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Hedley D, Uljarević M, Bury SM, Haschek A, Richdale AL, Trollor JN, Stokes MA. Examination of the Potential Moderating Role of Psychological Wellbeing in the Relationship Between Depression and Thoughts of Self-Harm in Autistic Adolescents and Adults: A Two-Year Longitudinal Study. J Autism Dev Disord 2024:10.1007/s10803-024-06489-x. [PMID: 39078579 DOI: 10.1007/s10803-024-06489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Autistic people have a significantly increased risk of death by suicide relative to the general population. In non-autistic samples, psychological wellbeing has been shown to moderate the relationship between depression and suicidal thoughts and behavior. Thoughts of self-harm may provide a useful indicator of suicidal risk. In this longitudinal study we examined (a) the potential role for psychological wellbeing to moderate the relationship between depressive symptoms and thoughts of self-harm and (b) the contribution of autistic traits to thoughts of self-harm. METHODS Participants were 209 autistic adolescents and adults aged 15 to 80 years (Mage = 34.20, SD = 15.38 years). RESULTS At both baseline and 2-year follow-up, 35% of participants reported recent thoughts of self-harm. Wellbeing was associated with autistic traits (r = - .350 to - 0.404) and depression (r = - .480 to - 0.759). Thoughts of self-harm were positively associated with autistic traits and depression (r = .242 to 0.659), and negatively associated with wellbeing (r = - .287 to - 0.609). Controlling for baseline thoughts of self-harm, depression (β = 0.254, p = .001) and autistic traits (β = 0.162, p = .007) significantly predicted thoughts of self-harm at 2-year follow-up. CONCLUSION Despite a lack of support for the hypothesis that wellbeing would moderate the relationship between depression and thoughts of self-harm, correlational data demonstrated significant associations between wellbeing and both depression and thoughts of self-harm. Future research considering psychological wellbeing as a potential protective factor for self-harm in autistic people is warranted.
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Affiliation(s)
- Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
| | | | - Simon M Bury
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Alexandra Haschek
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Julian N Trollor
- Department of Developmental Disability Neuropsychiatry, School of Clinical Medicine, UNSW, Sydney, NSW, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC),, Brisbane, QLD, Australia
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Carpita B, Nardi B, Bonelli C, Pascariello L, Massimetti G, Cremone IM, Pini S, Palego L, Betti L, Giannaccini G, Dell’Osso L. Platelet Levels of Brain-Derived Neurotrophic Factor in Adults with Autism Spectrum Disorder: Is There a Specific Association with Autism Spectrum Psychopathology? Biomedicines 2024; 12:1529. [PMID: 39062102 PMCID: PMC11274613 DOI: 10.3390/biomedicines12071529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
To date, although several studies have investigated the circulating levels of brain-derived neurotrophic factor (BDNF) in children with autism spectrum disorder (ASD), only a few authors have addressed their evaluation in adults. Furthermore, an important limitation of these studies lies in the fact that circulating BDNF is stored in platelets and released into the circulation when needed. To the best of our knowledge, a very limited number of studies have related peripheral BDNF values to platelet counts, and yet no study has evaluated intra-platelet BDNF levels in adults with ASD. In this framework, the aim of the present work is to pave the way in this field and evaluate platelet BNDF levels in adult ASD patients, as well as their correlation with autistic symptoms and related psychopathological dimensions. We recruited 22 ASD and 22 healthy controls, evaluated with the Adult autism subthreshold spectrum (AdAS Spectrum), the Social Anxiety Spectrum-self report (SHY-SR), the Trauma and loss spectrum-self report (TALS-SR), the Work and Social Adjustment Scale (WSAS), and the Mood Spectrum-self report for suicidality. Intra-platelet BDNF levels were also assessed. The results highlighted lower BDNF levels in the ASD group; moreover, AdAS Spectrum and WSAS total score as well as AdAS Spectrum Restricted interest and rumination, WSAS Private leisure activities, TALS-SR Arousal, and SHY-SR Childhood domains were significant negative predictors of platelet BDNF levels.
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Affiliation(s)
- Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Lavinia Pascariello
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Stefano Pini
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
| | - Lionella Palego
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (L.P.); (L.B.); (G.G.)
| | - Laura Betti
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (L.P.); (L.B.); (G.G.)
| | - Gino Giannaccini
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (L.P.); (L.B.); (G.G.)
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (B.C.); (C.B.); (L.P.); (G.M.); (I.M.C.); (S.P.); (L.D.)
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Huntjens A, van den Bosch LMCW, Sizoo B, Kerkhof A, Smit F, van der Gaag M. The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial. Psychol Med 2024:1-12. [PMID: 38606582 DOI: 10.1017/s0033291724000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUNDS Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts. METHODS At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes. RESULTS At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition. CONCLUSIONS DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.
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Affiliation(s)
- Anne Huntjens
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
| | | | | | - Ad Kerkhof
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Public Mental Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
- Parnassia Psychiatric Institute, The Hague, Netherlands
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Rybczynski S. Mortality and Autism: Suicide and Elopement. Pediatr Clin North Am 2024; 71:343-351. [PMID: 38423725 DOI: 10.1016/j.pcl.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
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.
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Affiliation(s)
- Suzanne Rybczynski
- East Tennessee Children's Hospital, 2018 Clinch Avenue, Knoxville, TN 37916, USA; Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Cook ML, Tomaszewski B, Lamarche E, Bowman K, Klein CB, Stahl S, Klinger LG. Suicide risk in transition-aged autistic youth: The link among executive function, depression, and autistic traits. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241227983. [PMID: 38340034 DOI: 10.1177/13623613241227983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
LAY ABSTRACT Autistic people are more likely to consider suicide than non-autistic people, with transition-aged youth (ages 16-21 years) at potentially the highest risk. Research has also shown that difficulties with executive functioning (e.g., difficulties with organization, sequencing, and decision-making) may heighten suicide risk among non-autistic people, but it is not clear whether this is also true for autistic people. This study explored this question by asking 183 transition-aged autistic youth about their experience with suicidal behavior and examining the relationship between their responses and additional measures of depression, autistic traits, and executive function skills. About one-third of autistic transition-aged youth (33.3%) said that they had experienced thoughts of hurting themselves with the intent to end their lives (i.e., suicidal ideation). Both depression and executive function challenges predicted suicide risk (i.e., participants who experienced depression were more likely to have had suicidal thoughts than those who had not, and participants who had more difficulty with executive function skills were more likely to have had suicidal thoughts than those who had less difficulty). These findings suggest that executive functioning, a common area of difficulty among autistic people, is an important indicator of suicide risk in this population.
