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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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“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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“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
“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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Ghaziuddin, M. (2021) · Springer eBooks · doi:10.1007/978-3-319-91280-6_455
Social camouflaging and mental health in adolescence: differences by sex and diagnosis
Bernardin, C. J. (2021) · MOspace Institutional Repository (University of Missouri) · doi:10.32469/10355/90961
“Autistic individuals have higher rates of suicidal ideation and attempts compared to the general population (Cassidy et al., 2014).”
BackgroundAutism Spectrum Disorder Versus Major Depressive Disorder
Stavropoulos, K. K. M., Bolourian, Y., & Gotham, K. O. (2022) · Oxford University Press eBooks · doi:10.1093/med-psych/9780197516881.003.0007
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Birthday blues: Aggravated depression and suicidality on birthdays in a sixty-year-old man
Chang, C.-Y., Hsieh, Y.-T., Kuo, C. Y., Lee, I. H., & Tseng, H. (2022) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2022.100072
Da anulação no discurso à eliminação em ato: o sofrimento do sujeito e o ato suicida no autismo
Romano, L., & Paravidini, J. (2022) · Physis Revista de Saúde Coletiva · doi:10.1590/s0103-73312022320309
Doctors with autism speak out against stigma
Scienceline, & Sun, A. (2023) · The Transmitter · doi:10.53053/xfep8273
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Anais do I Simpósio Brasileiro de Saúde Mental na Medicina
Lopes, J. R., Pires, B. C., Braga, A. C. A. D. A., Silva, I. Y., Arão, A. E. C. H., & Machado, T. K. F. (2023) · Editora Pascal LTDA eBooks · doi:10.29327/5311658
Health promotion through digital screening tools for adults with autistic phenotype
Stathopoulou, A., Christopoulou, M. V., Lagiou, A., & Driga, A. M. (2024) · Magna Scientia Advanced Research and Reviews · doi:10.30574/msarr.2024.10.2.0004
“It has also been found that individuals with the Asperger syndrome were more likely to report depression, suicidal ideation, suicidal plans and attempts compared with both the general population, and individuals with medical or mental illnesses (Cassidy et al., 2014).”
BackgroundFarley, M. A., McMahon, W. M., & Kirby, A. V. (2024) · Springer eBooks · doi:10.1007/978-3-031-46463-8_11
A Critical Analysis of How Local Autism Strategies Represent Autistic Adults’ Intimate Lives
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Mokhwelepa, L. W., Sumbane, G. O., & Ngwenya, M. W. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07212-5 · Cited by 1
“This may influence how depression manifests in individuals with autism [48, 53, 54].”
Experiences of Midwifery Education as a Neurodivergent Student
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Macenski, C. L., Ravichandran, C. T., Tran, D., McDougle, C. J., & Thom, R. P. (2025) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-025-07087-1
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“Research has consistently shown that individuals with ASD face a significantly higher risk of suicidality [74,105–108].”
Li, S., & Wang, W. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1679206
Baczewski, L. M., Gohari, D., Caplan, R., Nachman, B. R., Taylor, R., McDonald, M., Rodriguez, K., Sharp, K., Smith, M., Vu, A., et al. (2025) · Autism in Adulthood · doi:10.1177/25739581251387936
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Processes Associated with the Development of Depression in Autistic Individuals: A Narrative Review
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“One study conducted at a specialist diagnostic clinic found that 35% of autistic participants had either planned methods of suicide or made an active suicide attempt, and 66% of their sample had experienced suicidal ideation [9].”
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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