Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review
Open accessAbstract
Adults diagnosed with autism are at significantly increased risk of suicidal thoughts, suicidal behaviours and dying by suicide. However, it is unclear whether any validated tools are currently available to effectively assess suicidality in autistic adults in research and clinical practice. This is crucial for understanding and preventing premature death by suicide in this vulnerable group. This two stage systematic review therefore aimed to identify tools used to assess suicidality in autistic and general population adults, evaluate these tools for their appropriateness and measurement properties, and make recommendations for appropriate selection of suicidality assessment tools in research and clinical practice. Three databases were searched (PsycInfo, Medline and Web of Knowledge). Four frequently used suicidality assessment tools were identified, and subsequently rated for quality of the evidence in support of their measurement properties using the COSMIN checklist. Despite studies having explored suicidality in autistic adults, none had utilised a validated tool. Overall, there was lack of evidence in support of suicidality risk assessments successfully predicting future suicide attempts. We recommend adaptations to current suicidality assessment tools and priorities for future research, in order to better conceptualise suicidality and its measurement in autism.
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Autism often co-occurs with psychological comorbidities, including suicidality, anxiety disorders, and mood disorders like depression.
“As previously mentioned, autism often co-occurs with several additional psychological comorbidities, including suicidality, anxiety disorders, and mood disorders like depression (Cassidy et al., 2018;Hollocks et al., 2019).”
From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Cassidy et al., 2018
The Introduction states that autistic adults are at high risk of suicidality compared with other clinical groups. It does not establish that anxiety disorders or mood disorders such as depression often co-occur with autism; those terms appear in the cited references, but the references alone do not support that part of the claim. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe TAS-20 has never undergone a thorough examination as to whether autistic individuals understand items in the same way as non-autistic people.
“Another instance is the TAS-20, which despite being robustly used in autism research (see, for instance, [80, 82, 141]), has never undergone a thorough examination (e.g. [118, 119]) as to whether autistic individuals understand items in the same way as non-autistic people”
From A 'choice', an 'addiction', a way 'out of the lost': Exploring self-injury in autistic people without intellectual disability (2019) · cites this paper as [119]
The Introduction discusses how autistic people may interpret questions differently, and §5.1 recommends comparing suicidality measures across autistic and non-autistic groups. Neither section addresses the TAS-20 or whether its items have undergone the examination claimed; searches for TAS-20 and Toronto Alexithymia Scale found no relevant passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Validation of a Spanish version of the Columbia-Suicide Severity Rating Scale (C-SSRS)
Al‐Halabí, S., Sáiz, P. A., Burón, P., Garrido, M., Benabarre, A., Jiménez, E., Cervilla, J. A., Navarrete, M. I., Díaz-Mesa, E., García-Álvarez, L., et al. (2016) · Revista de Psiquiatría y Salud Mental (English Edition) · doi:10.1016/j.rpsmen.2016.06.004 · Cited by 56 · cited 6× · see citing works
“There was mixed evidence for internal consistency: two studies showed high Cronbach’s alpha for the whole measure (Madan et al. 2016, Posner et al. 2011), but not on some subscales (Madan et al. 2016), and another study showed a poor alpha (Al-Halabi et al. 2016).”
InfluentialFactor Analysis of the Beck Scale for Suicide Ideation With Female Suicide Attempters
Holden, R. R., & DeLisle, M. M. (2005) · Assessment · doi:10.1177/1073191105274925 · Cited by 54 · cited 3× · see citing works
“735 319 male, 413 female US BSS Holden and DeLisle (2005).”
BackgroundDeVylder, J., Jahn, D. R., Doherty, T., Wilson, C. S., Wilcox, H. C., Schiffman, J. E., & Hilimire, M. R. (2015) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-015-1139-6 · Cited by 52 · see citing works
Routine use of the Beck Scale for Suicide Ideation in a psychiatric emergency department
Healy, D. J., Barry, K., Blow, F. C., Welsh, D. E., & Milner, K. K. (2006) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2006.04.003 · Cited by 49 · cited 1× · see citing works
“Evidence in support of reliability of the BSS was indeterminate, with two studies of poor methodological quality - observations were not independent (Healy et al., 2006), or sample size was small with patients undergoing treatment between measurements (Pinninti et al.”
ResultA Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College
Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P. J., Demyttenaere, K., Green, J. G., Kessler, R. C., Nock, M. K., Zaslavsky, A. M., & Bruffaerts, R. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.17m11485 · Cited by 48 · see citing works
Chioqueta, A. P., & Stiles, T. C. (2006) · Nordic Journal of Psychiatry · doi:10.1080/08039480600937645 · Cited by 47 · cited 1× · see citing works
“904 442 female Pakistan BSS Chioqueta and Stiles (2006).”
Nieto, R. G., Blasco-Fontecilla, H., Yepes, M. P., & Baca‐García, E. (2012) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2012.07.001 · Cited by 46 · see citing works
Hanratty, J., Livingstone, N., Robalino, S., Terwee, C. B., Glod, M., Oono, I. P., Rodgers, J., Macdonald, G. M., & McConachie, H. (2015) · PLoS ONE · doi:10.1371/journal.pone.0144649 · Cited by 46 · cited 2× · see citing works
“There is a growing body of systematic reviews showing a paucity of research exploring the measurement properties of outcome measures in ASC, which have made important recommendations to improve research and clinical assessment (Cassidy, Bradley, Bowen, et al., 2018; Hanratty et al., 2015; McConachie et al., 2015; Wigh…”
BackgroundResultSelf-citationDhingra, K., Boduszek, D., & Klonsky, E. D. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12232 · Cited by 41 · see citing works
Optimizing the assessment of suicidal behavior: The application of curtailment techniques.