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Affiliation(s)
- Michal L Cook
- The University of North Carolina at Chapel Hill, USA
| | | | | | | | | | - Sara Stahl
- The University of North Carolina at Chapel Hill, USA
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Choi NG, Marti CN, Choi BY. Firearm use risk factors and access restriction among suicide decedents age 75 and older who disclosed their suicidal intent. Front Public Health 2023; 11:1255519. [PMID: 38026395 PMCID: PMC10654963 DOI: 10.3389/fpubh.2023.1255519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background and aims A majority of older adult suicide decedents used firearms. In this study, we focused on suicide decedents age 75+ who disclosed their suicidal intent within a month of their injury/death to examine demographic and clinical characteristics associated with firearm use and firearm access restriction attempts by their family members. Methods The 2017-2019 U.S. National Violent Death Reporting System provided data (N = 1,734 suicidal intent disclosers; 1,476 males and 258 females; 21.4% of decedents age 75+). Generalized linear model (GLM) for a Poisson distribution with a log link was used to examine firearm use risk factors. Firearm access restriction attempts by decedents' family members were examined based on coroner/medical examiner and law enforcement (CME/LE) reports. Results Nearly three quarters of disclosers disclosed their intent to family members, and 82.9% of males and 27.5% of females used firearms. GLM results showed males, non-Hispanic white people, and residents in the South and West regions had higher likelihood of firearm use. CME/LE reports of 140 out of 1,294 firearm decedents included narratives related to firearm restriction attempts or lack thereof. Firearm access restrictions were not attempted in 65 cases because family members did not take suicidal intent disclosure seriously or because decedents promised no self-harm. Partial or complete removal of firearms in 75 cases were not effective as decedents had hidden a firearm or purchased a new one. Others used different lethal methods. Implications The findings indicate a need for: (a) training family members of older adults who are at risk of suicide in effective means safety/access restriction and strategies to prevent means substitution; (b) more comprehensive legislative reforms reducing access to firearms by those at risk of suicide; and (c) more comfort and palliative care and counseling for psychosocial risk factors.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, United States
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, United States
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7
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French B, Daley D, Groom M, Cassidy S. Risks Associated With Undiagnosed ADHD and/or Autism: A Mixed-Method Systematic Review. J Atten Disord 2023; 27:1393-1410. [PMID: 37341291 PMCID: PMC10498662 DOI: 10.1177/10870547231176862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND The two most prevalent neurodevelopmental disorders-Attention Deficit Hyperactivity Disorder (ADHD) and Autism (ASD)-(ASD/ADHD) strongly impact individuals' functions. This is worsened when individuals are undiagnosed and risks such as increased imprisonments, depression or drug misuse are often observed. This systematic review synthesizes the risks associated with late/undiagnosed ASD/ADHD. METHODS Four databases were searched (Medline, Scopus, PsychInfor, and Embase). Published studies exploring the impact of undiagnosed ASD/ADHD were included. Exclusion criteria included, lack of diagnosis status, studies not solely on ASD or ADHD, gray literature and studies not in English. The findings were summarize through a narrative synthesis. RESULTS Seventeen studies were identified, 14 on ADHD and three on ASD. The narrative synthesis identified three main themes: (1) Health, (2) Offending behavior, and (3) Day-to-day impact. The risks highlighted a significant impact on mental wellbeing and social interactions, higher risks of substance abuse, accidents and offending behavior as well as lower levels of income and education. DISCUSSION The findings suggest that undiagnosed ASD/ADHD is linked to many risks and negative outcomes affecting individuals, their families, and the wider society. The restricted number of studies on ASD are a limitation to the generalization of these findings Implications for research and practice are discussed, highlighting the importance of screening and acknowledging the possibility of ASD/ADHD in many settings such as psychiatric and forensic.
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Wang W, Wang X. Non-suicidal self-injury in Chinese college students with elevated autistic traits: Associations with anxiety, rumination and experiential avoidance. Compr Psychiatry 2023; 126:152407. [PMID: 37566951 DOI: 10.1016/j.comppsych.2023.152407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Although existing studies have proved that autistic traits (AT) may have relations to non-suicidal self-injury (NSSI) behaviors, its associations with anxiety, rumination and experiential avoidance (EA) are still unclear. The current study, based on a sample of 1317 Chinese college students, explored the associations between AT, anxiety and NSSI, and the possible modulating roles of rumination and EA in these associations. The results shows that 1) a total of 334 (25.36%) students reported a history of NSSI and 30 (2.28%) students were categorized as high AT; 2) Students with high AT reported higher rates of NSSI than those with low AT (36.67% vs. 25.10%); 3) AT, anxiety, rumination and EA have positive relations with NSSI; 4) AT predicted NSSI indirectly through anxiety; 5) Rumination and EA significantly moderated the effects of AT on NSSI via anxiety. In conclusion, this study confirms the indirect effect of AT on NSSI through anxiety in Chinese college students, and further clarifies the reinforcing effects of rumination and EA on the associations between AT, anxiety and NSSI. These findings suggest that developing adaptive emotion-regulating strategies and positive coping styles might promote the prevention and treatment of NSSI behaviors among autistic individuals.
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Affiliation(s)
- Wan Wang
- Department of Child Developmental Behavior, The Third Affiliated Hospital of Zhengzhou University, 7 Kangfu Front Street, Zhengzhou 450001, China.
| | - Xi Wang
- College of Computer Science and Electronic Engineering, Hunan University, 109 Shijiachong Road, Changsha 410012, China
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Cassidy S, McLaughlin E, McGranaghan R, Pelton M, O'Connor R, Rodgers J. Is camouflaging autistic traits associated with defeat, entrapment, and lifetime suicidal thoughts? Expanding the Integrated Motivational Volitional Model of Suicide. Suicide Life Threat Behav 2023; 53:572-585. [PMID: 37129164 DOI: 10.1111/sltb.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/23/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION The current study explored whether camouflaging autistic traits is associated with defeat and entrapment and lifetime suicidal thoughts, as predicted by the Integrated Volitional Model of Suicide (IMV model). METHODS 180 UK undergraduate students (76.7% female 18-67 years) completed a cross-sectional online survey from February 5 to March 23, 2020, including self-report measures of defeat and entrapment (SDES), autistic traits (AQ-10), depression (PHQ-9), anxiety (GAD-7), camouflaging autistic traits (CAT-Q), and lifetime suicidal thoughts and behaviors (SBQ-R item 1). RESULTS After controlling for age, gender, current depression, and anxiety symptoms, autistic traits accounted for significantly more of the variance in defeat and entrapment (1.1%), and camouflaging accounted for a further 3.2% of the variance. The association between autistic traits and lifetime suicidality was significantly mediated by camouflaging, defeat, and entrapment. After controlling for age, gender, current depression, and anxiety symptoms, defeat and entrapment (but not camouflaging) accounted for significantly more variance in lifetime suicidal thoughts. The interaction between camouflaging, defeat and entrapment predicted significantly less variance in lifetime suicidal thoughts than either variable alone. CONCLUSION Results suggest that camouflaging autistic traits is a transdiagnostic risk factor for lifetime suicidality, relevant to the defeat and entrapment constructs of the IMV model.
