Autistic individuals are disproportionately likely to experience suicidal thoughts, feelings, and actions. Addressing suicidality is also a high priority of autistic community members. The goal of this study was to understand broad influences on suicidality and suicide-prevention needs for the autistic community. Using a community-based participatory research approach, we conducted a reflective thematic analysis of qualitative interviews with 16 autistic adults, 8 family members, and 14 mental health providers. Themes summarizing influences on suicidality and suicide-prevention needs centered on three broad thematic concepts: (1) Pervasive negative societal attitudes and social experiences have a lasting impact on autistic people’s feelings of worth; (2) negative experiences and stressors add strain, making life feel overwhelming and hopeless; and (3) difficulty regulating and managing emotions can increase the likelihood of suicidal feelings and actions. Participants provided autism-specific recommendations to incorporate into suicide prevention. The findings emphasize the need for multifaceted suicide-prevention efforts supporting autistic people through improved societal treatment, community-level supports, and individually tailored services.
Lay Abstract
Autistic people experience suicidal thoughts, feelings, and actions more often than non-autistic people. Autistic community members say this is an important research topic. The goal of this study was to understand broadly what kinds of things might lead autistic people to feel suicidal. We also wanted to know what is needed for suicide prevention for the autistic community. The research team for this study included autistic community partners using an approach called community-based participatory research. The study team did interviews with 16 autistic adults, 8 family members, and 14 mental health providers. The results show that different types of experiences can lead to suicidality. One influence is the negative treatment of autistic people. Negative experiences, challenges, and stressors can also make life feel overwhelming for autistic people. Finally, difficult emotions can be hard to manage. There are many things that participants thought would help autistic people feel less suicidal. The study shows that autistic people need to be treated better and need more community supports to help prevent suicidal feelings. They need individualized services to help manage their emotions.
BenevidesT. W.ShoreS. M.PalmerK.DuncanP.PlankA.AndresenM. L.CaplanR.CookB.GassnerD.HectorB. L.MorganL.NebekerL.PurkisY.RankowskiB.WittigK.CoughlinS. S. (2020). Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project. Autism, 24(4), 822–833. https://doi.org/10.1177/1362361320908410
2.
BentumJ. V.SijbrandijM.HuibersM.BegeerS. (2024). Occurrence and predictors of lifetime suicidality and suicidal ideation in autistic adults. Autism, 28(9), 2282–2294. https://doi.org/10.1177/13623613231225901
3.
BraunV.ClarkeV. (2022). Thematic analysis: A practical guide. Sage.
4.
BrownC. M.NewellV.SahinE.HedleyD. (2024). Updated systematic review of suicide in autism: 2018–2024. Current Developmental Disorders Reports, 11, 225–256.
5.
CaiR. Y.RichdaleA. L.UljarevićM.DissanayakeC.SamsonA. C. (2018). Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Research, 11(7), 962–978. https://doi.org/10.1002/aur.1968
6.
Camm-CrosbieL.BradleyL.ShawR.Baron-CohenS.CassidyS. (2019). ‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality. Autism, 23(6), 1431–1441. https://doi.org/10.1177/1362361318816053
CassidyS.BradleyP.RobinsonJ.AllisonC.McHughM.Baron-CohenS. (2014). Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: A clinical cohort study. The Lancet Psychiatry, 1(2), 142–147. https://doi.org/10.1016/S2215-0366(14)70248-2
9.
Centers for Disease Control and Prevention. (2024). Suicide prevention resource for action: A compilation of the best available evidence. National Center for Injury Prevention and Control. https://www.cdc.gov/suicide/resources/prevention.html
10.
ChanD. V.DoranJ. D.GalobardiO. D. (2023). Beyond friendship: The spectrum of social participation of autistic adults. Journal of Autism and Developmental Disorders, 53(1), 424–437. https://doi.org/10.1007/s10803-022-05441-1
11.
ChangJ. C.LaiM. C.ChangS. S.GauS. S. (2024). Factors mediating pre-existing autism diagnosis and later suicidal thoughts and behaviors: A follow-up cohort study. Autism, 28(9), 2218–2231. https://doi.org/10.1177/13623613231223626
12.
ChenM.-H.PanT.-L.LanW.-H.HsuJ.-W.HuangK.-L.SuT.-P.LiC.-T.LinW.-C.WeiH.-T.ChenT.-J.BaiY.-M. (2017). Risk of suicide attempts among adolescents and young adults with autism spectrum disorder: A nationwide longitudinal follow-up study. Journal of Clinical Psychiatry, 78(9), e1174–e1179. https://doi.org/10.4088/JCP.16m11100
13.
Colmenero-NavarreteL.García-SanchoE.SalgueroJ. M. (2022). Relationship between emotion regulation and suicide ideation and attempt in adults and adolescents: A systematic review. Archives of Suicide Research, 26(4), 1702–1735. https://doi.org/10.1080/13811118.2021.1999872
14.
