Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study
Open accessAbstract
BACKGROUND: Asperger's syndrome in adulthood is frequently associated with depression, but few studies have explored the lifetime experience of self-reported suicidal ideation and suicide plans or attempts in this clinical group. We aimed to assess this prevalence in a clinical cohort of patients in the UK. METHOD: In a clinical cohort study, we undertook a retrospective analysis of clinical survey data from adults newly diagnosed with Asperger's syndrome at a specialist diagnostic clinic between Jan 23, 2004, and July 8, 2013, in England. Patients completed a self-report questionnaire before clinical assessment, recording lifetime experience of depression, suicidal ideation, and suicide plans or attempts, along with self-reported measures of autistic traits and empathy. We compared the rate of suicidal ideation in the sample with published rates of suicidal ideation in the general population and other clinical groups. We also assessed associations between depression, autistic traits, empathy, and likelihood of suicidal ideation and suicide plans or attempts. FINDINGS: 374 adults (256 men and 118 women) were diagnosed with Asperger's syndrome in the study period. 243 (66%) of 367 respondents self-reported suicidal ideation, 127 (35%) of 365 respondents self-reported plans or attempts at suicide, and 116 (31%) of 368 respondents self-reported depression. Adults with Asperger's syndrome were significantly more likely to report lifetime experience of suicidal ideation than were individuals from a general UK population sample (odds ratio 9·6 [95% CI 7·6-11·9], p<0·0001), people with one, two, or more medical illnesses (p<0·0001), or people with psychotic illness (p=0·019). Compared with people diagnosed with Asperger's syndrome without depression, people with Asperger's syndrome and depression were more likely to report suicidal ideation (p<0·0001) and suicide plans or attempts (p<0·0001). INTERPRETATION: Our findings lend support to anecdotal reports of increased rates of suicidal ideation in adults with Asperger's syndrome, and depression as an important potential risk factor for suicidality in adults with this condition. Because adults with Asperger's syndrome often have many risk factors for secondary depression (eg, social isolation or exclusion, and unemployment), our findings emphasise the need for appropriate service planning and support to reduce risk in this clinical group. FUNDING: The Three Guineas Trust, the Baily Thomas Foundation, the Medical Research Council, NIHR-CLAHRC-EoE, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and the Autism Research Trust.
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Suicidal ideation (66%) and suicidal behaviour (35%) were common among autistic adults.
“In line with high depression prevalence, suicidal ideation (66%) and suicidal behaviour (35%) were also common among autistic adults (Cassidy et al., 2014).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al., 2014
The Discussion reports 66% lifetime suicidal ideation and 35% lifetime planned or attempted suicide. Those figures come from adults with Asperger’s syndrome attending a specialist diagnostic clinic, not autistic adults generally. The 35% also includes plans, so it cannot be described solely as suicidal behaviour. (LLM, conf=0.90)
Experimental — accuracy not yet measuredStudies most commonly discussed depression, anxiety, and psychotic disorders, comparing autistic adults with the general population and/or adults who were assessed but not diagnosed with autism.
“Studies most commonly discussed depression, anxiety, and psychotic disorders, comparing autistic adults with the general population (e.g. Cassidy et al., 2014; Kanai, Iwanami, Hashimoto, et al., 2011) and/or adults who were assessed but not diagnosed with autism (e.g. Happé et al., 2016; Wilson et al., 2016).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al., 2014
The Results (page not provided) compare suicidal ideation in adults with Asperger’s syndrome with a general UK population sample. The paper also examines depression and uses people with psychotic illness as a comparison group, but its primary outcome is suicidality; it does not study anxiety or compare rates of depression, anxiety, and psychotic disorders with the general population. The comparison with adults assessed but not diagnosed with autism is attached to other citations, not Cassidy et al. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAmong adults newly diagnosed with AS (n=355), 32% reported a history of depression, 66% suicidal ideation, and 35% suicide plans or attempts.