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Affiliation(s)
- Sarah Cassidy
- School of Psychology, University of Nottingham, Nottingham, UK
| | | | | | - Mirabel Pelton
- Centre for Intelligent Healthcare, Coventry University, Coventry, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Rory O'Connor
- School of Psychology, University of Glasgow, Glasgow, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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10
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Kurtz MR, Kana RK, Rivera DL, Newman SD. The role of the broader autism phenotype in anxiety and depression in college-aged adults. Front Psychiatry 2023; 14:1187298. [PMID: 37342174 PMCID: PMC10278885 DOI: 10.3389/fpsyt.2023.1187298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
The current study examines the relationship between the presence of autistic traits and anxiety and mood disorders in young adults from different racial groups. A representative sample from a predominately white university (2,791 non-Hispanic White (NHW) and 185 Black students) completed the broad autism phenotype questionnaire (BAPQ), a measure of depression (Patient Health Questionnaire, PHQ-9), and anxiety (Generalized Anxiety Disorder, GAD-7). Statistical Package for Social Sciences (SPSS) was used to perform two multiple regression analyses to determine the association between race, BAPQ score and anxiety and depression symptoms. The current study found a stronger association between autistic traits had depression and anxiety symptoms in Black participants than did NHW participants. These findings underscore the association between autistic traits and anxiety and depression in Black communities, and the need for further studies on this topic area. Additionally, it highlights the importance of improving access to mental health care for this population.
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Affiliation(s)
- McKayla R. Kurtz
- Department of Psychology, Center for Innovative Research in Autism, The University of Alabama, Tuscaloosa, AL, United States
| | - Rajesh K. Kana
- Department of Psychology, Center for Innovative Research in Autism, The University of Alabama, Tuscaloosa, AL, United States
| | - Daphne L. Rivera
- Department of Psychology, Center for Innovative Research in Autism, The University of Alabama, Tuscaloosa, AL, United States
| | - Sharlene D. Newman
- Department of Psychology, Center for Innovative Research in Autism, The University of Alabama, Tuscaloosa, AL, United States
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
- Alabama Life Research Institute, The University of Alabama, Tuscaloosa, AL, United States
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Pelton MK, Crawford H, Bul K, Robertson AE, Adams J, de Beurs D, Rodgers J, Baron‐Cohen S, Cassidy S. The role of anxiety and depression in suicidal thoughts for autistic and non-autistic people: A theory-driven network analysis. Suicide Life Threat Behav 2023; 53:426-442. [PMID: 36974940 PMCID: PMC10947106 DOI: 10.1111/sltb.12954] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/09/2023] [Accepted: 02/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Autistic adults experience more frequent suicidal thoughts and mental health difficulties than non-autistic adults, but research has yet to explain how these experiences are connected. This study explored how anxiety and depression contribute to suicidal thoughts according to the Interpersonal Theory of Suicide for autistic and non-autistic adults. METHODS Participants (autistic adults n = 463, 61% female; non-autistic n = 342, 64% female) completed online measures of anxiety, depression, thwarted belonging, and perceived burdensomeness. Network analysis explored whether: (i) being autistic is a risk marker for suicide; and (ii) pathways to suicidal thoughts are consistent for autistic and non-autistic adults. RESULTS Being autistic connected closely with feeling like an outsider, anxiety, and movement, which connected to suicidal thoughts through somatic experiences, low mood, and burdensomeness. Networks were largely consistent for autistic and non-autistic people, but connections from mood symptoms to somatic and thwarted belonging experiences were absent for autistic adults. CONCLUSION Autistic people experience more life stressors than non-autistic people leading to reduced coping, low mood, and suicidal thoughts. Promoting belonging, reducing anxiety, and understanding the role of movement could inform suicide prevention for autistic people. Research should accurately capture autistic lived experience when modeling suicide to ensure suicide prevention meets autistic needs.
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Affiliation(s)
- Mirabel K. Pelton
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Hayley Crawford
- Mental Health and Wellbeing Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Kim Bul
- Institute for Health and Wellbeing, Centre for Intelligent HealthcareCoventry UniversityCoventryUK
| | - Ashley E. Robertson
- School of Psychology & NeuroscienceUniversity of Glasgow, University AvenueGlasgowUK
| | - Jon Adams
- Autistic Advocate and ResearcherPortsmouthUK
| | | | - Jacqui Rodgers
- Population Health Sciences InstituteSir James Spence Institute, Newcastle University, Royal Victoria InfirmaryNewcastleUK
| | - Simon Baron‐Cohen
- Autism Research Centre, Department of PsychiatryUniversity of CambridgeCambridgeUK
| | - Sarah Cassidy
- School of PsychologyUniversity of Nottingham, University ParkNottinghamUK
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12
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Cremone IM, Nardi B, Amatori G, Palego L, Baroni D, Casagrande D, Massimetti E, Betti L, Giannaccini G, Dell'Osso L, Carpita B. Unlocking the Secrets: Exploring the Biochemical Correlates of Suicidal Thoughts and Behaviors in Adults with Autism Spectrum Conditions. Biomedicines 2023; 11:1600. [PMID: 37371695 DOI: 10.3390/biomedicines11061600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/27/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
Involving 1 million people a year, suicide represents one of the major topics of psychiatric research. Despite the focus in recent years on neurobiological underpinnings, understanding and predicting suicide remains a challenge. Many sociodemographical risk factors and prognostic markers have been proposed but they have poor predictive accuracy. Biomarkers can provide essential information acting as predictive indicators, providing proof of treatment response and proposing potential targets while offering more assurance than psychological measures. In this framework, the aim of this study is to open the way in this field and evaluate the correlation between blood levels of serotonin, brain derived neurotrophic factor, tryptophan and its metabolites, IL-6 and homocysteine levels and suicidality. Blood samples were taken from 24 adults with autism, their first-degree relatives, and 24 controls. Biochemical parameters were measured with enzyme-linked immunosorbent assays. Suicidality was measured through selected items of the MOODS-SR. Here we confirm the link between suicidality and autism and provide more evidence regarding the association of suicidality with increased homocysteine (0.278) and IL-6 (0.487) levels and decreased tryptophan (-0.132) and kynurenic acid (-0.253) ones. Our results suggest a possible transnosographic association between these biochemical parameters and increased suicide risk.
