Abstract
Suicide is a leading cause of premature death amongst autistic adults and there is limited support for autistic adults who experience suicidal thoughts and behaviours. One limiting factor in designing interventions is that suicide research amongst autistic people has not applied a theoretical framework and it is unclear whether suicide models designed for non-autistic people are applicable to the experiences of autistic people. One reason for this is that the way that autism and suicide research are carried out typically precludes the capture of the experiences of autistic people. The programme of studies described in this thesis aims to address this gap by working in partnership with autistic people to explore whether the Interpersonal Theory of Suicide (ITS) operates equivalently for autistic and non-autistic people.This thesis comprises four studies: an evaluation of the participatory methods used in this PhD and three empirical studies. Study 1 used tools from health research to report partnership working had many positive impacts on the research, researcher and autistic collaborators. Studies 2, 3 and 4 used an online survey dataset (n=865) of autistic, non-autistic and possibly autistic adults. Study 2 used structural equation modelling to report pathways from ITS proximal risk factors -perceived burdensomeness, thwarted belonging and lifetime trauma -to suicide were consistent, but pathway strengths were attenuated amongst autistic adults compared to non-autistic adults. Study 3 used measurement invariance analysis to report measurement properties of ITS questionnaires measuring perceived burdensomeness and thwarted belonging were not equivalent for autistic and non-autistic people. Study 4 used network analysis to co-produce, with autistic collaborators, the first conceptual suicide model for autistic people.
Findings suggest partnership working led the research to be more relevant and meaningful, and built trust between researchers and autistic people. Perceived burdensomeness and thwarted belonging have extended our understanding of suicide amongst autistic people, but overall, the ITS lacks specificity and accuracy when applied to autistic people. Suicide prevention could promote belonging and self-worth in a meaningful manner for autistic adults. Clinicians should be aware that belonging and burdensomeness may be experienced differently by autistic adults requiring tailored care pathways and personalised support. Future research should explore the role of trauma and mental health in suicide for autistic people and follow developments in understanding of suicidal behaviour. Theoretical research should continue to improve the evidence-base for participatory working with autistic collaborators and develop a suicide model for autistic people, independent of the experiences of non-autistic people.
| Date of Award | Jan 2024 |
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| Original language | English |
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| Supervisor | Kim Bul (Supervisor) |