“32% reported a history of depression, 66% suicidal ideation, 35% suicide plans or attempts.”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al. (2014)
The table in Statistical analyses reports 32% with a history of depression, 66% with suicidal ideation, and 35% with suicide plans or attempts. But the Results identify 374 newly diagnosed adults; 355 is the number for whom informants were available, not the cohort size. The denominators also differ across the three survey questions. (LLM, conf=0.91)
Experimental — accuracy not yet measuredAutistic people have high rates of suicide.
“have increased vulnerability to mental ill‐health (Lai et al., 2019), including high rates of suicide (Cassidy et al., 2014; Kirby et al., 2019).”
From Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science (2022) · cites this paper as Cassidy et al., 2014
The Discussion reports high lifetime rates of suicidal ideation (66%) and suicide plans or attempts (35%) among adults with Asperger’s syndrome attending a specialist clinic. It does not establish a high rate of death by suicide, and its clinical cohort does not represent all autistic people. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAutistic people are at substantially higher risk of suicidality and mental illness than others.
“One group at substantially higher risk of suicidality and mental illness are autistic people [10, 11].”
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 [10]
The Results report substantially higher lifetime suicidal ideation in adults diagnosed with Asperger’s syndrome at a specialist clinic than in a general UK population sample. The Introduction describes high rates of depression in this group, but the paper does not establish a higher risk of mental illness generally, or extend its clinical-cohort findings to all autistic people. Page numbers are not available for these passages in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured
ASD with depression has higher rates of suicidality, with 85% suicidal ideation and 49% suicidal plans and attempts.
“ASD with depression has even higher rates with 85% suicidal ideation and 49% suicidal plans and attempts [5, 6].”
From The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/or self-destructive behaviour (DIASS): Study protocol for a multicentre randomised controlled trial (2020) · cites this paper as [6]
The study’s table of patients with Asperger’s syndrome who reported depression gives 85% (98/115) for lifetime suicidal ideation and 49% (56/115) for suicide plans or attempts. The Abstract also reports higher rates in those with depression than in those without it. These figures come from adults attending a specialist diagnostic clinic, however, and do not establish those rates for people with ASD generally; the indexed passage has no page number. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDepression is an important risk factor for suicidality and social isolation is associated with suicidal behaviour in autism.
“Cassidy and colleagues showed that depression is an important risk factor for suicidality and that social isolation is also associated with suicidal behaviour in autism [6].”
From The effect of dialectical behaviour therapy in autism spectrum patients with suicidality and/or self-destructive behaviour (DIASS): Study protocol for a multicentre randomised controlled trial (2020) · cites this paper as [6]
The Abstract and Discussion report that adults with Asperger’s syndrome and depression were more likely to report suicidal ideation and suicide plans or attempts. The Introduction describes a possible association between social isolation and suicidal acts, but attributes it to anecdotal reports; this study did not show that association in its cohort. Page numbers are not specified in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSuicidal ideation and behaviour were associated with depression in adults newly diagnosed with AS.
“Suicidal ideation and behaviour were associated with depression.”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al. (2014)
Suicidal ideation in adults newly diagnosed with AS is significantly higher than previous data on the general population, people with medical illnesses, and people with psychotic disorders.
“Suicidal ideation is significantly higher than previous data on the general population, people with medical illnesses, and people with psychotic disorders.”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al. (2014)
In a sample of recently diagnosed autistic adults without ID, 66% self-reported suicidal ideation and 35% self-reported plans or attempts of suicide.
“Indeed, in a sample of recently diagnosed autistic adults without ID, 66% self-reported suicidal ideation and 35% self-reported plans or attempts of suicide (Cassidy et al., 2014).”
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 Cassidy et al., 2014
Standardised tools for assessing depression are frequently developed for neurotypical populations and may not adequately capture autism-specific features of depressive symptoms.
“Standardised tools for assessing depression are frequently developed for neurotypical populations, meaning they may not adequately capture autism-specific features of depressive symptoms, such as heightened sensory sensitivities or unique patterns of social withdrawal (Cassidy et al., 2014).”