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Affiliation(s)
- Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Lionella Palego
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy
| | - Dario Baroni
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy
| | - Danila Casagrande
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Enrico Massimetti
- ASST Bergamo Ovest, SSD Psychiatric Diagnosis and Treatment Service, 24047 Treviglio, Italy
| | - Laura Betti
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy
| | | | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy
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13
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Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S. A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Mol Autism 2023; 14:12. [PMID: 36922899 PMCID: PMC10018918 DOI: 10.1186/s13229-023-00544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. AIMS To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. RESULTS Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. CONCLUSIONS The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lucy Phillips
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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14
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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. Clin Psychol Rev 2023; 99:102235. [PMID: 36459876 DOI: 10.1016/j.cpr.2022.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
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.
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15
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Cleary M, West S, McLean L, Hunt GE, Hungerford C, Kornhaber R. A Scoping Review of Autism and the Way It Changes the Presentation of Suicidal Thoughts and Behavior Compared to the General Population. Issues Ment Health Nurs 2022; 44:282-301. [PMID: 36279193 DOI: 10.1080/01612840.2022.2132329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Autism spectrum conditions are a group of neurodevelopmental conditions that carries an array of co-occurring diagnoses, including a heightened risk of suicide attempts and suicide. This scoping review examined primary research focusing on autism and suicidality, to understand what is currently known on the topic, including how autism changes the presentation of suicidal thoughts and behavior; and to assess the suicide awareness and prevention education programs currently available for autistic people, their families, and health professionals and support workers. A comprehensive search (November 2021) across Scopus, PubMed and CINAHL identified 39 articles from 38 studies. Three themes emerged, with five subthemes. 1. The prevalence of suicidality in autistic people; 2. The presentation of suicidality in autistic people, including (a) risk of suicidality; (b) gender, age, employment and education; (c) co-occurring psychiatric conditions; (d) autism traits and social communication; (e) intellectual disability; and 3. Autism-specific approaches to suicidal thoughts, behavior and prevention. Findings were mixed, including conflicting evidence on the risk of autism and suicidality, and limited evidence of resources related to autism-specific suicide awareness or information, and education or prevention programs.
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Affiliation(s)
- Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Sancia West
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia
| | - Loyola McLean
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.,Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Westmead Psychotherapy Program for Complex Traumatic Disorders, Western Sydney Local Health District, Parramatta, New South Wales, Australia.,The Western Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Glenn E Hunt
- Speciality of Psychiatry, Concord Clinical School, The University of Sydney, Concord West, New South Wales, Australia
| | - Catherine Hungerford
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, New South Wales, Australia.,School of Health, Federation University, Mt Helen, Victoria, Australia
| | - Rachel Kornhaber
- School of Nursing, University of Tasmania, Sydney, New South Wales, Australia
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16
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Bal VH, Leventhal BL, Carter G, Kim H, Koh YJ, Ha M, Kwon HJ, Hong P, Kim YS, Kim YS. Parent-Reported Suicidal Ideation in Three Population-Based Samples of School-Aged Korean Children With Autism Spectrum Disorder and Autism Spectrum Screening Questionnaire Screen Positivity. Arch Suicide Res 2022; 26:1232-1249. [PMID: 34724876 PMCID: PMC9058040 DOI: 10.1080/13811118.2020.1868367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Higher prevalence of suicidality has been reported in individuals with ASD. This study aimed to (1) Estimate the prevalence of suicidal ideation (SI) in epidemiologically-ascertained, population-based, samples of children with ASD or Autism Spectrum Screening Questionnaire (ASSQ) Screen Positivity (ASP); (2) Determine whether ASD/ASP is an independent risk factor for SI, controlling for known SI risk factors; and, (3) Develop an explanatory model for SI in children with ASD/ASP. METHODS Participants came from three epidemiologically-ascertained samples of school-aged Korean children (n = 14,423; 3,702; 4,837). ASSQ ≥ 14 was the cutoff for ASP. A subsample (n = 86) was confirmed to have ASD. SI was based on parents' endorsement of items on the Behavioral Assessment System for Children-2-Parent Report Scale-Children. Logistic regressions were used to assess associations between SI and ASD/ASP, controlling for demographics, peer victimization, behavior problems, and depression. To develop an explanatory model for SI within ASD/ASP, the associations between SI and child characteristics (comorbid conditions, ASD symptoms, IQ, adaptive function) were tested. RESULTS SI was higher in children with ASD (14%) and ASP (16.6-27.4%) than ASSQ Screen Negative (ASN) peers (3.4-6.9%). ASD/ASP was strongly predictive of SI (ORs: 2.87-5.67), after controlling for known SI risk factors compared to ASN. Within the ASD and ASP groups, anxiety was the strongest predictor of SI. CONCLUSIONS SI prevalence was higher in non-clinical samples of children with ASD and ASP, relative to ASN peers. These results underscore the need for routine screening for SI in children with ASD and social difficulties, particularly those with high anxiety. HighlightsPopulation-based, epidemiologically-ascertained, school-aged childrenASD and ASP are independent risk factors for SI in school-aged childrenAnxiety is an independent risk factor for SI in children with ASD or ASP.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Young Shin Kim
- UCSF Center for ASD & NDDs, Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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Ishizuka K, Ishiguro T, Nomura N, Inada T. Autistic traits as predictors of persistent depression. Eur Arch Psychiatry Clin Neurosci 2022; 272:211-216. [PMID: 34286407 DOI: 10.1007/s00406-021-01292-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022]
Abstract
Persistent depression has been suggested to be associated with autistic traits in people of working age. This study aimed to clarify which autistic characteristics at the initial visit were associated with persistent depression at the 12 week follow-up in a primary care setting. Newly depressed outpatients aged 24-59 years with no history of autism were asked to complete the 50-item autism spectrum quotient (AQ) and the Beck depression inventory (BDI) at baseline and 12 week follow-up (N = 123, males: 48%, age: 37.7 ± 9.15 years). Nearly 40% of participants had an AQ score ≥ 26. Significant differences were observed between the group with remitted depression (N = 43) and those with persistent depression (N = 80) in educational years and AQ "attention switching" and "attention to detail" subscale scores. In addition, a statistically significant decrease in the total AQ and the "communication" and "imagination" scores were observed in the remitted group, while no such change was observed in the group with persistent depression. It remains unclear whether the self-perceived severity of communication and imagination traits in persistent depression was due to the state of persistent depression or a kind of premorbid autistic trait. The results suggest that high levels of autistic traits are frequently present in adults with depression. High "attention switching" and "attention to detail" scores in AQ screening at the first visit might predict the persistence of depressive symptoms after 12 weeks in adults with depression, while total AQ scores, especially for "communication" and "imagination" items, might be state-dependent.