Beurs, D. D., Fokkema, M., & O'Connor, R. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.02.033 · Cited by 33 · cited 1× · see citing works
“BSS De Beurs et al. (2015). Psychiatric patients Longitudinal 43 (15) age range not provided 872 (at baseline) 415 male, 457 female Netherlands”
BackgroundSelf-reported suicidal and help seeking behaviours in the general population in Latvia
Rancāns, E., Lapiņš, J., Renberg, E. S., & Jacobsson, L. H. (2003) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-003-0602-y · Cited by 32 · cited 1× · see citing works
“Paykel V1 1974 Assess lifetime and current experience of suicidal ideation and behaviours 5 N/A Scale 1-4 Clinician administered interview or self-report questionnaire N/A Jonson et al (2012); Rancāns et al. (2003); Renberg, (2001).”
Validation of the Urdu Translation of the Beck Scale for Suicide Ideation
Ayub, N. (2008) · Assessment · doi:10.1177/1073191107312240 · Cited by 31 · cited 2× · see citing works
“The quality of the translations were fair (with one back and forward translation), giving moderate evidence in support of the BSS cross-cultural validity (Ayub, 2008; Esfahani et al., 2015).”
BackgroundResultPereira‐Morales, A. J., Adán, A., Camargo, A., & Forero, D. A. (2017) · American Journal on Addictions · doi:10.1111/ajad.12552 · Cited by 31 · see citing works
Nieto, R. G., Blasco-Fontecilla, H., Yepes, M. P., & Baca‐García, E. (2013) · Revista de Psiquiatría y Salud Mental (English Edition) · doi:10.1016/j.rpsmen.2012.07.004 · Cited by 30 · see citing works
Youngstrom, E. A., Hameed, A., Mitchell, M. A., Meter, A. V., Freeman, A. J., Algorta, G. P., White, A. M., Clayton, P. J., Gelenberg, A. J., & Meyer, R. E. (2015) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.14m09353 · Cited by 26 · cited 1× · see citing works
“9) (Youngstrom et al., 2015), but two poor studies with small samples showed high agreement between raters (0.”
BackgroundSuicide screening tools and their association with near-term adverse events in the ED
Chang, B., & Tan, T. M. (2015) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2015.08.013 · Cited by 23 · cited 11× · see citing works
“fair fair C-SSRS (selfreport) Chang and Tan (2015). good C-SSRS (intervie w) Madan et al.”
BackgroundResultInfluentialSuicide risk in adults with Asperger's syndrome
Raja, M. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70257-3 · Cited by 22 · cited 4× · see citing works
“Given that autistic adults have difficulty accessing psychiatric services due to lack of expertise and service provision for mental health in autism (Crane, Adams, Harper, Welch, & Pellicano, 2018; Raja, 2014), suicidality assessment tools used in screening the general population in research and clinical practice will…”
BackgroundInfluentialHoron, R., McManus, T., Schmollinger, J., Barr, T., & Jimenez, M. M. (2012) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2012.00124.x · Cited by 22 · cited 2× · see citing works
“However, there was consistent strong evidence for high sensitivity and specificity when distinguishing clinical groups (Horon et al., 2013; Pinninti et al., 2002; Cochrane-Brink et al., 2000) (e.”
BackgroundLane, R., Cheref, S., & Miranda, R. (2016) · Asian American Journal of Psychology · doi:10.1037/aap0000039 · Cited by 22 · see citing works
Preti, A., Sheehan, D. V., Coric, V., Distinto, M., Mirko, P., Vacca, I., Siddi, A., Masala, C., & Петретто, Д. Р. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.03.012 · Cited by 21 · see citing works
Preliminary Results From an Examination of Episodic Planning in Suicidal Behavior
Anestis, M. D., Pennings, S. M., & Williams, T. J. (2014) · Crisis · doi:10.1027/0227-5910/a000250 · Cited by 20 · cited 3× · see citing works
“Plutchik Suicide Risk Scale (PSRS) V1 1989 Measures the degree to which an individual reveals characteristics similar to those of a suicide prototype.”