From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Cassidy et al., 2014
The Assessment section describes a self-report question about prior depression diagnosis, not a standardised depression scale. The Discussion (page unavailable) says the study’s questionnaire had not been validated for this sample, but does not say depression tools are developed for neurotypical populations or miss autism-specific symptoms. Searches for sensory sensitivities, social withdrawal, and depression-measure validity found no passage addressing that claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredTraits characteristic of autism are significantly associated with suicidality in those with and without ASC diagnosis.
“Traits characteristic of autism are also significantly associated with suicidality in those with [2], and without ASC diagnosis [16–18].”
From Risk markers for suicidality in autistic adults (2018) · cites this paper as [2]
There are elevated rates of suicidality in adults diagnosed with ASC.
“There are elevated rates of suicidality in adults diagnosed with autism spectrum conditions (ASC) [1–5].”
From Risk markers for suicidality in autistic adults (2018) · cites this paper as [2]
Autistic adults are at significantly increased risk of suicidality compared to the general population.
“Results are consistent with previous findings that autistic adults are at significantly increased risk of suicidality compared to the general population [2].”
From Risk markers for suicidality in autistic adults (2018) · cites this paper as [2]
Lifetime experience of depression in the general population (44.9%) and ASC group (80%) was much higher than previous estimates.
“However, lifetime experience of depression in the general population (44.9%) and ASC group (80%) were much higher than previous estimates [2, 22, 54], despite participants not being recruited because of experience with mental health problems.”
From Risk markers for suicidality in autistic adults (2018) · cites this paper as [2]
Lifetime suicide attempts in the general population (8%) and ASC group (38%) are similar to previous studies, suggesting the sample was not biased in this respect.
“Lifetime suicide attempts in the general population (8%) and ASC group (38%) are similar to previous studies [2, 17], which suggests that the sample was not biased in this respect.”
From Risk markers for suicidality in autistic adults (2018) · cites this paper as [2]
There is significant overrepresentation of mental health needs in people with autism.
“There is significant overrepresentation of mental health needs in people with autism.6,7”
From Current practice and adaptations being made for people with autism admitted to in-patient psychiatric services across the UK (2021) · cites this paper as [6]
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“Cassidy et al. (2014) similarly reported high rates of suicidal ideation (66%), plans or attempts (35%), and depression (31”
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“Studies most commonly discussed depression, anxiety and psychotic disorders, comparing autistic adults with the general population (e.g. Cassidy et al., 2014; Kanai, Iwanami, Hashimoto, et al., 2011) and/ or adults who were assessed but not diagnosed with autism (e.g. Happé et al., 2016; Wilson et…”
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“Our results add to a growing body of literature that indicates suicidality (Cassidy et al., 2014; Hirvikoski et al., 2016; Kato et al., 2013; Kirby et al., 2019; Zahid & Upthegrove, 2017) and intentional self-inflicted injury (Maddox et al., 2018; Moseley et al., 2019) are significantly more common…”
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Kallitsounaki, A., & Williams, D. M. (2023) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05517-y · Cited by 235 · see citing works
“, 2017) as well as with a higher risk of suicide than the general population (Cassidy et al., 2014; Hirvikoski et al., 2016).”
BackgroundGotham, K., Marvin, A. R., Taylor, J. L., Warren, Z., Anderson, C. M., Law, P. A., Law, J. K., & Lipkin, P. H. (2015) · Autism · doi:10.1177/1362361315583818 · Cited by 217 · see citing works
“…representative of many of the research samples of adults who have been carefully phenotyped since their early childhood, it does, however, represent an adult ASD population about whom little is known beyond preliminary reports of significant risk and high health care needs (Cassidy et al., 2014).”
