Autistic people are more likely to report suicide-related behaviours and psychological distress irrespective of previous traumatic experiences, according to new research from the University of Cambridge.
These findings have important implications for safeguarding and can help clinicians in screening for and monitoring suicide-related behaviours
Tanatswa Chikaura
Additionally, the study shows for the first time that higher levels of trauma are associated with an increased likelihood of reporting suicide-related behaviours and psychological distress in autistic people - as is the case in the general population.
Given that autistic people are recognised as a priority group for suicide prevention in the UK, these findings have important implications for national suicide prevention strategies. The results are published today in the journal Autism Research.
As many as 1 in 4 autistic people reports suicide attempts across their lifetime and autistic people have a higher likelihood of adverse life experiences. However, only one prior study has looked at the link between lifetime trauma and suicidality (the spectrum of experiences related to suicide, from suicidal thoughts to attempts), but it did not differentiate between suicidal thoughts and attempts. This approach overlooks evidence suggesting that the risk factors for suicide ideation and suicide attempts may differ.
This new study is the first to investigate how lifetime trauma is independently associated with specific outcomes - including lifetime self-harm, suicide attempts, suicide plans, having a mental health condition that impacts daily life, and regularly using substances such as alcohol as a coping mechanism - in autistic people. It is also the first to show that different types of traumas may be associated with different types of suicide-related behaviours and psychological distress.
The study was conducted by a team at the Autism Research Centre (ARC) at the University of Cambridge and used an anonymised, self-report survey to analyse the relationship between lifetime trauma and lifetime suicide-related behaviours and psychological distress in 424 autistic adults and 345 non-autistic adults.
The participants were international; however, the majority were from the UK. The survey was co-created with eight autistic adults to ask autistic and non-autistic people about their negative life experiences and measured 60 life experiences across 10 domains (education, employment, finances, social services, criminal justice system, childhood victimisation, adulthood victimisation, domestic abuse, lack of social support, and mental health). The analysis took into account other factors such as age, sex, country of residence, education-level and two or more neurodevelopmental/mental health conditions.
Autistic people who reported experiencing childhood victimisation were more likely to report a mental health condition that impacts daily life, as well as self-harm, suicide plans, and suicide attempts. Autistic people who reported experiencing a lack of social support were also more likely to report a mental health condition that impacts daily life, self-harm, and suicide plans. Even after accounting for trauma, autistic people showed higher rates of suicide-related behaviours than others. This suggests that there may be unique aspects of autism - such as sensory differences or the efforts involved in camouflaging - that contribute to how trauma relates to self-harm, suicide attempts, suicide plans, and having mental health conditions that impact daily life.
Tanatswa Chikaura, a PhD student at the ARC in Cambridge, who led the study, said: "We are aware that autistic people are at an increased risk of suicidality compared to non-autistic people. But this new research identifies for the first time that different types of traumas are potentially related to different types of suicide-related behaviours in both autistic and non-autistic people. These findings have important implications for safeguarding and can help clinicians in screening for and monitoring suicide-related behaviours."
The new research aligns with previous findings, showing that trauma is associated with suicide-related behaviours and psychological distress in autistic people. Critically, this study investigated self-harm, suicide attempts, and suicide plans independently which is key in understanding suicide-related experiences in autistic people. These results provide preliminary evidence that mental health professionals need to routinely assess for trauma and suicide-related behaviours in autistic people and adopt a trauma-focused approach in mental health care.
Dr Elizabeth Weir, a Research Associate at the ARC in Cambridge, who supervised the project, said: "This study adds to the limited evidence that a greater number of traumatic experiences is associated with higher rates of self-reported suicide-related behaviours in autistic people. However, trauma alone does not explain the increased risk of suicidality for autistic people. Future research must address what other factors are playing a key role in these outcomes, so that we have better means of preventing suicide and supporting autistic people who are already experiencing suicidality."
Professor Sir Simon Baron-Cohen, Director of the ARC and another member of the team, said: "It is essential that we understand the underlying mechanisms of these traumatic experiences and how trauma relates to suicide-related behaviours across the lifespan in autistic people, so that we can develop tools for trauma-focused mental healthcare in autistic people."
The research was supported by a grant from Autistica and the Autism Research Trust, whose legacy work is now managed by Autism Action.