MethodSheehan, D. V., Alphs, L. D., Mao, L., Li, Q., May, R. S., Bruer, E. H., Mccullumsmith, C. B., Gray, C. R., Li, X., & Williamson, D. J. (2014) · Europe PMC (PubMed Central) · Cited by 19 · see citing works
Cukrowicz, K. C., Smith, P. N., Hohmeister, H. C., & Joiner, T. E. (2009) · Journal of Clinical Psychology · doi:10.1002/jclp.20560 · Cited by 16 · see citing works
Anxiety symptoms and suicidal feelings in a population sample of 70-year-olds without dementia
Jonson, M., Skoog, I. G., Marlow, T., Fässberg, M. M., & Wærn, M. (2012) · International Psychogeriatrics · doi:10.1017/s1041610212000993 · Cited by 16 · see citing works
Psychological health and well-being among young Irish adults
Cleary, A., Nixon, E., & Fitzgerald, M. (2007) · Irish Journal of Psychological Medicine · doi:10.1017/s0790966700010569 · Cited by 15 · cited 7× · see citing works
“43 Suicide Behaviours Questionnaire Revised (SBQR) V2 2001 Measure of suicide risk 4 N/A 5/6 point scales Self-report questionnaire N/A Campose and Holden (2014); Campos, Besser and Blatt (2013); Wagner et al. (2013). Beck Scale for Suicidal Ideation (BSS) V2 1991 Assesses suicidal ideation and behaviours 21 1-19 curr…”
BackgroundInfluentialRecreational Drug Use and Suicidality Among Italian Young Adults
Innamorati, M., Pompili, M., Lester, D., Tatarelli, R., & Girardi, P. (2008) · Journal of Addictive Diseases · doi:10.1080/10550880802324796 · Cited by 13 · see citing works
Zuromski, K. L., Cero, I., Witte, T. K., & Zeng, P. (2016) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12270 · Cited by 11 · cited 1× · see citing works
“Self-report questionnaire N/A Spiker et al. (2012); Van Orden et al. (2012); Cleary, Nixon and Fitzgerald, (2007); Lane, Cheref and Miranda (2016); Zuromski et al (2017).”
BackgroundPrinsen, C. A. C., Mokkink, L. B., Bouter, L. M., Alonso, J., Patrick, D. L., de Vet, H. C. W., & Terwee, C. B. (2016) · Cited by 8 · see citing works
Mokkink, L. B., de Vet, H. C. W., Prinsen, C. A. C., Patrick, D., Alonso, J., Bouter, L. M., & Terwee, C. B. (2016) · Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) · Cited by 1 · see citing works
Scale for Suicide Ideation: Psychometric properties of a self-report version
Beck, A. T., Steer, R. A., & Ranieri, W. F. (1988) · Journal of Clinical Psychology · doi:10.1002/1097-4679(198807)44:4
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Research works printed but not linked: 1
- Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psy- chiatric interview for DSM-IVand ICD-10. Journal of Clinical Psychiatry, 59(Suppl. 20), 2233.
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Sorted by citations
Camm-Crosbie, L., Bradley, L., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019) · Autism · doi:10.1177/1362361318816053 · Cited by 415 · see citing works
Self-citationCassidy, S., Gould, K., Townsend, E., Pelton, M., Robertson, A., & Rodgers, J. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04323-3 · Cited by 320 · see citing works
Self-citationBeck, J. S., Lundwall, R. A., Gabrielsen, T., Cox, J. C., & South, M. (2020) · Autism · doi:10.1177/1362361320912147 · Cited by 224 · see citing works
Feeding and Eating Problems in Children and Adolescents with Autism: A Scoping Review
Baraskewich, J., von Ranson, K. M., McCrimmon, A., & McMorris, C. A. (2021) · Autism · doi:10.1177/1362361321995631 · Cited by 221 · see citing works
“Samples had to focus on children or adolescents aged 18 years or under; however, in line with previous reviews of mental health issues in persons with autism (e.g. Cassidy et al., 2018), studies were included if 50% or more of the total sample was under 18 years, to maximize the number included.”
ResultNicolaidis, C., Raymaker, D. M., McDonald, K. E., Lund, E. M., Leotti, S., Kapp, S. K., Katz, M., Beers, L. M., Kripke, C., Maslak, J., et al. (2020) · Autism in Adulthood · doi:10.1089/aut.2019.0074 · Cited by 210 · see citing works
How bad is it? Suicidality in the middle of the covid-19 pandemic.
Fitzpatrick, K. M., Harris, C., & Drawve, G. (2020) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12655 · Cited by 144 · see citing works
“Previous studies report a mixed assessment of suicidality using the SBQ-R among both clinical and non-clinical populations (Batterham et al., 2015; Cassidy, Bradley, Bowen, Wigham, & Rodgers, 2018; Osman et al., 2001).”
Au-Yeung, S. K., Bradley, L., Robertson, A. E., Shaw, R., Baron-Cohen, S., & Cassidy, S. (2019) · Autism · doi:10.1177/1362361318818167 · Cited by 136 · see citing works
Self-citationSwan, K., Speyer, R., Scharitzer, M., Farneti, D., Brown, T., Woisard, V., & Cordier, R. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1225850 · Cited by 142 · see citing works
“In numerous reviews, authors consistently find that the psychometric evidence for instruments is poor, limited, or lacking in quality (Crellin et al., 2015; Cassidy et al., 2018; Ghai et al., 2022; Thompson et al., 2023).”
BackgroundNewell, V., Phillips, L., Jones, C., Townsend, E., Richards, C., & Cassidy, S. (2023) · Molecular Autism · doi:10.1186/s13229-023-00544-7 · Cited by 143 · see citing works
“An example of this variability includes the measures used to assess suicidality, which are inconsistent within the literature and have not been validated for use in autistic populations [11, 23].”