BackgroundThe Autism Spectrum: Behavioral, Psychiatric and Genetic Associations
Genovese, A., & Butler, M. G. (2023) · Genes · doi:10.3390/genes14030677 · Cited by 241 · see citing works
“A landmark study that assessed suicidality in a sizable clinic population of autistic adults formerly diagnosed with Asperger syndrome (an outdated diagnosis defining a sub-group of individuals with ASD with normal intelligence and greater impairment in social skills compared to those with other autistic traits) found…”
BackgroundA Mixed Methods Study of Barriers to Formal Diagnosis of Autism Spectrum Disorder in Adults
Lewis, L. F. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3168-3 · Cited by 220 · see citing works
“As many as 70% experience comorbid disturbances such as depression, anxiety, and suicidal thoughts (Cassidy et al. 2014; Lehnhardt et al. 2013; Sterling et al. 2007).”
BackgroundA 20‐year study of suicide death in a statewide autism population
Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019) · Autism Research · doi:10.1002/aur.2076 · Cited by 192 · see citing works
Jackson, S. L. J., Hart, L., Brown, J. T., & Volkmar, F. R. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3315-x · Cited by 186 · see citing works
“Previous studies have already noted elevated rates of suicidal ideation (66%) and plans/attempts (35%) in high-functioning adults with ASD (Cassidy et al., 2014; Paquette-Smith, Weiss, & Lunsky, 2014).”
Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications
Hedley, D., & Uljarević, M. (2018) · Current Developmental Disorders Reports · doi:10.1007/s40474-018-0133-6 · Cited by 176 · see citing works
Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Foley, K., Magiati, I., Cai, R. Y., Dissanayake, C., Richdale, A. L., & Trollor, J. N. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04084-z · Cited by 164 · see citing works
“2015), and up to 35% have elevated depressive symptomatology (Cassidy et al. 2014; Crane et al. 2011; Joshi et al. 2013; Russell et al. 2015; for a systematic review, see Wigham et al. 2017).”
BackgroundHirvikoski, T., Boman, M., Chen, Q., D'Onofrio, B. M., Mittendorfer-Rutz, E., Lichtenstein, P., Bölte, S., & Larsson, H. (2020) · Psychological Medicine · doi:10.1017/s0033291719001405 · Cited by 157 · see citing works
“, 2016), and suicidal ideation in adults with ASD (Raja et al., 2011; Cassidy et al., 2014).”
BackgroundResultUntended wounds: Non-suicidal self-injury in adults with autism spectrum disorder
Maddox, B. B., Trubanova, A., & White, S. W. (2017) · Autism · doi:10.1177/1362361316644731 · Cited by 154 · see citing works
“Although there has been recent attention to increased rates of suicidal ideation and attempts in adults with ASD (e.g. Cassidy et al., 2014; Croen et al., 2015), no published reports on NSSI in this population could be found.”
BackgroundExploring the Experience of Self-Diagnosis of Autism Spectrum Disorder in Adults
Lewis, L. F. (2016) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2016.03.009 · Cited by 155 · see citing works
“Though these adults are often able to function independently, they face significant challenges that impact quality of life as well as comorbidities such as depression, anxiety, and risk of suicide (Cassidy et al., 2014; Sterling et al., 2007).”
BackgroundA comparative study of autistic and non-autistic women’s experience of motherhood
Pohl, A. L., Crockford, S. K., Blakemore, M., Allison, C. L., & Baron‐Cohen, S. (2020) · Molecular Autism · doi:10.1186/s13229-019-0304-2 · Cited by 153 · see citing works
“Autistic individuals were four times more likely to experience depression [19, 32] and have higher co-morbidity rates with other conditions such as anxiety and personality disorders [33].”
BackgroundSelf-citationHedley, D., Uljarević, M., Wilmot, M., Richdale, A., & Dissanayake, C. (2018) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2017.11.003 · Cited by 154 · see citing works
The Prevalence of Self-injurious Behaviour in Autism: A Meta-analytic Study
Steenfeldt-Kristensen, C., Jones, C. A., & Richards, C. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04443-1 · Cited by 150 · see citing works
Brede, J., Remington, A., Kenny, L., Warren, K., & Pellicano, E. (2017) · Autism & Developmental Language Impairments · doi:10.1177/2396941517737511 · Cited by 152 · see citing works
“, 2008), and of having suicidal thoughts and suicidal plans or attempts (Cassidy et al., 2014; Hirvikoski et al., 2016), suggesting that these young people may be doubly disadvantaged and, ultimately, disenfranchised in this regard.”
