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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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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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 al., 2016).”
From Diagnosis of autism in adulthood: A scoping review (2020) · cites this paper as Cassidy et al., 2014
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“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)
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“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
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“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]
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“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]
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“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]
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“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)
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“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)
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“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
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“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
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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]
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“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Self-citationBemmouna, D., Lagzouli, A., & Weiner, L. (2023) · Molecular Autism · doi:10.1186/s13229-023-00580-3 · Cited by 27
“On the CTQ-SF (childhood maltreatment), the Sexual abuse subscale score was signi�cantly higher in autistic women than autistic men (W = -5.00, p = 0.001) and comparable to the BPD group, although they tended to be lower than the latter group (W= 1.46, p = 0.056).”
ResultInfluentialRobeson, M., Brasil, K. M., Adams, H. C., & Zlomke, K. R. (2024) · Autism · doi:10.1177/13623613241240183 · Cited by 25
“With mounting research showing that suicide risk is higher among autistic adults compared to the non-autistic population (Cassidy et al., 2014), it is imperative that clinicians are able to accurately assess and follow up on suicidal ideation and self-harm behavior.”
Beck, K. B., MacKenzie, K. T., Kumar, T., Breitenfeldt, K. E., Chang, J. C., Conner, C. M., Mandell, D. L., White, S. W., & Mazefsky, C. A. (2024) · Autism in Adulthood · doi:10.1089/aut.2023.0214 · Cited by 40
Change of autism narrative is required to improve employment of autistic people
Djela, M. (2021) · Advances in Autism · doi:10.1108/aia-11-2019-0041 · Cited by 26
Dückert, S., Gewohn, P., König, H., Schöttle, D., Konnopka, A., Rahlff, P., Erik, F., Vogeley, K. T., Schulz, H., David, N., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05026-x · Cited by 37
“Furthermore, increased rates of premature mortality [4] and risk of committing suicide and dying by suicide [6, 7] have been reported.”
BackgroundMattys, L., Noens, I. L. J., Evers, K., & Baeyens, D. (2017) · Qualitative Health Research · doi:10.1177/1049732317730329 · Cited by 25
Hunsche, M. C., Saqui, S., Mirenda, P., Zaidman‐Zait, A., Bennett, T. A., Duku, E., Elsabbagh, M., Georgiades, S., Smith, I. M., Szatmári, P., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04373-y · Cited by 25
Barcelos, A. M., Kargas, N., Packham, C., & Mills, D. S. (2021) · Scientific Reports · doi:10.1038/s41598-021-02504-8 · Cited by 30
O'Connor, R. A. G., Doherty, M., Ryan-Enright, T., & Gaynor, K. (2023) · Autism · doi:10.1177/13623613231215026 · Cited by 21
“Furthermore, they report higher levels of depression and suicidality than autistic males (Cassidy et al., 2014; Hirvikoski et al., 2020; Lai et al., 2019; Oswald et al., 2016) and may have higher levels of anxiety (Angell et al., 2021; Sedgewick et al., 2021; Uljarević et al., 2020).”
BackgroundDifferential Diagnosis of Autism and Other Neurodevelopmental Disorders
Olson, L., Bishop, S. L., & Thurm, A. E. (2024) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2023.12.004 · Cited by 34
“I felt shamed and blamed”: an exploration of the parental lived experience of school distress
Mullally, S. L., & Connolly, S. E. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1489316 · Cited by 33
Baraskewich, J., & McMorris, C. A. (2019) · Current Developmental Disorders Reports · doi:10.1007/s40474-019-0154-9 · Cited by 25
Widnall, E., Epstein, S., Polling, C., Velupillai, S. U., Jewell, A., Dutta, R., Simonoff, E. A., Stewart, R. J., Gilbert, R. E., Ford, T. J., et al. (2022) · BMC Medicine · doi:10.1186/s12916-022-02329-w · Cited by 23
“66% of adults newly diagnosed with ASD in a clinical sample reported that they had contemplated suicide (UK general population prevalence 17%) while 35% had planned or attempted suicide [20].”