BackgroundSelf-citationGreater gender diversity among autistic children by self-report and parent-report
Corbett, B. A., Muscatello, R. A., Klemencic, M. E., West, M., Kim, A., & Strang, J. F. (2022) · Autism · doi:10.1177/13623613221085337 · Cited by 101 · see citing works
“The C-SSRS has not been validated in autistic samples specifically; however, several studies with autistic adults and adolescents suggest that the C-SSRS provides one of the most comprehensive assessments of suicidality of the measures available (Cassidy et al., 2018a, 2018b; Howe et al., 2020).”
BackgroundMoseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2019) · Molecular Autism · doi:10.1186/s13229-019-0267-3 · Cited by 97 · see citing works
Pelton, M., Crawford, H., Robertson, A., Rodgers, J., Baron‐Cohen, S., & Cassidy, S. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04393-8 · Cited by 103 · see citing works
Self-citationLipinski, S., Bögl, K., Blanke, E. S., Suenkel, U., & Dziobek, I. (2021) · Autism · doi:10.1177/13623613211057973 · Cited by 97 · see citing works
“Furthermore, a lack of support for this group has been associated with an increased risk of depression and suicidality (Cassidy et al., 2018c).”
BackgroundMeasuring Depression in Autistic Adults: Psychometric Validation of the Beck Depression Inventory–II
Williams, Z. J., Everaert, J., & Gotham, K. O. (2020) · Assessment · doi:10.1177/1073191120952889 · Cited by 84 · see citing works
“…autistic adults and TD controls, empirically testing the claim that individuals on the autism spectrum answer depression questionnaires in a qualitatively different manner from the general population (Cassidy et al., 2018b; Gotham et al., 2015; Pezzimenti et al., 2019; Uljarević et al., 2018).”
BackgroundMethodInfluentialCassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021) · Molecular Autism · doi:10.1186/s13229-021-00449-3 · Cited by 84 · see citing works
Self-citationProvenzani, U., Fusar‐Poli, L., Brondino, N., Damiani, S., Vercesi, M., Meyer, N., Rocchetti, M., & Politi, P. (2019) · Autism · doi:10.1177/1362361319854641 · Cited by 78 · see citing works
Unrelenting Depression and Suicidality in Women with Autistic Traits
South, M., Beck, J. S., Lundwall, R. A., Christensen, M., Cutrer‐Párraga, E. A., Gabrielsen, T. P., Cox, J. C., & Lundwall, R. A. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04324-2 · Cited by 76 · see citing works
Links between self-injury and suicidality in autism
Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. (2020) · Molecular Autism · doi:10.1186/s13229-020-0319-8 · Cited by 76 · see citing works
Measurement Properties of the Suicidal Behaviour Questionnaire-Revised in Autistic Adults
Cassidy, S., Bradley, L., Cogger-Ward, H., Shaw, R., Bowen, E., Glod, M., Baron‐Cohen, S., & Rodgers, J. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04431-5 · Cited by 74 · see citing works
Self-citationAdvancing Our Understanding of Self-harm, Suicidal Thoughts and Behaviours in Autism
Cassidy, S. A., Robertson, A., Townsend, E., O’Connor, R. C., & Rodgers, J. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04643-9 · Cited by 68 · see citing works
Self-citationRubenstein, E., & Furnier, S. M. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0031 · Cited by 65 · see citing works
“27 As a public health issue, it is important to accurately describe the extent of suicidal ideation in autistic people so that we have accurate estimates of occurrence of ideation and prevalence of factors associated with increased risk.”
Psychiatric and Medical Profiles of Autistic Adults in the SPARK Cohort
The SPARK Consortium, Fombonne, E., Green Snyder, L., Daniels, A., Feliciano, P., & Chung, W. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04414-6 · Cited by 65 · see citing works
Costa, A. P., Loor, C., & Steffgen, G. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04433-3 · Cited by 62 · see citing works
Howe, S. J., Hewitt, K., Baraskewich, J., Cassidy, S., & McMorris, C. A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04394-7 · Cited by 61 · see citing works
Self-citationArwert, T. G., & Sizoo, B. B. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04372-z · Cited by 56 · see citing works
Stability of co-occurring psychiatric diagnoses in autistic men and women
Kentrou, V., Oostervink, M., Scheeren, A. M., & Begeer, S. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101736 · Cited by 54 · see citing works
“…be used in clinical practice or research with autistic adults without first undergoing adaptation and validation for appropriate use in this group (Cassidy et al., 2018a, 2020), we recommend that future studies circumvent this limitation by developing appropriately adapted measures to corroborate…”
MethodCurnow, E., Rutherford, M., Maciver, D., Johnston, L., Prior, S., Boilson, M., Shah, P., Jenkins, N., & Meff, T. (2023) · PLoS ONE · doi:10.1371/journal.pone.0288275 · Cited by 50 · see citing works
Dow, D., Morgan, L., Hooker, J. L., Michaels, M. S., Joiner, T. E., Woods, J. J., & Wetherby, A. M. (2019) · Archives of Suicide Research · doi:10.1080/13811118.2019.1678537 · Cited by 49 · see citing works
A comparison between American and Chinese college students on suicide-related behavior parameters
Lew, B., Osman, A., Huen, J. M. Y., Siau, C. S., Talib, M. A., Jia, C.-X., Chan, C. M. H., & Leung, A. N. M. (2020) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2020.03.005 · Cited by 47 · see citing works
Jager‐Hyman, S., Maddox, B. B., Crabbe, S. R., & Mandell, D. S. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04441-3 · Cited by 44 · see citing works
McDonnell, C. G., DeLucia, E. A., Hayden, E. P., Anagnostou, E. A., Nicolson, R., Kelley, E. A., Georgiades, S., Liu, X., & Stevenson, R. A. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04320-6 · Cited by 43 · see citing works
Oliphant, R. Y. K., Smith, E. M., & Grahame, V. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04422-6 · Cited by 40 · see citing works
Personal, social and relational predictors of UK postgraduate researcher mental health problems
Berry, C., Niven, J. E., & Hazell, C. M. (2021) · BJPsych Open · doi:10.1192/bjo.2021.1041 · Cited by 39 · see citing works
“7 psychometrically valid tool for distinguishing between people who have and have not attempted suicide 179 (32).”