ConnerC. M.GoltJ.RighiG.ShafferR.SiegelM.MazefskyC. A. (2020). A comparative study of suicidality and its association with emotion regulation impairment in large ASD and US Census-matched samples. Journal of Autism and Developmental Disorders, 50, 3545–3560. https://doi.org/10.1007/s10803-020-04370-1
15.
GlennC. R.NockM. K. (2014). Improving the short-term prediction of suicidal behavior. American Journal of Preventative Medicine, 47(3), S176–S180. https://doi.org/10.1016/j.amepre.2014.06.004
16.
GrahamJ.RodgersJ.CassidyS. (2024). Why are autistic people more likely to experience suicidal thoughts? Applying the integrated motivational-volitional model with autistic adults. Autism in Adulthood, 6(3), 272–283. https://doi.org/10.1089/aut.2023.0039
17.
GuoS.QingG.YangG. (2024). The relationship between chronic disease variety and quantity and suicidal ideation: A cross-sectional study of NHANES. Journal of Psychosomatic Research, 184, 111854. https://doi.org/10.1016/j.jpsychores.2024.111854
18.
HandB. N.BenevidesT. W.CarrettaH. J. (2020). Suicidal ideation and self-inflicted injury in Medicare enrolled autistic adults with and without co-occurring intellectual disability. Journal of Autism & Developmental Disorders, 50(10), 3489–3495. https://doi.org/10.1007/s10803-019-04345-x
HedleyD.UljarevićM.FoleyK.-R.RichdaleA.TrollorJ. (2018). Risk and protective factors underlying depression and suicidal ideation in autism spectrum disorder. Depression & Anxiety, 35, 648–657. https://doi.org/10.1002/da.22759
21.
HirvikoskiT.Mittendorfer-RutzE.BomanM.LarssonH.LichtensteinP.BölteS. (2016). Premature mortality in autism spectrum disorder. The British Journal of Psychiatry, 208, 232–238. https://doi.org/10.1192/bjp.bp.114.160192
22.
HuntjensA.LandlustA.WissenburgS.van der GaagM. (2024). The prevalence of suicidal behavior in autism spectrum disorder. Crisis, 45(2), 144–153. https://doi.org/10.1027/0227-5910/a000922
23.
IsraelB. A.SchultzA. J.ParkerE. A.BeckerA. B.AllenA. J.GuzmanJ. R.LichtensteinR. (2018). Critical issues in developing and following CBPR principles. In WallersteinN.DuranB.OetzelJ.MinklerM. (Eds.), Community-based participatory research for health: Advancing social and health equity (pp. 31–44). Jossey-Bass.
24.
KirbyA. V.ConnerC. M.MazefskyC. A. (2024). Are autistic females at greater risk of suicide? A call for clarity to advance suicide prevention for the whole community. Autism Research, 17(5), 898–905. https://doi.org/10.1002/aur.3120
25.
KlonskyE. D.Dixon-LuinenburgT.MayA. M. (2021). The critical distinction between suicidal ideation and suicide attempts. World Psychiatry, 20(3), 439–441. https://doi.org/10.1002/wps.20909
26.
LernerM. D.GurbaA. N.GassnerD. L. (2023). A framework for neurodiversity-affirming interventions for autistic individuals. Journal of Consulting and Clinical Psychology, 91(9), 503–504. https://doi.org/10.1037/ccp0000839
27.
LincolnY. S.GubaE. G. (1985). Naturalistic inquiry. Sage.
28.
LopezK.NicolaidisC.GarciaA.WaismanT. C.CascioM. A.FengB. (2022). An expert roundtable discussion on intersectionality and autism in adulthood. Autism in Adulthood, 4(4), 258–264. https://doi.org/10.1089/aut.2022.29021.klo
29.
MoseleyR. L.GregoryN. J.SmithP.AllisonC.Baron-CohenS. (2019). A “choice,” an “addiction,” a way ‘out of the lost’: Exploring self-injury in autistic people without intellectual disability. Molecular Autism, 10, 18. https://doi.org/10.1186/s13229-019-0267-3
30.
MoseleyR. L.GregoryN. J.SmithP.AllisonC.Baron-CohenS. (2020). Links between self-injury and suicidality in autism. Molecular Autism, 11(1), 14. https://doi.org/10.1186/s13229-020-0319-8
31.
MoseleyR. L.GregoryN. J.SmithP.AllisonC.CassidyS.Baron-CohenS. (2022). The relevance of the interpersonal theory of suicide for predicting past-year and lifetime suicidality in autistic adults. Molecular Autism, 13(1), 14. https://doi.org/10.1186/s13229-022-00495-5
32.
MournetA. M.KellermanJ. K.GarnerR. C.KleimanE. M. (2024). Suicidal thoughts and behaviors among autistic transgender or gender-nonconforming US college students. JAMA Network Open, 7(10), Article e2438345. https://doi.org/10.1001/jamanetworkopen.2024.38345
33.
