Tuesday, 26 September 2017

Autism diagnosis as an "independent risk factor of attempted suicide"

The topic covered in the paper by Mu-Hong Chen and colleagues [1] is unfortunately, a familiar one to this blog examining the association between a diagnosis of autism or autism spectrum disorder (ASD) and suicidality.

Although various research and clinical efforts continue in this area, there remains a worrying association between autism and various aspects of suicidality covering ideation/discussion, attempts and unfortunately, completion in some cases. I might even add in the concept of assisted suicide to such as association (see here). Lives are being lost.

Chen et al once again drew on the 'big data' resource that is the Taiwan National Health Insurance Research Database to look at whether: "ASD independently increases the risk of attempted suicide" on the basis that comorbidity such as depression, has been suggested to exert an influence on suicidality - peripherally or directly - in the context of autism (see here).

Looking at over 5,500 adolescents (12-17 years) and young adults (18-29 years) with a diagnosis of ASD compared to over 22,000 sex- and aged-matched 'not autism' controls, researchers looked for catalogued instances of suicide attempt(s) alongside various other data on participants - "demographic data and psychiatric comorbidities." They observed that suicide attempts were significantly higher in the ASD cohort compared with controls (~4% vs. ~1%) and onward presented with elevated hazard ratios. Those elevated hazard ratios took into account those various demographic and psychiatric comorbidity data, leading the authors to conclude that the diagnosis of ASD was itself an independent risk factor for attempted suicide.

One might um-and-ah about how representative Taiwanese data might be to the rest of the world or indeed, whether with all the strengths of the Taiwanese dataset, there may be psychopathology such as depression that is not recorded in the insurance database on the basis of being sub-clinical for example. But with big participant numbers comes big(ger) confidence that the findings might be generalisable. Knowing also that various types of depression do seem to be over-represented in cases of autism (see here), so one might assume that it would be on the clinical radar no matter what country you come from or are currently living in.

Without trying to simplify the road(s) that lead someone to contemplate suicide (big data Taiwan has also already told us about some of them) I do find some hope in the findings of Chen and colleagues. Their suggestion that autism - the facets of autism - might be an independent risk factor for suicide suggest that if one is able to 'pin down' what specific parts of autism might be linked to a greater risk for suicide, then one could conceivably act upon them. I know some people don't like the idea of 'acting on' autism, but taking the example of another pretty disabling feature of quite a few instances of autism - anxiety - there are indications that acting on core symptoms *might* aid in reducing/dispensing with this quality-of-life-draining clinical feature also (see here). I might also add that even though facets of autism itself might be linked to an elevated risk of suicidality, one shouldn't necessarily assume that comorbid depression is completely off the hook; also keeping in mind that a variety of social factors might play a role in such behaviour(s) (see here)...

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[1] Chen MH. et al. Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Follow-Up Study. J Clin Psychiatry. 2017 Aug 29. pii: 16m11100.

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