MethodThe Prevalence of Suicidal Behavior in Autism Spectrum Disorder
Huntjens, A., Landlust, A. M., Wissenburg, S. A., & van der Gaag, M. (2023) · Crisis · doi:10.1027/0227-5910/a000922 · Cited by 37 · see citing works
“Many studies in this meta-analysis used measures to assess SI and/or SA without any evidence of validity or used one single question only on a short subscale of a broader mental health measure (e.g., MINI, BDI, PHQ-9; Cassidy, Bradley, Bowen, et al., 2018).”
Pelton, M., Crawford, H., Robertson, A., Rodgers, J., Baron‐Cohen, S., & Cassidy, S. (2020) · Autism in Adulthood · doi:10.1089/aut.2019.0055 · Cited by 37 · see citing works
“However, there is a lack of research to explore how proximal risk factors may lead to the development of suicidality in autistic people, and there are no validated tools to identify such constructs and assess risk severity.(4) This study explores the appropriateness and measurement properties of the self-report scales…”
BackgroundSelf-citationRecommended Instruments for Analyzing Cyber Dating Violence: A Systematic Review
Soto, A. M., & Ibabe, I. (2022) · The Spanish Journal of Psychology · doi:10.1017/sjp.2021.50 · Cited by 34 · see citing works
“COSMIN is a rigorous methodological tool, but there is a certain level of subjectivity in rating each paper (Cassidy et al., 2018).”
BackgroundRethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach.
Graf‐Kurtulus, S., & Gelo, O. C. G. (2025) · Counselling and Psychotherapy Research · doi:10.1002/capr.12874 · Cited by 34 · see citing works
Marlow, N. M., Xie, Z., Tanner, R., Jacobs, M., Hogan, M. K., Joiner, T. E., & Kirby, A. V. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.07.014 · Cited by 32 · see citing works
Wichers, R., van der Wouw, L. C., Brouwer, M. E., Lok, A., & Bockting, C. (2022) · Psychological Medicine · doi:10.1017/s0033291722003415 · Cited by 32 · see citing works
Hedley, D., Batterham, P. J., Bury, S. M., Clapperton, A., Denney, K. E., Dissanayake, C., Fox, P., Frazier, T. W., Gallagher, E., Hayward, S. M., et al. (2022) · Autism · doi:10.1177/13623613221131234 · Cited by 28 · see citing works
“Indeed, recent research has identified a clear need for instruments that can be used to assess suicide behavior in autistic people, in both research and clinical settings (Cassidy et al., 2018b; Hedley et al., 2022).”
BackgroundInfluentialStacey, R., & Cage, E. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0039 · Cited by 27 · see citing works
Cassidy, S., McLaughlin, E., McGranaghan, R., Pelton, M., O’Connor, R. C., & Rodgers, J. (2023) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12965 · Cited by 26 · see citing works
Self-citationRodgers, J., Goodwin, J., Nielsen, E., Bhattarai, N., Heslop, P., Kharatikoopaei, E., O’Connor, R. C., Ogundimu, E. O., Ramsay, S. E., Steele, K., et al. (2023) · Pilot and Feasibility Studies · doi:10.1186/s40814-023-01264-8 · Cited by 26 · see citing works
“age, gender, unemployment, mental health problems, and satisfaction with living arrangements) [14].”
BackgroundSelf-citationStewart, T. M., Martin, K., Fazi, M., Oldridge, J., Piper, A., & Rhodes, S. M. (2022) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12366 · Cited by 25 · see citing works
Chang, J.-C., Lai, M., Tai, Y., & Gau, S. S. (2021) · Autism · doi:10.1177/13623613211024098 · Cited by 25 · see citing works
Rim, S. J., Kwak, K., & Park, S. (2023) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2023.102134 · Cited by 27 · see citing works
Rodgers, J., Cassidy, S., Pelton, M., Goodwin, J., Wagnild, J. M., Bhattarai, N., Gordon, I., Wilson, C., Heslop, P., Ogundimu, E. O., et al. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102662 · Cited by 24 · see citing works
“14,15 Thus, secondary aims of this study are to explore the extent to which clinical and health economics outcomes can be accurately measured and reported in a future de fi nitive trial.”