BackgroundDarazsdi, Z., & Bialka, C. S. (2023) · Autism · doi:10.1177/13623613231154622 · Cited by 23
“It is of utmost importance to understand their interplay, as research has found that low self-esteem is a factor in the high suicide rates of the autistic population (Arwert & Sizoo, 2020; Cassidy et al., 2014) and suicide is the leading cause of premature death for autistic people (Hirvikoski et al.”
Occurrence and predictors of lifetime suicidality and suicidal ideation in autistic adults
van Bentum, J. S., Sijbrandij, M., Huibers, M. J. H., & Begeer, S. (2024) · Autism · doi:10.1177/13623613231225901 · Cited by 24
“This might be similar in autistic individuals as Kirby et al. (2019) report a significant effect of age, and previous research has shown that autistic females are more likely to die by suicide than non-autistic females (Cassidy et al., 2014; Hirvikoski et al., 2016).”
ResultMournet, A. M., Kellerman, J. K., Garner, R. C., & Kleiman, E. M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.38345 · Cited by 22
Mental Health and University Students on the Autism Spectrum: a Literature Review
Kuder, S. J., Accardo, A. L., & Bomgardner, E. M. (2020) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-020-00222-x · Cited by 23
Autistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project
Micai, M., Ciaramella, A., Salvitti, T., Fulceri, F., Fatta, L. M., Poustka, L., Diehm, R., Iskrov, G. G., Stefanov, R. S., Guillon, Q., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.614102 · Cited by 24
Suicide risk in adults with Asperger's syndrome
Raja, M. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70257-3 · Cited by 26
Suicidality in Children with Elevated Autistic Traits
Chen, Y., Chen, Y., & Gau, S. S. (2020) · Autism Research · doi:10.1002/aur.2333 · Cited by 24
“Recent studies have indicated that high autistic traits and ASD diagnosis are associated with an increased risk of suicidality [Cassidy et al., 2014; Cassidy, Bradley, Shaw, & Baron-Cohen, 2018; Culpin et al., 2018; Hirvikoski et al., 2016;Mayes, Gorman, Hillwig-Garcia, & Syed, 2013;…”
BackgroundSelf-Focused Attention and Depressive Symptoms in Adults with Autistic Spectrum Disorder (ASD)
Burns, A., Irvine, M., & Woodcock, K. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3732-5 · Cited by 20
Recognising and responding to physical and mental health issues in neurodivergent girls and women
Kelly, C. A., Martin, R., Taylor, R., & Doherty, M. (2024) · British Journal of Hospital Medicine · doi:10.12968/hmed.2023.0337 · Cited by 26
Identifying autism spectrum disorder in undiagnosed adults
Lewis, L. F. (2018) · The Nurse Practitioner · doi:10.1097/01.npr.0000544285.02331.2c · Cited by 19
“Counseling and management of frequently co-occurring symptoms, such as anxiety, depression, and suicidal thoughts, is also warranted.(17) With this in mind, HCPs should never view age, lack of available treatment, or presence of only mild symptoms as reasons not to disclose or pursue a diagnosis of ASD when suspected.”
BackgroundA case study of suicidality presenting as a restricted interest in autism Spectrum disorder
Weiner, L., Flin, A., Causin, J.-B., Weibel, S., & Bertschy, G. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2122-7 · Cited by 20
Barriers to tests and exams for autistic pupils: improving access and longer-term outcomes
Wood, R., & Happe, F. G. E. (2020) · International Journal of Inclusive Education · doi:10.1080/13603116.2020.1866685 · Cited by 20
“2004; Levy and Perry 2011) and highly impoverished health and well-being outcomes in the longer term (Cassidy et al. 2014; Hirvikoski et al. 2016).”