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Affiliation(s)
- Kanako Ishizuka
- Health Support Center, Nagoya Institute of Technology, Gokiso-cho, Showa-ku, 466-8555, Nagoya, Aichi, Japan
- Department of Child and Adolescent Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan
| | - Tomomi Ishiguro
- Hidamari Kokoro Clinic, 156 Goida, 490-1111, Ama, Aichi, Japan
| | - Norio Nomura
- Hidamari Kokoro Clinic, 156 Goida, 490-1111, Ama, Aichi, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Aichi, Japan.
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18
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Cassidy S, Au-Yeung S, Robertson A, Cogger-Ward H, Richards G, Allison C, Bradley L, Kenny R, O'Connor R, Mosse D, Rodgers J, Baron-Cohen S. Autism and autistic traits in those who died by suicide in England. Br J Psychiatry 2022; 221:1-9. [PMID: 35166201 DOI: 10.1192/bjp.2022.21] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Autism and autistic traits are risk factors for suicidal behaviour. AIMS To explore the prevalence of autism (diagnosed and undiagnosed) in those who died by suicide, and identify risk factors for suicide in this group. METHOD Stage 1: 372 coroners' inquest records, covering the period 1 January 2014 to 31 December 2017 from two regions of England, were analysed for evidence that the person who died had diagnosed autism or undiagnosed possible autism (elevated autistic traits), and identified risk markers. Stage 2: 29 follow-up interviews with the next of kin of those who died gathered further evidence of autism and autistic traits using validated autism screening and diagnostic tools. RESULTS Stage 1: evidence of autism (10.8%) was significantly higher in those who died by suicide than the 1.1% prevalence expected in the UK general alive population (odds ratio (OR) = 11.08, 95% CI 3.92-31.31). Stage 2: 5 (17.2%) of the follow-up sample had evidence of autism identified from the coroners' records in stage 1. We identified evidence of undiagnosed possible autism in an additional 7 (24.1%) individuals, giving a total of 12 (41.4%); significantly higher than expected in the general alive population (1.1%) (OR = 19.76, 95% CI 2.36-165.84). Characteristics of those who died were largely similar regardless of evidence of autism, with groups experiencing a comparably high number of multiple risk markers before they died. CONCLUSIONS Elevated autistic traits are significantly over-represented in those who die by suicide.
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Affiliation(s)
- Sarah Cassidy
- School of Psychology, University of Nottingham, UK and Faculty of Health and Life Sciences, Coventry University, UK
| | - Sheena Au-Yeung
- School of Psychology, University of Nottingham, UK, Faculty of Health and Life Sciences, Coventry University, UK and Department of Psychiatry, University of Oxford, UK
| | - Ashley Robertson
- Faculty of Health and Life Sciences, Coventry University, UK and School of Psychology, University of Glasgow, UK
| | - Heather Cogger-Ward
- School of Psychology, University of Nottingham, UK, School of Psychology, University of Lincoln, UK and Lincolnshire Partnership NHS Foundation Trust, UK
| | - Gareth Richards
- School of Psychology, Newcastle University, UK and Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
| | - Louise Bradley
- The International Centre, University of Bedfordshire, UK
| | - Rebecca Kenny
- Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
| | - Rory O'Connor
- Suicidal Behavior Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, UK
| | | | - Jacqui Rodgers
- Population Health Sciences Institute, Sir James Spence Institute, Newcastle University, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, UK
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19
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Abstract
I suggest that the current study of autism is problematic, due to: (1) its failure to pursue a medical model of disease causation, with protocols for differential diagnoses of causes; (2) a notable incidence of unrecognized false positive diagnoses in children; (3) the conceptual equating of autism with sets of traits that have been shown to be genetically and phenotypically unrelated to one another; and (4) the expansion of use of the terms "autism" and "autism traits" to psychiatric conditions that have no substantive etiological or symptomatic overlap with autism. These problems can be alleviated by, like Kanner, considering autism as a syndrome, a constellation of traits, conceptualized as differences rather than deficits, some set of which is found in each affected individual to some degree. The original, prototypical form of autism can be delineated based on the "hallmarks" of autism: a set of core traits, originally explicated by Kanner, that defines a relatively-homogeneous group, and that connects with the larger set of autism symptoms. The hallmarks of autism provide a touchstone for research that is unambiguous, historically continuous to the present, and linked with major theories for explaining the causes and symptoms of autism. Use of the hallmarks of autism does not impact recognition and treatment of individuals with DSM diagnosed autism, or individuals with the many disorders that involve social deficits. This perspective is compatible with the research domain criteria approach to studying autism, via analyses of autism's constituent traits and the differential diagnosis of its individual-specific causes.