BackgroundSelf-citationFlannigan, K., McMorris, C. A., Ewasiuk, A., Badry, D., Mela, M., Gibbard, W. B., Unsworth, K., Cook, J. L., & Harding, K. D. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211053288 · Cited by 24 · see citing works
“Future research should involve multimethod, multiinformant suicide assessment tools to explore suicidality in FASD across the lifespan, with special consideration for how some tools may be less appropriate for use with individuals with ND disorders.(52,53) Similar limitations relate to how most Database variables are…”
MethodIngemann, C., & Larsen, C. V. L. (2018) · Nordic Council of Ministers eBooks · doi:10.6027/anp2018-720 · Cited by 33 · see citing works
Measuring What Matters in Autism Research and Practice
Benevides, T. W., & Cassidy, S. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.29009.twb · Cited by 19 · see citing works
“The measurement of autistic adult outcomes remains in its infancy, with few valid and reliable measures, and a reliance on utilizing standardized measures validated for other non-autistic groups in research and practice.(5,6) Autism research has also historically neglected to meaningfully involve all autistic adults i…”
Self-citationA Systematic Review of Self-Reported Stress Questionnaires in People on the Autism Spectrum
Thoen, A., Steyaert, J. G., Alaerts, K., Evers, K., & Damme, T. V. (2021) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-021-00293-4 · Cited by 21 · see citing works
Cañas, M., Ibabe, I., & de Paúl, J. (2020) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2020.104713 · Cited by 21 · see citing works
Depression in Ultra-endurance Athletes, A Review and Recommendations
Onate, J. (2018) · Sports Medicine and Arthroscopy Review · doi:10.1097/jsa.0000000000000233 · Cited by 20 · see citing works
Cassidy, S., Bradley, L., Cogger-Ward, H., Graham, J. R., & Rodgers, J. (2021) · Research Square · doi:10.21203/rs.3.rs-358997/v1 · Cited by 17 · see citing works
“Page 13/19 necessary to develop a range of depression and mental health assessment tools appropriate for different subgroups and contexts, including autistic children and youth, with or without intellectual disability, in research and clinical practice, given that tools are not valid or invalid, but rather developed a…”
BackgroundSelf-citationExperiences of Loneliness and Connection for Autistic Young People: A Systematic Review
White, L. L., Tecwyn, E. C., & Petty, S. (2024) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-024-00487-6 · Cited by 14 · see citing works
Measurement properties of tools used to assess self-harm in autistic and general population adults
Newell, V., Townsend, E., Richards, C., & Cassidy, S. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102412 · Cited by 13 · see citing works
Self-citationKhudiakova, V., & Chasteen, A. L. (2022) · Journal of Interpersonal Relations Intergroup Relations and Identity · doi:10.33921/isnu8742 · Cited by 13 · see citing works
Cleary, M. L., West, S., McLean, L., Hunt, G. E., Hungerford, C. L., & Kornhaber, R. A. (2022) · Issues in Mental Health Nursing · doi:10.1080/01612840.2022.2132329 · Cited by 12 · see citing works
“One particular trait of autism commonly linked to suicidality was identified as camouflaging, where the person adapts their behavior to mask their autism symptoms, which can lead to delays in diagnosis and assistance during times of heightened suicide risk (Cassidy et al., 2018).”
BackgroundInfluentialLifetime stressor exposure is related to suicidality in autistic adults: A multinational study
Moseley, R. L., Hedley, D., Turner‐Cobb, J. M., Uljarević, M., Bury, S. M., Shields, G. S., Trollor, J. N., Stokes, M. A., & Slavich, G. M. (2024) · Autism · doi:10.1177/13623613241299872 · Cited by 12 · see citing works
Jiménez, A. L., Cruz-Gonzalez, M. A., Calhoun, T. F., Cohen, L., & Alegria, M. M. (2022) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/cdp0000524 · Cited by 12 · see citing works
Synapse: A co-designed neurodivergent peer support programme for higher education settings
Coyle, A., O’Hare, L., & Ramey, D. (2025) · Autism · doi:10.1177/13623613251320448 · Cited by 16 · see citing works
“However, both camouflaging and masking are exhausting and can cause mental health issues and an increased risk of suicidality in this group (Cassidy et al., 2018; Shmulsky et al., 2021).”
Hedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., Robinson, J., Trollor, J. N., Uljarević, M., & Stokes, M. A. (2024) · Autism · doi:10.1177/13623613241289493 · Cited by 10 · see citing works
“…of effective and appropriate STB screening and assessment instruments that are accessible and meet the unique language and communication needs of this population (American Psychiatric Association, 2013; Cassidy, Bradley, Bowen, et al., 2018; Hedley, Batterham, et al., 2023; Schiltz et al., 2023).”
InfluentialTaylor, A. K., Steeg, S., Quinlivan, L. M., Gunnell, D., Hawton, K. E., & Kapur, N. (2020) · BJPsych Open · doi:10.1192/bjo.2020.123 · Cited by 10 · see citing works
Gallyer, A. J., Stanley, I. H., Day, T. N., & Joiner, T. E. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.092 · Cited by 10 · see citing works
Ingram, M., Thorne, E., Letourneau, E. J., & Nestadt, P. S. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221150304 · Cited by 8 · see citing works
Psychometric properties of problematic exercise measures: a systematic review
Alcaraz‐Ibáñez, M., Paterna, A., Griffiths, M. D., & Sicilia, Á. (2022) · International Review of Sport and Exercise Psychology · doi:10.1080/1750984x.2022.2111664 · Cited by 7 · see citing works
“In the second case, in view of the high level of inter-coder agreement in the present study (75% to 100%), which is similar to those reported in previous reviews conducted utilizing the COSMIN initiative (e.g. Cassidy et al., 2018; Wittkowski et al., 2020).”
