Cited by 104Suicide and Self-Harm StudiesAutism Spectrum Disorder ResearchPsychometric Methodologies and Testing

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Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review

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Cassidy, S.A., Bradley, L., Bowen, E., Wigham, S., Rodgers, J.·2018·Clinical Psychology Review

DOI 10.1016/j.cpr.2018.05.002

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Abstract

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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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement
PRISMA-P Group, Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015) · Systematic Reviews · doi:10.1186/2046-4053-4-1 · Cited by 26,223 · cited 1×
“This systematic review follows the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (Moher et al., 2015).”
Method
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BackgroundMethodResultInfluential
The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study
Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W., Knol, D. L., Bouter, L. M., & de Vet, H. C. W. (2010) · Quality of Life Research · doi:10.1007/s11136-010-9606-8 · Cited by 4,260 · cited 2×
“properties of health outcome assessment tools: the consensus based standards for the selection of health measurement instruments (COSMIN) (Mokkink et al., 2010; Mokkink et al., 2016; Mokkink, Terwee, Patrick, Alonso, & Stratford, 2012).”
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“This is consistent with previous research (Lijmer et al. 1999), which recommends the use of cohort studies in assessing the usefulness of suicidality assessment tools.”
Result
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“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.”
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“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).”
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“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).”
Background
A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability
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“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-citation
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“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).”
Background
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“Furthermore, a lack of support for this group has been associated with an increased risk of depression and suicidality (Cassidy et al., 2018c).”
Background
Measuring 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
“…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).”
BackgroundMethodInfluential
Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults
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“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.”
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“…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…”
Method
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“7 psychometrically valid tool for distinguishing between people who have and have not attempted suicide 179 (32).”
Method
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“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).”
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“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-citation
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“COSMIN is a rigorous methodological tool, but there is a certain level of subjectivity in rating each paper (Cassidy et al., 2018).”
Background
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“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).”
BackgroundInfluential
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Self-citation
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“age, gender, unemployment, mental health problems, and satisfaction with living arrangements) [14].”
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“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-citation
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“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…”
Method
A scoping review
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“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…”
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“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).”
BackgroundInfluential
Lifetime stressor exposure is related to suicidality in autistic adults: A multinational study
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Additional file 1 of Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults
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A Systematic Review of the Risk and Protective Factors for Suicide in Autism Spectrum Disorder
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“…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.
ORCID: Cassidy, S.A.
Bradley, L.
Bowen, E.
Wigham, S.
Rodgers, J.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2018-06
Volume: 62
Pages: 56-70
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2018.05.002
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: cc-by
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
creativecommons.org/licenses/by/4.0/ (vor)
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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Measurement properties of tools used to assess suicidality in autistic and general population adults: A systematic review

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