Autism and autistic traits in those who died by suicide in England

Sarah Cassidy; Sheena Au-Yeung; Ashley Robertson; Heather Cogger-Ward; Gareth Richards; Carrie Allison; Louise Bradley; Rebecca Kenny; Rory O'Connor; David Mosse; Jacqui Rodgers; Simon Baron-Cohen

doi:10.1192/bjp.2022.21

Autism and autistic traits in those who died by suicide in England

Sarah Cassidy
, Sheena Au-Yeung
, Ashley Robertson
, Heather Cogger-Ward
, Gareth Richards
, Carrie Allison
, Louise Bradley
, Rebecca Kenny
, Rory O'Connor
, David Mosse
, Jacqui Rodgers
, Simon Baron-Cohen

University of Nottingham
University of Oxford
Lincolnshire Partnership NHS Foundation Trust
Newcastle University
University of Cambridge
University of Bedfordshire
University of Glasgow
University of Lincoln
SOAS, University of London

Research output: Contribution to journal › Article › peer-review

74 Citations (Scopus)

176 Downloads (Pure)

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.

Original language	English
Pages (from-to)	683-691
Number of pages	9
Journal	British Journal of Psychiatry
Volume	221
Issue number	5
Early online date	15 Feb 2022
DOIs	https://doi.org/10.1192/bjp.2022.21
Publication status	Published - 25 Nov 2022

Bibliographical note

© The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/ licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funder

This research was supported by Autistica [grant number: 7247], the Economic and Social Research Council Future Research Leaders grant [grant number: ES/N000501/2], Coventry University, and the University of Nottingham (received by S.C.). S.B.C. received funding from the Wellcome Trust 214322\Z\18\Z. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. In addition, S.B.-C. received funding from Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. S.B.-C. also received funding from the Autism Research Trust, SFARI, the Templeton World Charitable Fund, SFARI and the NIHR Cambridge Biomedical Research Centre. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of Health and Social Care. The funding sources were not involved in any aspect of the study design, recruitment, data collection, analysis, interpretation of results, writing of the manuscript, or the decision to submit for publication. The corresponding author has full access to all data used in the study and had final responsibility for the decision to submit for publication.

Publisher Copyright:
Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Funding

This research was supported by Autistica [grant number: 7247], the Economic and Social Research Council Future Research Leaders grant [grant number: ES/N000501/2], Coventry University, and the University of Nottingham (received by S.C.). S.B.C. received funding from the Wellcome Trust 214322\Z\18\Z. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. In addition, S.B.-C. received funding from Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. S.B.-C. also received funding from the Autism Research Trust, SFARI, the Templeton World Charitable Fund, SFARI and the NIHR Cambridge Biomedical Research Centre. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of Health and Social Care. The funding sources were not involved in any aspect of the study design, recruitment, data collection, analysis, interpretation of results, writing of the manuscript, or the decision to submit for publication. The corresponding author has full access to all data used in the study and had final responsibility for the decision to submit for publication.

Funders	Funder number
University of Nottingham
Economic and Social Research Council
European Federation of Pharmaceutical Industries and Associations
National Institute for Health and Care Research
Autism Research Trust
European Commission
Coventry University
NIHR Cambridge Biomedical Research Centre
Templeton World Charity
Simons Foundation Autism Research Initiative
AUTISM SPEAKS
Economic and Social Research Council	ES/N000501/1
Innovative Medicines Initiative	777394
UK Research and Innovation	ES/N000501/2
Wellcome Trust	214322

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

autism
autism spectrum disorders
autistic traits
mortality
suicide

ASJC Scopus subject areas

Psychiatry and Mental health

Access to Document

10.1192/bjp.2022.21Licence: CC BY

PublishedFinal published version, 835 KBLicence: CC BY

Cite this

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title = "Autism and autistic traits in those who died by suicide in England",

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. ",

keywords = "autism, autism spectrum disorders, autistic traits, mortality, suicide",

author = "Sarah Cassidy and Sheena Au-Yeung and Ashley Robertson and Heather Cogger-Ward and Gareth Richards and Carrie Allison and Louise Bradley and Rebecca Kenny and Rory O'Connor and David Mosse and Jacqui Rodgers and Simon Baron-Cohen",

note = "{\textcopyright} The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/ licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.",

year = "2022",

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doi = "10.1192/bjp.2022.21",

language = "English",

volume = "221",

pages = "683--691",

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TY - JOUR

T1 - Autism and autistic traits in those who died by suicide in England

AU - Cassidy, Sarah

AU - Au-Yeung, Sheena

AU - Robertson, Ashley

AU - Cogger-Ward, Heather

AU - Richards, Gareth

AU - Allison, Carrie

AU - Bradley, Louise

AU - Kenny, Rebecca

AU - O'Connor, Rory

AU - Mosse, David

AU - Rodgers, Jacqui

AU - Baron-Cohen, Simon

N1 - © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/ licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

PY - 2022/11/25

Y1 - 2022/11/25

N2 - 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.

AB - 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.

KW - autism

KW - autism spectrum disorders

KW - autistic traits

KW - mortality

KW - suicide

UR - https://www.scopus.com/pages/publications/85124939587

U2 - 10.1192/bjp.2022.21

DO - 10.1192/bjp.2022.21

M3 - Article

C2 - 35166201

AN - SCOPUS:85124939587

SN - 0007-1250

VL - 221

SP - 683

EP - 691

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

IS - 5

ER -

Autism and autistic traits in those who died by suicide in England

Abstract

Bibliographical note

Funder

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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