InfluentialMazefsky, C. A., Conner, C. M., Siegle, G. J., Scott, L. N., Bylsma, L. M., Beck, K. B., Antezana, L., Hu, X., Cohen, A. D., Borue, X., et al. (2025) · Autism in Adulthood · doi:10.1177/25739581251393807 · Cited by 6 · see citing works
Lee, D. W., Kim, K., Hyun, J., & Jung, S. J. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.171 · Cited by 5 · see citing works
Suicidality among bisexual youths: the role of parental sexual orientation support and concealment
Reyes, M. E. S., Escote, A. M. D., Ferrer, A. V. C., Marpuri, J. K. O., Santos, A. C. D. R., Torres, R. F. E., Cayubit, R. F. O., & Bacaoco, J. R. A. (2022) · Current Psychology · doi:10.1007/s12144-022-03474-4 · Cited by 4 · see citing works
“8, and strong structural validity showing support for a one-factor solution in another study (Cassidy et al., 2018).”
BackgroundAddressing suicidality in autistic youth: Implications for school mental health professionals
Rodriguez, G., Holmberg, D. R., Fredrick, A., & Stadelman, S. (2024) · Psychology in the Schools · doi:10.1002/pits.23273 · Cited by 4 · see citing works
Adachi, M., Takahashi, M., & Mori, H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1566098 · Cited by 3 · see citing works
French, B., Newell, V., Nalbant, G., Wright, H., Daley, D., & Cassidy, S. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1702822 · Cited by 3 · see citing works
“Four reviews examined additional social and lifestyle outcomes (40, 147 – 149), with some focusing on speci fi c functional outcomes, such as driving, while others examined experiences of ageing in autism.”
Self-citationMusich, F. M., Berardo, C., & Aragón-Daud, A. (2024) · Vertex Revista Argentina de Psiquiatría · doi:10.53680/vertex.v35i163.526 · Cited by 3 · see citing works
Long, M., & Register‐Brown, K. (2021) · Pediatrics in Review · doi:10.1542/pir.2020-000547 · Cited by 4 · see citing works
The Cardiff Self‐Injury Inventory (English version): Convergent validity and psychometric properties
Snowden, R. J., Tiley, O., & Gray, N. S. (2022) · Health Science Reports · doi:10.1002/hsr2.1028 · Cited by 3 · see citing works
Sadıç, Ç. Ç. (2024) · Medicine · doi:10.1097/md.0000000000040607 · Cited by 2 · see citing works
“[30] The relationship between depression and suicide is also well known.”
Montiel‐Nava, C., Rattazzi, A., Sepúlveda, R. G., Valdez, D., Candela, G. G., Rosoli, A., Alzugaray, F., Liz, G. P., Agosto, N. M. V., Montenegro, M. C., et al. (2026) · Autism in Adulthood · doi:10.1177/25739581261432581 · Cited by 2 · see citing works
Managing self-regulatory behaviour in young autistic children in the Western Cape, South Africa
Veerasamy, S. (2024) · South African Journal of Childhood Education · doi:10.4102/sajce.v14i1.1352 · Cited by 3 · see citing works
Structural Equation Modeling of Suicidal Ideation and Behavior: A Three-Step Theory Perspective
Mohammadi, M. S., Ahmadi, F., Rasouli, A., Seraji, H. T., Tirgari, A., & Saed, O. (2024) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-149047 · Cited by 2 · see citing works
Gray, E., Rumball, F., Happe, F. G. E., Quinton, A. M. G., & Spain, D. (2025) · Research in Autism · doi:10.1016/j.reia.2025.202545 · Cited by 2 · see citing works
Cassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2020) · Research Square · doi:10.21203/rs.3.rs-48455/v1 · Cited by 2 · see citing works
“The SBQ-R is widely used in research with moderate-strong evidence in support of internal consistency, structural validity, and criterion validity in research with general population samples [16].”