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Affiliation(s)
- Bernard J Crespi
- Department of Biological Sciences, Simon Fraser University, Burnaby, BC, Canada
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20
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. The Mental and Physical Health Profiles of Older Adults Who Endorse Elevated Autistic Traits. J Gerontol B Psychol Sci Soc Sci 2021; 76:1726-1737. [PMID: 32756953 DOI: 10.1093/geronb/gbaa112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The mental and physical health profile of autistic people has been studied in adolescence and adulthood, with elevated rates of most conditions being reported. However, this has been little studied taking a dimensional approach to autistic traits and in older age. METHODS A total of 20,220 adults aged 50-81 years from the PROTECT study reported whether they experienced persistent sociocommunicative traits characteristic of autism. Approximately 1%, 276 individuals, were identified as endorsing elevated autistic traits in childhood and currently, henceforth the "Autism Spectrum Trait" (AST) group. An age- and gender-matched comparison group was formed of 10,495 individuals who did not endorse any autistic behavioral traits, henceforth the "Control Older Adults" (COA) group. Differences between AST and COA groups were explored in self-reported psychiatric diagnoses, self-reported symptoms of current depression and anxiety, and self-reported physical health diagnoses. Associations were also examined between autistic traits and health across the whole sample. RESULTS The AST group reported significantly elevated rates of psychiatric diagnoses compared to the COA group. Additionally, the AST group showed significantly higher self-reported symptoms of current depression and anxiety than the COA group. However, few differences were observed in individual physical health conditions, and no differences in total co-occurring physical diagnoses between groups. Similar associations between autistic traits and health were also found taking a dimensional approach across the whole sample. DISCUSSION These findings suggest that older adults with elevated autistic traits may be at greater risk of poorer mental, but not physical, health in later life. Future studies should incorporate polygenic scores to elucidate the possible genetic links between the propensity to autism/high autistic traits and to psychiatric conditions, and to explore whether those with elevated autistic traits experience particular barriers to mental health care.
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Affiliation(s)
- Gavin R Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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21
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Cassidy SA, Bradley L, Cogger-Ward H, Rodgers J. Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults. Mol Autism 2021; 12:46. [PMID: 34154642 PMCID: PMC8218414 DOI: 10.1186/s13229-021-00449-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups. METHODS A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults, to create the Suicidal Behaviours Questionnaire-Autism Spectrum Conditions (SBQ-ASC). The adapted tool was refined through nine interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups. RESULTS There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test-retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales. LIMITATIONS The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which limits the generalisability of results to the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm. The SBQ-ASC has been designed with and for autistic and possibly autistic adults, and is not appropriate to compare to non-autistic adults given measurement differences between these groups. CONCLUSIONS The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.
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Affiliation(s)
- Sarah A Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Louise Bradley
- The International Centre, University of Bedfordshire, Luton, UK
| | - Heather Cogger-Ward
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- School of Psychology, University of Lincoln, Lincoln, UK
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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22
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Jachyra P, Lai MC, Zaheer J, Fernandes N, Dale M, Sawyer A, Lunsky Y. Suicidal Thoughts and Behaviours Among Autistic Adults Presenting to the Psychiatric Emergency Department: An Exploratory Chart Review. J Autism Dev Disord 2021; 52:2367-2375. [PMID: 34128145 PMCID: PMC9021086 DOI: 10.1007/s10803-021-05102-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/04/2022]
Abstract
Despite increasing attention on suicidality in autistic people, we know little about suicidal presentations when autistic individuals present to hospital emergency departments (ED). We conducted an exploratory retrospective chart review of suicidal thoughts and behaviours (STB) of autistic adults who presented to a psychiatric ED. The analysis included 16 charts over a 10-week period. Findings highlight that reported STB were not always the presenting issue. Life transitions and interpersonal conflicts were common antecedents, and active rumination about STB was distressing and fatiguing. Findings imply that ED visits serve as important opportunities for suicidal risk reduction for autistic individuals, through implementation of strategies for identification of STB such as active screening, and the provision of suicide resources tailored to autistic people.
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Affiliation(s)
- Patrick Jachyra
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Meng-Chuan Lai
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Juveria Zaheer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
- Institute for Mental Health Policy Research, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Natasha Fernandes
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Michelle Dale
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Amanda Sawyer
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
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23
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Anderson MP, Quinton R, Kelly K, Falzon A, Halladay A, Schumann CM, Hof PR, Tamminga CA, Hare CK, Amaral DG. Autism BrainNet: A Collaboration Between Medical Examiners, Pathologists, Researchers, and Families to Advance the Understanding and Treatment of Autism Spectrum Disorder. Arch Pathol Lab Med 2021; 145:494-501. [PMID: 32960953 DOI: 10.5858/arpa.2020-0164-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Autism spectrum disorder is a neurodevelopmental condition that affects over 1% of the population worldwide. Developing effective preventions and treatments for autism will depend on understanding the neuropathology of the disorder. While evidence from magnetic resonance imaging indicates altered development of the autistic brain, it lacks the resolution needed to identify the cellular and molecular underpinnings of the disorder. Postmortem studies of human brain tissue currently represent the only viable option to pursuing these critical studies. Historically, the availability of autism brain tissue has been extremely limited. OBJECTIVE.— To overcome this limitation, Autism BrainNet, funded by the Simons Foundation, was formed as a network of brain collection sites that work in a coordinated fashion to develop a library of human postmortem brain tissues for distribution to researchers worldwide. Autism BrainNet has collection sites (or Nodes) in California, Texas, and Massachusetts; affiliated, international Nodes are located in Oxford, England and Montreal, Quebec, Canada. DATA SOURCES.— Pubmed, Autism BrainNet. CONCLUSIONS.— Because the death of autistic individuals is often because of an accident, drowning, suicide, or sudden unexpected death in epilepsy, they often are seen in a medical examiner's or coroner's office. Yet, autism is rarely considered when evaluating the cause of death. Advances in our understanding of chronic traumatic encephalopathy have occurred because medical examiners and neuropathologists questioned whether a pathologic change might exist in individuals who played contact sports and later developed severe behavioral problems. This article highlights the potential for equally significant breakthroughs in autism arising from the proactive efforts of medical examiners, pathologists, and coroners in partnership with Autism BrainNet.
