Autism significantly increases risk for self-harm, suicidality

Children and adults with autism spectrum disorder had significantly increased risk for self-harm and suicidality, according to results of a systematic review and meta-analysis published in JAMA Network Open.

“Among the myriad potential health problems for people with ASD is the excess risk of injury morbidity and mortality,” Ashley Blanchard, MD, MS, of the department of emergency medicine at Columbia University Vagelos College of Physicians and Surgeons in New York, and colleagues wrote. “Several epidemiologic studies using emergency department visit data have shown that children with ASD are at an elevated risk for injuries. Epidemiologic evidence has also indicated that people with ASD are at a heightened risk of injury mortality, with a risk of premature death that is two- to 10-fold higher than in the general population.”

The investigators sought to examine available epidemiologic studies on the risk for self-injurious behavior and suicidality in children and adults with ASD to assess potential associations. They systematically searched five databases from year of inception to April 2020 through June 2020 for studies with an observational design, with no language, age or date restrictions. Further, they compared self-injurious behavior, defined as “nonaccidental behavior resulting in self-inflicted physical injury but without intent of suicide or sexual arousal,” and/or suicidality, defined as “suicidal ideation, suicide attempt or suicide,” among children aged younger than 20 years or adults aged 20 years or older with ASD.

The researchers calculated the ORs for the associations of ASD with self-injurious behavior and suicidality and stratified analyses by study setting and age groups as planned a priori. Overall, they identified 31 eligible studies of moderate to high quality, of which 16 (52%) were conducted among children, 13 (42%) among adults and two (6%) among both children and adults.

Seventeen studies examined the link between ASD and self-injurious behavior and produced ORs ranging from 1.21 to 18.76, which resulted in a pooled OR of 3.18 (95% CI, 2.45-4.12). Sixteen studies examined the link between ASD and suicidality and produced ORs ranging from 0.86 to 11.1, which results in a pooled OR of 3.32 (95% CI, 2.6-4.24). Stratified analyses show consistent results between clinical and nonclinical settings and between children and adults.

“Further research is needed to examine the role of primary care screenings, preventive mental health services and lethal means counseling in reducing self-harm among people with ASD,” Blanchard and colleagues wrote.