BackgroundMethodInfluentialSelf-citationBinder, M. D., Sterckx, S., & Assche, K. V. (2023) · The International Library of Bioethics · doi:10.1007/978-3-031-25315-7_11 · Cited by 1 · see citing works
Franco, G. H. J., Montiel‐Nava, C., Cruz, B. B., Rosoli, A., Valdez, D., Garrido, G., García, R. N., Teixeira, M. C. T. V., Liz, G. P., Rattazzi, A., et al. (2026) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2026.2690387 · Cited by 1 · see citing works
“The findings of our adaptation process align with and extend upon the original study conducted by Cassidy et al. (2018a), which emphasized the scale’s ability to capture nuanced patterns of suicidal ideation and behaviors, specifically among autistic individuals without intellectual disabilities, a…”
InfluentialRani, D., Krishan, K., Tumram, N. K., Parekh, U., & Kanchan, T. (2022) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v93i4.12805 · Cited by 1 · see citing works
Pelton, M., Adams, J., Crawford, H., Bul, K., Robertson, A. E., Rodgers, J., & Cassidy, S. (2024) · doi:10.31234/osf.io/4f3vt · Cited by 1 · see citing works
Self-citationHedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., Robinson, J., Trollor, J. N., Uljarević, M., & Stokes, M. A. (2024) · doi:10.31219/osf.io/xqd9b · Cited by 1 · see citing works
Gordon, I., Pelton, M., Goodwin, J., Herrington, R., Rodgers, J., & Cassidy, S. (2025) · doi:10.31234/osf.io/pkej5_v2 · Cited by 1 · see citing works
Self-citationRepetitive Skin Focused Disorders May Express a Functional Connectome
Reisz, C. (2019) · Social Behavior Research and Practice - Open Journal · doi:10.17140/sbrpoj-4-114
Measuring Psychiatric Symptoms in Individuals With Intellectual and Developmental Disabilities
Ahlers, K. P., Kurtz‐Nelson, E. C., Grebe, S. C., Samaco, R. C., & Storch, E. A. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-819641-0.00127-4
Gabrielsen, T. P., Begay, K. K., Campbell, K. M., Hahn, K., & Harrington, L. T. (2023) · Springer eBooks · doi:10.1007/978-3-031-33969-1_10
Huska, M., Devine, A. E., & Naccarella, L. (2023) · International Journal of Educational and Life Transitions · doi:10.5334/ijelt.58
Autonomy and Coping with Stress in Persons with ASD
Prokopiak, A. (2023) · Forum Pedagogiczne · doi:10.21697/fp.2023.2.24
Howe, S. J., Flannigan, K., Harding, K. D., Badry, D., & McMorris, C. A. (2024) · International Journal of Developmental Disabilities · doi:10.1080/20473869.2024.2439721
Applications of Evidence-Based Practice in Pediatric Settings
Bennett, A., Kruger, H., Hamdan, S. Z., & Glatts, C. (2025) · Springer eBooks · doi:10.1007/978-3-031-78143-8_17
Gordon, I., Pelton, M., Goodwin, J., Herrington, R., Rodgers, J., & Cassidy, S. (2026) · Autism · doi:10.1177/13623613261435249
“…high-lighting a lack of validated tools for autistic people to explore suicide and self-harm (Cassidy et al., 2018, 2020; Newell et al., 2024) and that ambiguous language can make it difficult for autistic people to understand questionnaire items (Cassidy et al., 2018, 2020; Pelton et al., 2020).”
InfluentialSelf-citationMournet, A. M., Kukaj, G., Libsack, E. J., Wilkinson, E. H., Bober, I., Walker, E. M., & Bal, V. H. (2025) · Autism · doi:10.1177/13623613251380445
“…that some students misun-derstood screening items is consistent with existing literature on measurement variance in suicide risk screening items (Robeson et al., 2024) and the need to develop screening measures that are designed specifically for autistic individuals (Cassidy et al., 2018, 2021).”
Cassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021) · Figshare · doi:10.6084/m9.figshare.14821042
Self-citationRodgers, J., Goodwin, J., Nielsen, E., Bhattarai, N., Heslop, P., Kharatikoopaei, E., O’Connor, R. C., Ogundimu, E. O., Ramsay, S. E., Steele, K., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22603616
Self-citationNewell, V., Phillips, L., Jones, C. A., Townsend, E., Richards, C., & Cassidy, S. (2023) · Figshare · doi:10.6084/m9.figshare.22625015
Self-citationA Systematic Review of the Risk and Protective Factors for Suicide in Autism Spectrum Disorder
Tubío-Fungueiriño, M., Cruz, S., Zubizarreta, S. C.-P., Pozo-Rodríguez, M., Amaia Hervas, G., Carracedo, Á., & Fernández-Prieto, M. (2026) · The Spanish Journal of Psychology · doi:10.1017/sjp.2026.10034
“…about ending one ’ s own life; suicide planning, which refers to the presence of a concrete plan to end one ’ s own life; suicide attempts, which are defined as any behavior undertaken with the intention of ending one ’ s own life; and completed suicide (Cassidy et al., 2018; Costa et al., 2020).”
- Authors
- Cassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J.
- Affiliations
- University of Nottingham (GB)
- University of Worcester (GB)
- Newcastle University (GB)
- Corresponding author
- Cassidy, S.A.
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 62
- Pages
- 56-70
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2800246475
- Cited by
- 104
- References
- 96
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 15 · 2023: 14 · 2022: 13 · 2021: 13 · 2020: 21 · 2019: 8 · 2018: 4
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Clinical Psychology Review (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure (Coventry University) (acceptedVersion, cc-by)
- e-space (Manchester Metropolitan University) (acceptedVersion)
- Worcester Research and Publications (University of Worcester) (submittedVersion)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by-nc-nd)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
- Funders
- Economic and Social Research Council (ES/N000501/1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- suicidality, autism spectrum disorder, autistic adults, suicide risk assessment, measurement properties, psychometric validation, COSMIN checklist, suicide prevention, suicide attempts
- MeSH terms
- Adult, Autistic Disorder, Humans, Psychometrics, Suicide, Attempted, Self-Injurious Behavior, Checklist, Suicidal Ideation
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