NewellV.PhillipsL.JonesC.TownsendE.RichardsC.CassidyS. (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Molecular Autism, 14(1), 12. https://doi.org/10.1186/s13229-023-00544-7
34.
NicolaidisC.RaymakerD.KappS. K.BaggsA.AshkenazyE.McDonaldK.WeinerM.MaslakJ.HunterM.JoyceA. (2019). The AASPIRE practice-based guidelines for the inclusion of autistic adults in research as co-researchers and study participants. Autism, 23(8), 2007–2019. https://doi.org/10.1177/1362361319830523
35.
NicolaidisC.RaymakerD.McDonaldK.DernS.AshkenazyE.BoisclairC.RobertsonS.BaggsA. (2011). Collaboration strategies in nontraditional community-based participatory research partnerships: Lessons from an academic−community partnership with autistic self-advocates. Progress in Community Health Partnerships: Research, Education, and Action, 5(2), 143–150. https://doi.org/10.1353/cpr.2011.0022
PearsonA.RoseK. (2021). A conceptual analysis of autistic masking: Understanding the narrative of stigma and the illusion of choice. Autism in Adulthood, 3(1), 52–60. https://doi.org/10.1089/aut.2020.0043
38.
PeltonM. K.CrawfordH.RobertsonA. E.RodgersJ.Baron-CohenS.CassidyS. (2020). Understanding suicide risk in autistic adults: Comparing the interpersonal theory of suicide in autistic and non-autistic samples. Journal of Autism and Developmental Disorders, 50, 3620–3637. https://doi.org/10.1007/s10803-020-04393-8
39.
RaymakerD. M.TeoA. R.StecklerN. A.LentzB.ScharerM.Delos SantosA.KappS. K.HunterM.JoyceA.NicolaidisC. (2020). “Having all of your internal resources exhausted beyond measure and being left with no clean-up crew”: Defining autistic burnout. Autism in Adulthood, 2(2), 132–143. https://doi.org/10.1089/aut.2019.0079
40.
ReidM.DelgadoD.HeinlyJ.KiernanB.ShapiroS.MorganL.MaddoxB.Jager-HymanS. (2024). Suicidal thoughts and behaviors in people on the autism spectrum. Current Psychiatry Reports, 26(11), 563–572. https://doi.org/10.1007/s11920-024-01533-0
41.
RodgersJ.CassidyS.PeltonM.GoodwinJ.WagnildJ.BhattaraiN.GordonI.WilsonC.HeslopP.OgundimuE.O’ConnorR.RamsayS. E.TownsendE.ValeL. (2024). Feasibility and acceptability of autism adapted safety plans: An external pilot randomised controlled trial. The Lancet, 73, 102662. https://doi.org10.1016/j.eclinm.2024.102662
42.
RonningstamE.SchechterM.HerbstmanB.GoldbalattM. (2024). Chronic suicidal ideations: A risk or a protection. Research in Psychotherapy: Psychopathology, Process, and Outcome, 27(3), 764. https://doi.org/10.4081/ripppo.2024.764
43.
SantomauroD. F.HedleyD.SahinE.BrughaT. S.NaghaviM.VosT.WhitefordH. A.FerrariA. J.StokesM. A. (2024). The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021. Psychiatry Research, 341, 116150. https://doi.org/10.1016/j.psychres.2024.116150
44.
SchindelB. J.Baer ChenB.WilcoxH. C.MarvinA. R.LawJ. K.LipkinP. H. (2024). Suicidal thoughts and behaviors among children and adolescents with autism spectrum disorder. JAMA Pediatrics, 178(6), 620–622. https://doi.org/10.1001/jamapediatrics.2024.0207
45.
SchreierM. (2018). “Sampling and generalization.” In FlickU. (Ed.), The Sage handbook of qualitative data collection (pp. 84–98). SAGE.
46.
SchwandtT. A. (2007). The Sage dictionary of qualitative inquiry. Sage.
47.
SchwartzmanJ. M.McMorrisC. A.BrownC. M.TrollorJ. N.UljarevićM.StokesM. A.WilliamsZ. J.HedleyD. (2025). Elevated suicidal thoughts and behaviors and nonsuicidal self-injury in autistic youth and adults: A multinational study. Autism in Adulthood. Advance online publication. https://doi.org/10.1089/aut.2024.0225
48.
SchwartzmanJ. M.MuscatelloR. A.CorbettB. A. (2023). Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating Scale. Autism, 27(8), 2310–2323. https://doi.org/10.1177/13623613231162154
49.
SchwartzmanJ. M.SmithJ. R.BettisA. H. (2021). Safety planning for suicidality in autism: Obstacles, potential solutions, and future directions. Pediatrics, 148(6), Article e2021052958. https://doi.org/10.1542/peds.2021-052958
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
