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Cited by 191Suicide and Self-Harm StudiesAutism Spectrum Disorder ResearchHomicide, Infanticide, and Child Abuse

Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark

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Kõlves, Kairi, Fitzgerald, Cecilie, Nordentoft, Merete, Wood, Stephen James, Erlangsen, Annette·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2020.33565PMC PMC12578491
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Abstract

Importance: There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide among people with ASD. Existing research highlights the need for national cohort studies. Objectives: To analyze whether people with ASD have higher rates of suicide attempt and suicide compared with people without ASD using national register data, identify potential risk factors for suicide attempt and suicide among those with ASD, and examine associations with comorbid disorders. Design, Setting, and Participants: In this cohort study, nationwide register data from January 1, 1995, to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10 years or older. Statistical analysis was performed from November 20, 2018, to November 21, 2020. Main Outcomes and Measures: Rates of suicide attempt and suicide among persons with ASD were compared with rates among persons without ASD, using Poisson regression models to calculate incidence rate ratios adjusted for sex, age, and time period. Results: Of the total study population of 6 559 266 individuals, 35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3] years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI, 2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For individuals with ASD, the aIRR for suicide attempt among female individuals was 4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43) higher compared with male individuals. Higher rates of suicide attempt were noted across all age groups for those with ASD. Persons with a diagnosis of ASD only had an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt compared with those without any psychiatric disorders. A total of 542 of 587 individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least 1 other comorbid condition. Conclusions and Relevance: This nationwide retrospective cohort study found a higher rate of suicide attempt and suicide among persons with ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90% of those with ASD who attempted or died by suicide having another comorbid condition. Several risk factors are different from the risk factors in the general population, which suggests the need for tailored suicide prevention strategies.

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  • Two population-based cohort studies led in Denmark and Sweden reported respectively a 3.7 and a 9-fold increase in death by suicide among autistic adults without ID compared to the general population.

    “More generally, two population-based cohort studies led in Denmark and Sweden highlighted the importance of this problem in autistic individuals, as they reported respectively a 3.7 and a 9-fold increase in death by suicide among autistic adults without ID compared to the general population (Hirvikoski et al., 2016; Kõlves et al., 2021).”

    From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Kõlves et al., 2021

    The Danish study’s Results > Suicide report a 3.75-fold higher suicide rate for people with ASD overall, but a 4.73-fold rate for those with ASD without intellectual disability—not the claimed 9-fold rate for that subgroup. The study supports an elevated suicide rate, but not the sentence’s subgroup-specific magnitude; its Swedish-study figure cannot be assessed from this source. (LLM, conf=0.88)

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Authors
Kõlves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A.
Affiliations
  • Griffith University (AU)
  • University of Copenhagen (DK)
  • The University of Melbourne (AU)
  • Australian National University (AU)
Corresponding author
Kõlves, Kairi
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-01-12
Volume
4
Issue
1
Pages
e2033565
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2020.33565
PMC
PMC12578491
OpenAlex
W3119137758
Cited by
191
References
34
Citations by year
2026: 27 · 2025: 39 · 2024: 42 · 2023: 32 · 2022: 32 · 2021: 19
FWCI
21.32
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc-nd)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
  • Griffith Research Online (submittedVersion, cc-by)
Funders
Griffith University
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
Keywords
autism spectrum disorder, suicide attempts, suicide, suicidality, risk factors, comorbidities, sex differences, age differences, psychiatric comorbidity, substance use disorders, anxiety disorders, personality disorders, intellectual disability, suicide prevention, Denmark, incidence rate ratio
MeSH terms
Autism Spectrum Disorder, Adolescent, Adult, Aged, Child, Denmark, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Risk Factors, Suicide, Suicide, Attempted

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