children with autism spectrum disorder had higher rates of positive screenings compared with all other clinic attendees. Seventy-two of 187 children (38.5%) with positive screenings were identified and referred to outpatient mental health referrals. Seven (2.5%) of these children required acute psychiatric treatment.

CONCLUSION

Routine screening, identification of increased suicide risk, and referral to mental health care among children with NDD are feasible. It remains unclear whether variation in rates among youth with and without NDD may indicate true differences in suicide risk or cognitive impairments or reflect psychiatric comorbidities. High rates of declined participation may have influenced identification of children with NDD and suicide risk. Preliminary findings identified groups of children with NDD at heightened risk for suicidal ideation and behavior. Further research is needed to assess the validity of suicide risk screening tools in children with neurodevelopmental disorders.

Temperament in individuals with Autism Spectrum Disorder: A systematic review

The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.

The role of loneliness as a mediator between autism features and mental health among autistic young adults

LAY ABSTRACT

Autistic adults commonly experience mental health concerns including social anxiety and depression, which can have negative effects on their quality of life. It is not completely clear, however, why rates of mental health concerns are so high. Some evidence suggests that social connectedness might play a key role. The goal of this study was to explore links between loneliness, mental health concerns, autism features, and social contact among autistic adults and test whether the links between mental health with autism features and social contact can be explained by loneliness. Researchers in this study collected data using questionnaires completed by 69 autistic young adults. Autistic adults who reported more autism features also reported more social and family loneliness, higher levels of social anxiety and depression, and fewer initiated social contacts. In addition, adults with more social contact initiations were likely to report lower levels of social and family loneliness and social anxiety but not depression. Results showed that the link from social engagement and autism features to social anxiety and depression symptoms could be mostly explained by loneliness. The results of this study expand previous findings by illustrating one factor (loneliness) that might be responsible for the high rates of mental health concerns among adults on the autism spectrum. These findings highlight the importance of studying factors related to mental health concerns among autistic adults and ways to best support social connectedness for the mental well-being of autistic young adults.

Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is associated with self-harm during adolescence and young adulthood, especially among females. Yet little is known about the developmental trajectories or childhood predictors/moderators of self-harm in women with and without childhood histories of ADHD. We characterized lifetime risk for nonsuicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SA), comparing female participants with (n = 140) and without (n = 88) childhood ADHD. We examined theory-informed childhood predictors and moderators of lifetime risk via baseline measures from childhood. First, regarding developmental patterns, most females with positive histories of lifetime self-harm engaged in such behaviors in adolescence yet desisted by adulthood. Females with positive histories of self-harm by late adolescence emanated largely from the ADHD-C group. Second, we found that predictors of NSSI were early externalizing symptoms, overall executive functioning, and father's negative parenting; predictors of SI were adverse childhood experiences and low self-esteem; and predictors of SA were early externalizing symptoms, adverse childhood experiences, and low self-esteem. Third, receiver operating characteristics analyses helped to ascertain interactive sets of predictors. Findings indicate that pathways to self-harm are multifaceted for females with ADHD. Understanding early childhood predictors and moderators of self-harm can inform both risk assessment and intervention strategies.

Associations Among Monoamine Neurotransmitter Pathways, Personality Traits, and Major Depressive Disorder

Major depressive disorder (MDD) is a complex psychiatric disease requiring multidisciplinary approaches to identify specific risk factors and establish more efficacious treatment strategies. Although the etiology and pathophysiology of MDD are not clear until these days, it is acknowledged that they are almost certainly multifactorial and comprehensive. Monoamine neurotransmitter system dysfunction and specific personality traits are independent risk factors for depression and suicide. These factors also demonstrate complex interactions that influence MDD pathogenesis and symptom expression. In this review, we assess these relationships with the aim of providing a reference for the development of precision medicine.