Conference Agenda

Background: Suicide theories designed to explain suicidal thoughts in the general population are less accurate in accounting for the experiences of autistic people. Research to date has focused largely on autistic adults, yet adolescence and the transition to adulthood pose unique challenges for autistic young people.

Methods: We undertook reflexive thematic analysis of interview transcripts with autistic people aged 16-25 (n=9, M=21.1 SD=.55), which explored: (i) retrospective reflections on contributing factors to developing suicidal thoughts aged 11-15; and (ii) recovery factors.

Results: Results reported a nested hierarchical sub-theme structure: an over-arching theme ‘chronic, fluctuating suicidal thoughts’ encapsulated two sub-themes of contributing factors (‘conceptual disorientation’ and ‘minority stress’) and one sub-theme of recovery factors (‘epistemic awakening’). Nested sub-themes included: (1) ‘existential disconnection’ which described intense social isolation including separation from life’s meaning and purpose; and (2) entrapment in ‘neuro normative education’ systems. ‘Epistemic awakening’ described developing an understanding of the influence of autistic traits – such as monotropic attention, emotional express and time perception – on suicidal thoughts. Nested sub-theme ‘Developing coping strategies for adult life’ described how detachment in nature and special interests enabled coping with continued marginalisation in a neurotypical adult world.

Conclusion: Themes informed a conceptual model of suicidal thoughts. Future longitudinal research will quantitatively test aspects of this conceptual model using Experience Sampling Methodology (ESM). Providing a neuro affirming education system could reduce onset of suicidal thoughts, whilst validating the personal quality of suicidal thoughts in clinical services could hasten recovery. Creating accommodation and accessible environments with meaningful support would lead to less suicidal ideation.

Keywords: autism, suicidal ideation, precipitating factors, recovery

Background: Autistic youth experience high rates of self-harm and suicidal ideation, and substantial barriers to adequate mental health care. Research suggests that mental health services may not meet the needs of autistic individuals, though autistic youth experiencing self-harm and suicidal ideation are underrepresented in this literature. The present study aimed to explore experiences of self-harm, suicidal ideation and mental health care among a sample of autistic youth recruited through two Australian government-funded youth mental health services.

Methods: Online interviews with seven autistic participants aged 15–23 years were transcribed and thematically analysed using a reflexive approach.

Results: Four themes and two subthemes were generated: (1) social rejection as risk, and connection as protection; (2) overwhelming emotions can lead to self-harm and hinder help-seeking; (3) feeling (mis)understood and (in)adequately accommodated by clinicians (comprising two subthemes related to poor understanding and accommodation of autism within mental health services); and (4) safety planning can feel like a box-ticking exercise.

Conclusions: These findings highlight the importance of social connectedness as a protective factor against self-harm and suicidal ideation for autistic youth, and the necessity of improving understanding and accommodation of autism in mental health care settings and suicide interventions.

Keywords: autism, self-harm, suicidal ideation, mental health care

Background: Autistic children are at an increased risk of trauma and suicide related behaviours (SRB), yet few studies have examined the relationship between trauma and SRB. This study explored how trauma may influence SRB and mental health in autistic children.

Methods: We administered an anonymised, parent-report survey to 436 parents of autistic and non-autistic children aged 4-17 years. The final sample was n=315. Unadjusted and adjusted binomial logistic regression models identified whether trauma and autism diagnosis were significant predictors of (i) self-harm/suicide attempt, (ii) talking about suicide and (iii) a mental health condition that impacts daily life. We generated heatmaps to identify traumas that frequently co-occurred with SRB and poor mental health.

Results: After accounting for trauma, autism remained a significant predictor of self-harm/suicide attempt (OR: 3.07, 95% CI: 1.52-6.2, p-value: <0.01) and a mental health condition that impacts daily life (OR: 6.3, 95% CI: 3.09-12.83, p-value: <0.01). Autism did not remain a significant predictor of talking about suicide (OR: 1.15, 95% CI: 0.56-2.37, p-value: 070). Our findings suggest a dose-response association between trauma and SRB and poor mental health in our sample. Our heatmaps showed that parents of autistic children who reported experiences of victimisation and educational difficulties were also likely to report that their child had experienced a mental health condition impacting daily life, self-harm/suicide attempt and talking about suicide.