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Affiliation(s)
- Matthew P Anderson
- From the Departments of Neurology and Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Anderson)
| | - Reade Quinton
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Quinton)
| | - Karen Kelly
- Department of Pathology and Laboratory Medicine, Brody School of Medicine at East Carolina University Greenville, North Carolina (Kelly)
| | - Andrew Falzon
- Office of the Chief State Medical Examiner, Trenton, New Jersey (Falzon)
| | - Alycia Halladay
- Autism Science Foundation, New York, New York (Halladay).,Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey (Halladay)
| | - Cynthia M Schumann
- The MIND Institute, University of California at Davis, Sacramento (Schumann and Amaral)
| | - Patrick R Hof
- Nash Family Department of Neuroscience, Friedman Brain Institute, and Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York (Hof)
| | - Carol A Tamminga
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas (Tamminga)
| | | | - David G Amaral
- The MIND Institute, University of California at Davis, Sacramento (Schumann and Amaral)
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24
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De Berardis D, De Filippis S, Masi G, Vicari S, Zuddas A. A Neurodevelopment Approach for a Transitional Model of Early Onset Schizophrenia. Brain Sci 2021; 11:brainsci11020275. [PMID: 33672396 PMCID: PMC7926620 DOI: 10.3390/brainsci11020275] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decades, the conceptualization of schizophrenia has dramatically changed, moving from a neurodegenerative process occurring in early adult life to a neurodevelopmental disorder starting be-fore birth, showing a variety of premorbid and prodromal symptoms and, in relatively few cases, evolving in the full-blown psychotic syndrome. High rates of co-occurring different neurodevelopmental disorders such as Autism spectrum disorder and ADHD, predating the onset of SCZ, and neurobio-logical underpinning with significant similarities, support the notion of a pan-developmental disturbance consisting of impairments in neuromotor, receptive language, social and cognitive development. Con-sidering that many SCZ risk factors may be similar to symptoms of other neurodevelopmental psychi-atric disorders, transition processes from child & adolescent to adult systems of care should include both high risk people as well as subject with other neurodevelopmental psychiatric disorders with different levels of severity. This descriptive mini-review discuss the need of innovative clinical approaches, re-considering specific diagnostic categories, stimulating a careful analysis of risk factors and promoting the appropriate use of new and safer medications.
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Affiliation(s)
- Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital “G. Mazzini,” National Health Service (NHS), 64100 ASL 4 Teramo, Italy
- Department of Neurosciences and Imaging, University “G. D’Annunzio”, 66100 Chieti, Italy
- Correspondence:
| | - Sergio De Filippis
- Department of Neuropsychiatry, Villa von Siebenthal Neuropsychiatric Hospital and Clinic, Genzano di Roma, 100045 Rome, Italy;
| | - Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56128 Pisa, Italy;
| | - Stefano Vicari
- Department of Life Sciences and Publich Health, Catholic University, 00135 Rome, Italy;
- Child & Adolescent Psychiatry, Bambino Gesù Children’s Hospital, 00168 Rome, Italy
| | - Alessandro Zuddas
- Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari and “A Cao” Paediatric Hospital, “G Brotzu” Hospital Trust, 109134 Cagliari, Italy;
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25
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Cassidy SA, Gould K, Townsend E, Pelton M, Robertson AE, Rodgers J. Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample. J Autism Dev Disord 2020; 50:3638-3648. [PMID: 31820344 PMCID: PMC7502035 DOI: 10.1007/s10803-019-04323-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The current study explored whether people who camouflage autistic traits are more likely to experience thwarted belongingness and suicidality, as predicted by the Interpersonal Psychological Theory of Suicide (IPTS). 160 undergraduate students (86.9% female, 18–23 years) completed a cross-sectional online survey from 8th February to 30th May 2019 including self-report measures of thwarted belongingness and perceived burdensomeness, autistic traits, depression, anxiety, camouflaging autistic traits, and lifetime suicidality. Results suggest that camouflaging autistic traits is associated with increased risk of experiencing thwarted belongingness and lifetime suicidality. It is important for suicide theories such as the IPTS to include variables relevant to the broader autism phenotype, to increase applicability of models to both autistic and non-autistic people.
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Affiliation(s)
- S A Cassidy
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK. .,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
| | - K Gould
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - E Townsend
- School of Psychology, University of Nottingham, Nottingham, NG7 2RD, UK
| | - M Pelton
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - A E Robertson
- School of Psychological, Social and Behavioural Sciences, Coventry University, Coventry, UK.,Centre for Innovative Research Across the Lifespan, Coventry University, Coventry, UK
| | - J Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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26
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DiBlasi E, Kirby AV, Gaj E, Docherty AR, Keeshin BR, Bakian AV, Coon H. Brief Report: Genetic Links Between Autism and Suicidal Behavior-A Preliminary Investigation. J Autism Dev Disord 2020; 50:3525-3530. [PMID: 32096122 DOI: 10.1007/s10803-020-04419-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evidence suggests there may be increased risk for suicidal behavior among individuals with autism spectrum disorder (ASD). An emerging body of research explores social factors that may contribute to increased risk, however little is known about the potential role of biological factors. The current project addresses this knowledge gap through a preliminary study of genes associated with both ASD and suicidal behavior. Gene set enrichment tests of eight genes strongly associated with both ASD and suicidal behavior revealed overrepresentation of nine biological processes, including cognition and synapse function, and 14 cellular components, including the neuron, the synapse, and the synaptic and postsynaptic membrane. These results can be used to inform future investigations of the biological underpinnings of suicidal behavior and ASD.
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Affiliation(s)
- Emily DiBlasi
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT, USA.
| | - Eoin Gaj
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Anna R Docherty
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brooks R Keeshin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
- Center for Safe and Healthy Families, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Amanda V Bakian
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
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27
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Abstract
Understanding the cognitive and emotional mechanisms that link autistic traits and risk for suicide is a vital next step for research and clinical practice. This study included a broad sample of adult women (n = 74) who report finding social situations confusing and/or exhausting, and who score high on measures of autistic traits. Regardless of autism diagnostic status, these women reported high rates of suicidal thoughts and behaviors. Depression symptoms were more associated with suicidality than were autistic trait measures of social communication. Measures of neurotypical "imagination" and of repetitive behavior likewise were associated with suicidality risk. Simultaneously feeling sad and feeling stuck or unable to imagine alternate strategies, may uniquely increase suicide risk in autism.
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28
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Inner Speech Moderates the Relationship Between Autism Spectrum Traits and Emotion Regulation. J Autism Dev Disord 2020; 51:3322-3330. [PMID: 33219916 DOI: 10.1007/s10803-020-04750-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2020] [Indexed: 12/29/2022]
Abstract
Inner speech processes are thought to be associated with decreases in cognitive performance in autism spectrum disorder (ASD). Although verbal thinking is also a key component in emotional responses, no studies have investigated whether inner speech is linked to emotion regulation in ASD. The aim of this study was to investigate whether inner speech moderates the relationship between ASD traits and emotion regulation strategies. Our results indicate that only the evaluative/motivational form of inner speech moderates the relationship between ASD traits and cognitive reappraisal; inner speech processes did not moderate the association between ASD traits and expressive suppression. These findings are a first step to further investigate the role of inner speech in affective and self-regulatory processes in ASD.
