Objective

To examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years.

Method

We examined associations between ASD diagnosis and 4 dichotomized ASD traits (social communication, pragmatic language, repetitive behavior, and sociability) with suicidal and nonsuicidal self-harm, suicidal thoughts, and suicidal plans at age 16 years in 5,031 members of the United Kingdom−based birth cohort study the Avon Longitudinal Study of Parents and Children. We assessed whether any associations were explained by depressive symptoms in early adolescence measured by the Short Moods and Feelings Questionnaire at 12 years.

Results

Children with impaired social communication had a higher risk of self-harm with suicidal intent (relative risk [RR] = 2.14, 95% CI = 1.28–3.58), suicidal thoughts (RR = 1.42, 95% CI = 1.06–1.91), and suicidal plans (RR = 1.95, 95% CI = 1.09–3.47) by age 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and outcomes, although these analyses were imprecise because of small numbers. There was also no evidence of an association between other autism traits and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at 12 years.

Conclusion

Social communication impairments are an important autistic trait in relation to suicidality. Early identification and management of depression may be a preventative mechanism, and future research identifying other potentially modifiable mechanisms may lead to interventions against suicidal behavior in this high-risk group.

中文翻译：

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自闭症特征和自杀观念，计划以及青春期后期的自我伤害：基于人群的队列研究

客观的

为了检验以下假设：儿童自闭症谱系障碍（ASD）的诊断和特征与16岁时的自杀念头，计划和自我伤害有关，并且观察到的任何相关现象均由12岁时的抑郁症引起。

方法

我们在英国的5,031名成员中研究了16岁时ASD诊断与4分二分的ASD特征（社交沟通，实用语言，重复行为和社交能力）与自杀和非自杀自我伤害，自杀念头和自杀计划之间的关联：基于出生的队列研究父母和子女的雅芳纵向研究。我们评估了是否有任何关联是由12岁时通过“短期情绪和情感问卷”测量的青春期早期的抑郁症状来解释的。

结果

社会交往障碍的儿童有自杀意图的自残风险较高（相对危险度[RR] = 2.14，95％CI = 1.28-3.58），有自杀念头（RR = 1.42，95％CI = 1.06-1.91），和没有自杀计划的自杀计划（RR = 1.95，95％CI = 1.09–3.47）相比，未满16岁。没有证据表明ASD诊断与结果之间存在关联，尽管由于数量少，这些分析并不精确。也没有证据表明其他自闭症特征与结果之间存在关联。在社交沟通障碍和自我伤害之间的估计总关联中，约有32％由12岁时的抑郁症状解释。

结论

社交沟通障碍是与自杀有关的重要自闭症特征。尽早发现和控制抑郁症可能是一种预防机制，而未来的研究发现其他可能改变的机制可能会导致干预这一高危人群的自杀行为。