Suicide Risk among People with Autism Spectrum Disorder

A recent national retrospective study from Denmark found individuals with a diagnosed autism spectrum disorder (ASD) have an increased risk for suicide attempt and suicide death.

The study design involved secondary analysis of Danish national register data. The country’s national registries contain anonymized socio-demographic, educational, employment, morbidity, and mortality data on the entire Danish population, which offer unique opportunities for research. Participants included 6,559,266 people ages 10 and older living in Denmark from 1995 through 2016. The primary outcome variables were suicide attempt and death.

Among study participants, 35,020 had received a diagnosis of ASD. When adjustments were made for sex, age, and time period, individuals with ASD were over three times more likely to attempt suicide than those without ASD. This difference was more pronounced for females with ASD, who were more than 8 times more likely to attempt suicide than females without ASD, while males with ASD were 1.93 times more likely to attempt suicide than males without ASD. Individuals with ASD were also nearly four times more likely to die by suicide compared to individuals without ASD. Among individuals with ASD, males were over 3 times more likely to die by suicide and females 2.63 times more likely than males and females without ASD.

One of the most important findings from this study was that protective factors for suicide in the general population were not protective for individuals with ASD. In fact, being married or cohabitating and employed were less protective for those with ASD. In addition, the risk of suicide attempt increased with education level and was highest among those with a university degree. However, psychiatric comorbidity was a major risk factor for suicide in the ASD population, with more than 90% of those who attempted or died by suicide having another psychiatric diagnosis. The authors suggested social isolation and poor access to health care could explain the link between ASD and suicide risk. 

The results of this research highlight the need for tailored suicide prevention strategies for individuals with ASD whose risk and protective factors may differ from those in the general population. Study strengths include the availability of a validated national dataset with socio-demographic, medical, and educational variables. Limitations include possible underreporting of ASD and suicide attempts and deaths. While the results of this study are important, they may not generalize to populations outside Denmark.

Kolves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A. (2021). Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark. JAMA Network Open, 4(1), e2033565. doi:10.1001/jamanetworkopen.2020.33565