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29
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Abstract
Prevalence rates of autism based upon child samples have shown a consistent increase over the past three decades, suggesting that many autistic adults are undiagnosed. Adult diagnostic pathways typically are initiated with measures of autistic-like traits. Whilst autistic-like traits represent a continuous dimension across the general population, autism is a categorical diagnosis and the relationship between the two is unclear. A self-report dimensional reflection upon the two diagnostic criteria for autism was developed and reflected upon by 1076 participants embedded within two online surveys. Those with an informal (self) diagnosis of autism self-reported comparable social difficulties but fewer restricted and repetitive behaviour difficulties than those with a formal diagnosis of autism. The new items also significantly correlated with autistic-like traits.
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Affiliation(s)
- Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
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30
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Hochard KD, Pendrous R, Mari T, Flynn S. Examining the Relationship Between Autism Traits and Sleep Duration as Predictors of Suicidality. J Autism Dev Disord 2020; 50:3575-3584. [PMID: 32086693 PMCID: PMC7502050 DOI: 10.1007/s10803-020-04405-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Short sleep duration is a known risk factor for suicidality in the general population, yet it is unclear how short sleep interacts with autism traits in predicting suicidality. In this cross-sectional online study, a general population sample (N = 650) completed measures assessing autism traits, suicidal ideation, and sleep duration. Moderated hierarchical regressions demonstrated that higher autism traits and shorter sleep were independent predictors of increased suicide ideation. However, sleep duration did not significantly moderate the autism trait to suicide ideation relationship. Future work should explore this relationship longitudinally using objective measures before considering intervention work to increase sleep duration in those with elevated autism traits.
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Affiliation(s)
- K D Hochard
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
| | - R Pendrous
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - T Mari
- Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, UK
| | - S Flynn
- Centre for Educational Development, Appraisal and Research, University of Warwick, Coventry, CV4 7AL, UK
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31
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Howes A, Richards G, Galvin J. A Preliminary Investigation Into the Relationship Between Autistic Traits and Self-Compassion. Psychol Rep 2020; 124:1988-1997. [PMID: 32903137 DOI: 10.1177/0033294120957244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Self-compassion refers to the extension of kindness to oneself when faced with feelings of inadequacies, shortcomings or failures. It is possible that individuals high in autistic traits may encounter difficulties with self-compassion, and this could be particularly pronounced due to the social challenges they might face. To explore this potential relationship, we recruited university students and members of the general population to an online survey (n = 176). Participants completed measures on demographics, autistic traits, and self-compassion. We found that autistic traits were indeed negatively correlated with self-compassion in both males and females. Interestingly, a comparison of the slopes showed significantly stronger relationships in males compared to females for the negative (but not the positive) subscales of the self-compassion scale. Although speculative at this point, it is possible that self-compassion acts as a mediator between autistic traits and psychopathology. With this in mind, further work is warranted to determine whether self-compassion could be a target for therapeutic intervention.
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Affiliation(s)
- Abby Howes
- Department of Psychology, Birmingham City University, UK.,Department of Psychology, Birmingham City University, UK
| | - Gareth Richards
- School of Psychology, Faculty of Medical Sciences, Newcastle University, UK; Autism Research Centre, Department of Psychiatry, University of Cambridge, UK.,Department of Psychology, Birmingham City University, UK
| | - John Galvin
- Department of Psychology, Birmingham City University, UK
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32
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Chen Y, Chen Y, Gau SS. Suicidality in Children with Elevated Autistic Traits. Autism Res 2020; 13:1811-1821. [DOI: 10.1002/aur.2333] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/13/2020] [Accepted: 05/30/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ying‐Yeh Chen
- Taipei City Psychiatric Center, Taipei City Hospital Taipei City Taiwan
- Institute of Public Health, School of Medicine, National Yang‐Ming University Taipei City Taiwan
| | - Yi‐Lung Chen
- Department of Healthcare Administration Asia University Taichung Taiwan
- Department of Psychology Asia University Taichung Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Taipei Taiwan
| | - Susan Shur‐Fen Gau
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University Taipei Taiwan
- Department of Psychiatry National Taiwan University Hospital, College of Medicine Taipei Taiwan
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33
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Holden R, Mueller J, McGowan J, Sanyal J, Kikoler M, Simonoff E, Velupillai S, Downs J. Investigating Bullying as a Predictor of Suicidality in a Clinical Sample of Adolescents with Autism Spectrum Disorder. Autism Res 2020; 13:988-997. [PMID: 32198982 PMCID: PMC8647922 DOI: 10.1002/aur.2292] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/13/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022]
Abstract
For typically developing adolescents, being bullied is associated with increased risk of suicidality. Although adolescents with autism spectrum disorder (ASD) are at increased risk of both bullying and suicidality, there is very little research that examines the extent to which an experience of being bullied may increase suicidality within this specific population. To address this, we conducted a retrospective cohort study to investigate the longitudinal association between experiencing bullying and suicidality in a clinical population of 680 adolescents with ASD. Electronic health records of adolescents (13–17 years), using mental health services in South London, with a diagnosis of ASD were analyzed. Natural language processing was employed to identify mentions of bullying and suicidality in the free text fields of adolescents' clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality outcomes. Reported experience of bullying in the first month of clinical contact was associated with an increased risk suicidality over the follow‐up period (hazard ratio = 1.82; 95% confidence interval = 1.28–2.59). In addition, female gender, psychosis, affective disorder diagnoses, and higher intellectual ability were all associated with suicidality at follow‐up. This study is the first to demonstrate the strength of longitudinal associations between bullying and suicidality in a clinical population of adolescents with ASD, using automated approaches to detect key life events within clinical records. Our findings provide support for identifying and dealing with bullying in schools, and for antibullying strategy's incorporation into wider suicide prevention programs for young people with ASD. Autism Res 2020, 13: 988‐997. © 2020 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc.
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Affiliation(s)
- Rachel Holden
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK.,Canterbury Christ Church University, Canterbury, UK
| | - Joanne Mueller
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John McGowan
- Canterbury Christ Church University, Canterbury, UK
| | - Jyoti Sanyal
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK
| | | | - Emily Simonoff
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sumithra Velupillai
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Johnny Downs
- NIHR South London and Maudsley NHS Foundation Trust, Biomedical Research Centre, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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34
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Affiliation(s)
- Bernard Crespi
- Department of Biological Sciences, Simon Fraser University Burnaby, British Columbia, V5A 1S6, Canada
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