BackgroundDepression in young autistic people: A scoping review
Kim, S. Y., & Lecavalier, L. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101841 · Cited by 22
Nyrenius, J., Wærn, M., Eberhard, J., Ghaziuddin, M., Gillberg, C., & Billstedt, E. (2023) · BJPsych Open · doi:10.1192/bjo.2023.553 · Cited by 39
Bemmouna, D., & Weiner, L. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1238116 · Cited by 27
Jones, K., Gangadharan, S., Brigham, P., Smith, E., & Shankar, R. (2021) · BJPsych Open · doi:10.1192/bjo.2021.58 · Cited by 18
O’Nions, E., Brown, J. M., Buckman, J. E. J., Charlton, R. A., Cooper, C., Baou, C. E., Happe, F. G. E., Hoare, S., Lewer, D., Manthorpe, J., et al. (2024) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2024.100907 · Cited by 27
“17,20,25,26 Surveys, 27 – 30 clinic-based, 31 registry, 32 – 35 and medical claims database studies 36 – 38 suggest that autistic young people and adults experience poorer mental health and higher rates of substance use relative to the general population.”
Jachyra, P., Lai, M., Zaheer, J., Fernandes, N., Dale, M., Sawyer, A., & Lunsky, Y. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05102-9 · Cited by 22
Autism and self‐harm: A population‐based and discordant sibling study of young individuals
Stark, I., Rai, D., Lundberg, M., Culpin, I., Nordström, S. I., Ohlis, A., & Magnusson, C. (2022) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13479 · Cited by 22
Autism Spectrum Disorder: a Review of Behavioral and Psychiatric Challenges Across the Lifespan
Genovese, A., & Ellerbeck, K. A. (2022) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-022-01302-1 · Cited by 23
Suicidal Thoughts and Behaviors in People on the Autism Spectrum
Reid, M., Delgado, D., Heinly, J. M., Kiernan, B., Shapiro, S. L., Morgan, L., Maddox, B. B., & Jager‐Hyman, S. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01533-0 · Cited by 18
“Additionally, Hedley et al. [2 ] found that the Suicidal Ideation Attributes Scale (SIDAS) [ 53 ], modified with autistic individuals’ input (SIDAS-M), may be appropriate for identifying SI in autistic adults without ID.”
InfluentialFereidouni, Z., Behnammoghadam, M., Jahanfar, A., & Dehghan, A. (2019) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s210757 · Cited by 23
“7,8 Suicide is the process of deliberately ending one ’ s own life.”
BackgroundAnxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Cai, R. Y., Hardan, A. Y., & South, M. (2020) · Springer eBooks · doi:10.1007/978-1-4614-6435-8_102432-1 · Cited by 17
van Elst, L. T., Fangmeier, T., Schaller, U. M., Hennig, O., Kieser, M., Koelkebeck, K., Küpper, C. S., Roessner, V., Wildgruber, D., & Dziobek, I. (2021) · Trials · doi:10.1186/s13063-021-05205-9 · Cited by 23
“Furthermore, rates of suicidality are higher than in the general population (10, 11).”
BackgroundDiagnostic Challenges of High-Functioning Autism Spectrum Disorder in Females
Gupta, M., & Chaudhary, R. (2021) · Cureus · doi:10.7759/cureus.13006 · Cited by 17
“It found higher suicidal ideation rates among AS even though depression rates were low [19].”
BackgroundAdvancing Mental Health Supports for Autistic Postsecondary Students: A Call for Research
Gunin, G. B., Gravino, A., & Bal, V. H. (2021) · Autism in Adulthood · doi:10.1089/aut.2020.0044 · Cited by 22
Mahony, C., & O’Ryan, C. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.985713 · Cited by 22
Are autistic people disadvantaged by the criminal justice system? A case comparison
Slavny‐Cross, R., Allison, C. L., Griffiths, S., & Baron‐Cohen, S. (2022) · Autism · doi:10.1177/13623613221140284 · Cited by 24
“Autistic people are particularly vulnerable to adverse mental health outcomes and are more likely to engage in self-harm and have a history of suicide attempts (Hirvikoski et al., 2020), with 66% reporting suicidal ideation (Cassidy et al., 2014).”
Self-citationDell’Osso, L., Carpita, B., Nardi, B., Benedetti, F., Dell’Oste, V., Massimetti, G., Cremone, I. M., Barlati, S., Castellini, G., Luciano, M., et al. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115270 · Cited by 18
The role of the broader autism phenotype in anxiety and depression in college-aged adults
Kurtz, M. R., Kana, R. K., Rivera, D. L., & Newman, S. D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1187298 · Cited by 17
Metadata
- 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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