BackgroundMortality and cause of death of Australians on the autism spectrum
Hwang, Y. I. (., Srasuebkul, P., Foley, K., Arnold, S., & Trollor, J. N. (2019) · Autism Research · doi:10.1002/aur.2086 · Cited by 144 · see citing works
“…link between the psychological vulnerabilities posed by social and communication differences in autism, high rates of depression and anxiety (Buck et al., 2014), and high suicidal ideation or experiences (Cassidy et al., 2014), there is a lack of evidence specifically investigating these outcomes.”
BackgroundThe lifetime social cost of autism: 1990–2029
Cakir, J., Frye, R. E., & Walker, S. J. (2020) · Research in Autism · doi:10.1016/j.rasd.2019.101502 · Cited by 146 · see citing works
Suicidality in autistic youth: A systematic review and meta-analysis
O'Halloran, L., Coey, P., & Wilson, C. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102144 · Cited by 146 · see citing works
Depression in Youth with Autism Spectrum Disorder
Pezzimenti, F., Han, G. T., Vasa, R. A., & Gotham, K. (2019) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2019.02.009 · Cited by 144 · see citing works
“J Autism Dev Disord 2002;32(4):299–306.”
BackgroundInfluentialCassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018) · Autism Research · doi:10.1002/aur.1922 · Cited by 144 · see citing works
“Studies have also highlighted high rates of depression in adults with ASC [e.g., Cassidy et al., 2014; Hofvander et al., 2009].”
BackgroundSelf-citationSizoo, B. B., & Kuiper, E. (2017) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2017.03.004 · Cited by 140 · see citing works
Hedley, D., Uljarević, M., Wilmot, M., Richdale, A. L., & Dissanayake, C. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3274-2 · Cited by 139 · see citing works
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-citationPelton, M. K., & Cassidy, S. A. (2017) · Autism Research · doi:10.1002/aur.1828 · Cited by 135 · see citing works
“[Cassidy et al., 2014].”
BackgroundInfluentialSelf-citationUnderstanding and prevention of suicide in autism
Cassidy, S., & Rodgers, J. (2017) · The Lancet Psychiatry · doi:10.1016/s2215-0366(17)30162-1 · Cited by 119 · see citing works
Self-citationSuicidality in Autistic Spectrum Disorders: A Systematic Review
Zahid, S., & Upthegrove, R. (2017) · Crisis · doi:10.1027/0227-5910/a000458 · Cited by 115 · see citing works
“Prevalence of Suicidal Ideation in ASD Four papers examined both suicide attempts and suicidal ideation (Cassidy et al., 2014; Mayes, Gorman, Hillwig-Garcia, & Syed, 2013; Mukaddes & Fateh, 2010; Raja, Azzoni, & Frustaci, 2011a). The rates of suicide attempts and suicidal ideation varied from 3.8% to 66%. Raja et al.…”
BackgroundResultInfluentialNewell, 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 influential study of late diagnosed autistic adults found 66% had experienced suicidal ideation, which was nine times higher than the general population, and 35% had a suicide plan or had made a suicide attempt [10].”
BackgroundSelf-citationBernardin, C. J., Lewis, T., Bell, D., & Kanne, S. (2021) · Autism · doi:10.1177/1362361321997284 · Cited by 185 · see citing works
“Anxiety may lead to increase in social withdrawal among autistic individuals, and comorbid depression is associated with increased suicidality (Cassidy et al., 2014).”
BackgroundAdults with Autism: Changes in Understanding Since DSM-111
Howlin, P. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04847-z · Cited by 128 · see citing works
Mazefsky, C. A. (2015) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2602-7 · Cited by 103 · see citing works
“functioning ASD (Cassidy et al. 2014).”
