Lifetime suicidal ideation and nonsuicidal self-injury (NSSI) during early adolescence is reported by a greater proportion of youth with autism spectrum disorder (ASD) than without. However, no sex-based differences in recent and lifetime suicidal thoughts and behaviors (STBs) were observed among adolescent groups. Study results, published in the journal Autism, suggest further research into earlier screening and safety planning through clinician-administered interviews will more accurately detect the risk for STBs in adolescents with ASD.

Suicide represents the second leading cause of death among youth in the US. Nearly 1 in 5 adolescents with ASD self-report STBs. They are also more likely to experience depression and premature death by suicide than adolescents without ASD and the general population, respectively. Investigators sought to assess diagnostic and sex-based differences in STBs and NSSI in youth with and without ASD. They concluded that although clinician-administered resources have not been developed to measure STBs in adolescents with ASD, the Columbia Suicide Severity Rating Scale (C-SSRS) is a widely accepted screening tool for detecting the risk for suicide and was, therefore, used in the study.

The investigators conducted a longitudinal study that sourced data from clinician, caregiver, and youth interviews, as well as questionnaires and visits at Vanderbilt University Medical Center in Nashville, Tennessee. Participants were recruited through research registries, clinics, regional ASD/disability organizations, and social media platforms.

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The study comprised 229 adolescents, of which 138 adolescents, 26.1% girls, had ASD (mean age 11.2 years) and 101 adolescents, 42.6% girls, did not have ASD (mean age 11.7 years). Overall, participants were 82.8% White, 8.9% multiracial, 7.9% Black, and 6.7% Hispanic/Latino. Among the participants with ASD, 47.8% were using psychotropic medications, compared with 10.9% of participants without ASD.

The investigators found that a greater proportion of adolescents with ASD (23.9%) reported lifetime suicidal ideation compared with those without ASD (6.9%). Similarly, adolescents with ASD (8.7%) reported higher rates of NSSI compared with those without ASD (2.0%). However, the participants without ASD experienced more frequent suicidal thoughts with a significant difference (P =.026). The investigators found no sex-based differences, nor were there any significant between-group differences in controllability of lifetime suicidal thoughts or in duration of suicidal thoughts.

The majority of youth without ASD (92.0%) self-reported recent suicidal ideation consistently with the C-SSRS. A smaller majority of youth with ASD (76.1%) self-reported recent suicidal ideation consistently with clinician-rated measures.

Study limitations include the nature of cross-sectional data lacking power to provide information on causal relationships between variables; the imbalance in numbers of males vs females in the group with ASD, thereby limiting generalizability; the lack of data on recent NSSI; the imbalance of racial diversity, which limits generalizability of the findings; and a sample size that lacked statistical power for meaningful clinical evaluation of differences observed between groups in the incidence of STBs and NSSI.

The investigators concluded, “Though youth in the present study had clinical diagnoses of autism, undiagnosed autistic youth may also be at risk for STBs and highlight the importance of studying autistic traits in the pathway to STBs in autism.” The investigators wrote, “[N]early 20% of autistic youth endorsed suicidal thoughts on a self-report questionnaire and not to a study psychiatrist, which underscores the need for multimethod assessments of suicide risk in autism and/or suicide assessments developed for and with autistic youth.” Early-life evaluation of adolescents with ASD through clinician-administered interviews and self-reported questionnaires, they suggested, may be essential for more accurate and reliable reporting of STBs and NSSIs.


Schwartzman JM, Muscatello RA, Corbett BA. Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating ScaleAutism. Published online April 12, 2023. doi:10.1177/13623613231162154

This article originally appeared on Psychiatry Advisor