Conclusion: This study provides evidence of complex relationships between autism, trauma, self-harm/suicide attempt and a mental health condition that impacts daily life. There is a need to enforce policies that safeguard autistic children from adverse childhood experiences. Furthermore, our findings show the importance of implementing early interventions, awareness programs and services in educational environments. Clinicians are encouraged to routinely screen for trauma, poor mental health and SRB in autistic children.

Keywords: Autism, trauma, self-harm, suicide attempt, mental health

Background: Young autistic people face heightened risk of suicidality, yet few studies have explored contributing factors using self-report data. This study examined the occurrence and correlates of suicidal thoughts among young autistic users of a UK mental-health app.

Methods: Analysis drew on anonymous self-report survey data from 365 diagnosed or self-identifying autistic users of the Tellmi app aged 11–19+ years. Binomial logistic regression was used to explore the relationship between suicidal thoughts (recorded as yes/no) and demographic variables, autism-related factors, mental health-related symptoms, and adverse life experiences.

Results: 63% of participants reported suicidal thoughts, with similar rates across age groups. The final multivariate model explained 49% of variability in the presence of suicidal thoughts (R²_Nagelkerke = 0.49, p < 0.001). Self-harm (OR = 6.4), depression (OR = 4.6), a history of physical abuse (OR = 3.1), and gender-minority identity (OR = 2.1) were the strongest correlates of suicidal thoughts, controlling for age, ethnicity, and autism diagnosis (formal diagnosis vs no formal diagnosis/unsure). Conversely, use of the term “neurodiversity”—reflecting a neurodiversity-affirming identity—was associated with greatly reduced likelihood of suicidal thoughts (OR = 0.45).

Conclusions: Suicidal thoughts were common among young autistic users of a mental health app. The strongest risk factors for suicidal thoughts were similar to those previously reported for autistic adults, while a neurodiversity-affirming identity may be protective. Overall, the findings underscore the urgency for accessible, autism-adapted mental health services, alongside promotion of neurodiversity-affirming and connection-building supports. Longitudinal studies are needed to test whether such interventions can reduce suicidality among autistic youth engaging with digital mental health services.

Keywords: autism, mental health, suicidal ideation

Background: Since 2011, there has been a threefold increase in recorded suicide deaths amongst autistic mental health patients in the UK, particularly among young people (NCISSH 2024). Autistic people report negative experiences of help-seeking for suicidal thoughts and behaviours, which increase hopelessness and suicidal intent. Suicide theories have not yet been applied to explore suicide deaths in autistic adults.

Methods: This community-based psychological autopsy study presented by one of our lived experience experts, harnesses a novel multi-disciplinary team of bereaved people, autism and suicide experts and practising psychiatrists. This study aims to identify: (i) risk and protective factors for death by suicide and/or self-inflicted injury amongst autistic people; (ii) service-level improvements to avoid future deaths; and (iii) the feasibility and acceptability of research methods to explore this topic.

Results: Mixed-methods quantitative and qualitative analyses will inform the development of: (i) a conceptual model of pathways to suicide in autistic people; (ii) future service pathways and models; and (iii) methods guidance for the conduct of safe future research on this topic. This project is the first to take a systematic approach to understand the experiences of autistic people who lost their lives to suicide from the perspective of those closest to them in life.

Conclusions: This presentation will offer emerging findings: (i) increased conceptual understanding to inform future research and clinical practice; (ii) specific proposals for service level improvements, such as adaptations to processes such as mental health admission, removal of liberty, individual risk formulation and support; and (iii) the safe inclusion of bereaved autistic people in future research. This novel study will significantly advance our understanding of suicide in autistic people to inform targeted prevention strategies and clinical improvements to practice.

Keywords: autism; death by suicide; protective factors; service improvement