BackgroundCassidy, S. A., Bradley, L., Bowen, E., Wigham, S., & Rodgers, J. (2018) · Clinical Psychology Review · doi:10.1016/j.cpr.2018.05.002 · Cited by 104 · see citing works
“(ASC without language delay or intellectual disability) reported having contemplated suicide, significantly higher than the UK general population (17%); and 35% reported that they had planned or attempted suicide (Cassidy et al., 2014).”
BackgroundInfluentialSelf-citationJourney to diagnosis for women with autism
Zener, D. (2019) · Advances in Autism · doi:10.1108/aia-10-2018-0041 · Cited by 108 · see citing works
Moseley, 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
Self-citationPelton, 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-citationSchiltz, H. K., McVey, A. J., Dolan, B. K., Haendel, A. D., Stanley, R. E., Arias, A. A., Gordon, N. S., & Hecke, A. V. V. (2020) · Autism · doi:10.1177/1362361320967789 · Cited by 98 · see citing works
“Anxiety and depression in autism are associated with an increased risk for suicidality (Hooijer & Sizoo, 2019), and recent findings reveal concerningly high rates of suicidality among people on the autism spectrum (Cassidy et al., 2014; Griffiths et al., 2019; Hirvikoski et al., 2020), highlighting the importance of p…”
BackgroundRealizing a diagnosis of autism spectrum disorder as an adult
Lewis, L. F. (2016) · International Journal of Mental Health Nursing · doi:10.1111/inm.12200 · Cited by 95 · see citing works
Mood symptoms and suicidality across the autism spectrum
Dell'Osso, L., Carpita, B., Muti, D., Morelli, V., Salarpi, G., Salerni, A., Scotto, J., Massimetti, G., Gesi, C., Ballerio, M., et al. (2019) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2019.03.004 · Cited by 93 · see citing works
“[45] identified an increased rate of suicidal ideation in adults with Asperger's disorder, reporting also MD as a significant risk factor among adults with this condition.”
BackgroundTakara, K., & Kondo, T. (2014) · Annals of General Psychiatry · doi:10.1186/s12991-014-0033-z · Cited by 93 · see citing works
“Several studies have consistently reported that many individuals with AS experience suicide-related behaviors [7-10].”
BackgroundAutism and autistic traits in those who died by suicide in England
Cassidy, S., Au‐Yeung, S. K., Robertson, A., Cogger-Ward, H., Richards, G., Allison, C. L., Bradley, L., Kenny, R., O’Connor, R. C., Mosse, D., et al. (2022) · The British Journal of Psychiatry · doi:10.1192/bjp.2022.21 · Cited by 91 · see citing works
Self-citationHorowitz, L. M., Thurm, A. E., Farmer, C., Mazefsky, C. A., Lanzillo, E. C., Bridge, J. A., Greenbaum, R., Pao, M., & Siegel, M. S. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3180-7 · Cited by 90 · see citing works
“The few studies on suicidal ideation or behavior in ASD have been limited by small sample sizes, variations in methods, or a frequent focus on adults and those with Asperger Disorder (Balfe and Tantam 2010; Cassidy et al. 2014; Mandell et al. 2005; Raja et al. 2011; Shtayermman 2007) (see Table 1).”
ResultInfluentialKwan, C., Gitimoghaddam, M., & Collet, J. (2020) · Brain Sciences · doi:10.3390/brainsci10110786 · Cited by 88 · see citing works
Autistic traits in adults who have attempted suicide
Richards, G., Kenny, R., Griffiths, S., Allison, C. L., Mosse, D., Holt, R., O’Connor, R. C., Cassidy, S., & Baron‐Cohen, S. (2019) · Molecular Autism · doi:10.1186/s13229-019-0274-4 · Cited by 84 · see citing works
Self-citationUljarević, M., Richdale, A. L., McConachie, H., Hedley, D., Cai, R. Y., Merrick, H., Parr, J. R., & Le Couteur, A. (2018) · Autism Research · doi:10.1002/aur.1872 · Cited by 85 · see citing works
“7%) was somewhat lower than rates of depression reported in previous studies with adults with ASD [Cassidy et al., 2014; Hofvander et al., 2009; Lever et al., 2016]; however, this finding was most likely due to the younger age of participants in our study and due to the fact that our study used dedicated measure of de…”
ResultBotha, M., Dibb, B., & Frost, D. M. (2022) · Autism · doi:10.1177/13623613221080248 · Cited by 85 · see citing works
“…connectedness’ relationship to mental health and wellbeing in other minority communities (Kaniuka et al., 2019), it might prove a useful concept to understand in relation to autism given the high rate of mental ill-health (Hannon & Taylor, 2013; Lai et al., 2019) and suicide (Cassidy et al., 2014).”
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 · see citing works
“” Interestingly, this finding runs counter to previous results suggesting that autistic adults may endorse suicidal ideation at a relatively high rate even when not reporting depression (Cassidy et al., 2014).”
ResultCassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021) · Molecular Autism · doi:10.1186/s13229-021-00449-3 · Cited by 84 · see citing works
“Autistic people who have experienced delay in autism diagnosis until adulthood show the highest estimates of lifetime suicidal thoughts (66%), and suicide attempt(s) (35–36%) [9, 10].”
BackgroundSelf-citationWarrier, V., & Baron‐Cohen, S. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0550-x · Cited by 83 · see citing works
Self-citationPark, S. H., Song, Y. J. C., Demetriou, E. A., Pepper, K. L., Thomas, E. E., Hickie, I. B., & Guastella, A. J. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113300 · Cited by 87 · see citing works
Culpin, I., Mars, B., Pearson, R. M., Golding, J., Heron, J., Bubak, I., Carpenter, P. K., Magnusson, C., Gunnell, D., & Rai, D. (2018) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2018.01.023 · Cited by 85 · see citing works
Drug development for Autism Spectrum Disorder (ASD): Progress, challenges, and future directions
McCracken, J. T., Anagnostou, E. A., Arango, C., Dawson, G., Farchione, T. R., Mantua, V., McPartland, J. C., Murphy, D., Pandina, G., & Veenstra-VanderWeele, J. M. (2021) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2021.05.010 · Cited by 87 · see citing works
Annabi, H., & Locke, J. J. (2019) · Journal of Management & Organization · doi:10.1017/jmo.2018.79 · Cited by 82 · see citing works
Ozsivadjian, A., Hollocks, M. J., Magiati, I., Happé, F., Baird, G., & Absoud, M. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13295 · Cited by 81 · see citing works
Patel, S., Day, T. N., Jones, N., & Mazefsky, C. A. (2017) · Autism · doi:10.1177/1362361316633566 · Cited by 82 · see citing works
“Depression may confer substantial added impairment as well as particularly high suicidal ideation rates among individuals with ASD (Cassidy et al., 2014).”
BackgroundKerns, C. M., Roux, A. M., Connell, J. E., & Shattuck, P. T. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.06.002 · Cited by 80 · see citing works
Conner, C. M., Golt, J., Righi, G., Shaffer, R., Siegel, M., & Mazefsky, C. A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04370-1 · Cited by 77 · see citing works
“2013), while the rates of suicidal behavior/attempts are lower than those reported in adult ASD samples (Cassidy et al. 2014).”
Montgomery, C. B., Allison, C. L., Lai, M., Cassidy, S., Langdon, P. E., & Baron‐Cohen, S. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2698-4 · Cited by 77 · see citing works
“Recent studies have shown experiences of suicidal ideation to be more than nine times higher in adults with AS than in the general population in England (Cassidy et al. 2014).”
Self-citationUnrelenting 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
What are the views and experiences of autistic teachers? Findings from an online survey in the UK
Wood, R., & Happe, F. G. E. (2021) · Disability & Society · doi:10.1080/09687599.2021.1916888 · 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
Self-citationPłatos, M., & Pisula, E. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4432-3 · Cited by 78 · see citing works
“anxiety, and other mental health problems [6, 7] and higher rates of suicidal ideation in this population [8].”
BackgroundMeasurement 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-citationRisk for Premature Mortality and Intentional Self-harm in Autism Spectrum Disorders
Jokiranta‐Olkoniemi, E., Gyllenberg, D., Sucksdorff, D., Suominen, A., Kronström, K., Chudal, R., & Sourander, A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04768-x · Cited by 73 · see citing works
Hedley, D., Uljarević, M., Bury, S. M., & Dissanayake, C. (2019) · Autism Research · doi:10.1002/aur.2064 · Cited by 76 · see citing works
Timing of diagnosis, depression and self-harm in adolescents with autism spectrum disorder
Hosozawa, M., Sacker, A., & Cable, N. (2020) · Autism · doi:10.1177/1362361320945540 · Cited by 72 · see citing works
“…study among adults diagnosed as Asperger’s syndrome suggested the importance of late diagnosis being a potential risk factor for suicidal behaviours (Cassidy et al., 2014); however, the question of whether earlier identification of ASD could reduce the risk of developing depression and…”
BackgroundCounterventions: a reparative reflection on interventionist HCI
Williams, R. M., Boyd, L., & Gilbert, J. E. (2023) · Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems · doi:10.1145/3544548.3581480 · Cited by 74 · see citing works
“Eunjung Kim explains that curative projects (those that seek to restore the sick and injured or to overcome an embodied defcit) can produce violence when they engage in “the exercise of force to erase diferences for the putative better-ment of the Other” [28:14].”
BackgroundSchiltz, H. K., McVey, A. J., Dolan, B. K., Willar, K. S., Pleiss, S. S., Karst, J. S., Carson, A. M., Caiozzo, C. N., Vogt, E. M., Yund, B. D., et al. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3396-6 · Cited by 70 · see citing works
“suicidal ideation and 35% reported plans or attempts at suicide (Cassidy et al. 2014).”
Advancing 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-citationHand, B. N., Benevides, T. W., & Carretta, H. J. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04345-x · Cited by 66 · see citing works
Bemmouna, D., Coutelle, R., Weibel, S., & Weiner, L. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05317-w · Cited by 64 · see citing works
Rubenstein, E., & Furnier, S. M. (2020) · Autism in Adulthood · doi:10.1089/aut.2020.0031 · Cited by 65 · see citing works
“26 With the importance of acting quickly to change policy and practice, 32 using efficient online surveys in an unbiased and methodologically sound manner becomes more vital.”
Cyborg Perspectives on Computing Research Reform
Williams, A., & Gilbert, J. E. (2019) · CHI Conference Extended Abstracts on Human Factors in Computing Systems (CHI EA) · doi:10.1145/3290607.3310421 · Cited by 65 · see citing works
“Autistic adult STB rates have estimated at 66-75% compared to the general population’s 17% [6,7].”
BackgroundPsychiatric 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
Autism Spectrum Disorder and Co-occurring Substance Use Disorder – A Systematic Review
Arnevik, E. A., & Helverschou, S. B. (2016) · Substance Abuse Research and Treatment · doi:10.4137/sart.s39921 · Cited by 61 · see citing works
- Authors
- Cassidy, S., Bradley, P., Robinson, J., Allison, C., McHugh, M., & Baron-Cohen, S.
- Affiliations
- University of Cambridge (GB)
- Cambridgeshire and Peterborough NHS Foundation Trust (GB)
- Corresponding author
- Cassidy, Sarah
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 1
- Issue
- 2
- Pages
- 142-147
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2126021938
- Cited by
- 432
- References
- 30
- Citations by year
- 2026: 33 · 2025: 43 · 2024: 40 · 2023: 41 · 2022: 41 · 2021: 45 · 2020: 65 · 2019: 44 · 2018: 25 · 2017: 24 · 2016: 17 · 2015: 10 · 2014: 3
- FWCI
- 21.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
- Coventry University Open Collections (Coventry university) (submittedVersion)
- The Open Collections (Coventry University) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Keywords
- Asperger syndrome, suicidal ideation, suicide attempts, suicide planning, depression, autistic traits, empathy, suicide risk factors, social isolation, unemployment, social exclusion, secondary depression, psychiatric comorbidity
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