Department of Psychology, Bournemouth University, Poole, UK.
Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
Mol Autism. 2020 Feb 10;11(1):14. doi: 10.1186/s13229-020-0319-8.
Autistic individuals without intellectual disability are at heightened risk of self-injury, and appear to engage in it for similar reasons as non-autistic people. A wide divergence of autistic perspectives on self-injury, including those who frame it as a helpful coping mechanism, motivate investigating the link between self-injury, suicide ideation, and attempts which has been reported in typically developing individuals.
One hundred three autistic participants completed the Non-Suicidal Self-Injury Assessment Tool (NSSI-AT), the Suicide Behaviors Questionnaire (SBQ-R), and the Interpersonal Social Evaluation List (ISEL-12) across two online studies. Logistic regression was conducted to predict self-harming status via responses to questions on suicidality, and to predict whether certain self-injurious behaviors, including cutting, were especially associated with suicide ideation and attempts. Non-parametric correlation analysis examined relationships between suicide ideation/attempts and other variables that might characterize self-harmers especially at risk of suicidality. These included perceived access to social support, purposes or reasons for self-injury, the number of different self-injurious behaviors engaged in, the duration and lifetime incidence of self-injury, and the individual's feelings about their self-injury.
While self-injuring status was significantly predicted by responses to a question on suicide ideation and attempts, there was no relationship between suicide ideation/attempts and a participant's personal feelings about their self-injury. The method of cutting was also predicted by suicide ideation and attempts, though other methods common in autistic people were at borderline significance. Use of self-injury for the regulation of low-energy emotional states like depression, for self-punishment or deterrence from suicide, and for sensory stimulation, was associated with suicide ideation and attempts, as was the number of self-injurious behaviors engaged in. There was no significant relationship between suicide ideation/attempts and the duration and lifetime incidence of self-injury or social support.
These preliminary data suggest that while individuals might frame their self-injury as a positive or neutral thing, there remains a concerning relationship between self-injury and suicidality which exists regardless of individual feelings on self-injury. This is consistent with the theoretical perspective that self-injury can be a "gateway" through which individuals acquire capability for lethal suicidal behaviors. The data highlight that particular methods (cutting) and reasons for self-injury may be of significant concern, but this information, which might be of extreme value for clinicians, requires further investigation and validation.
非智障自闭症个体自残风险较高，自残原因似乎与非自闭症个体相似。自闭症个体对自残的看法差异很大，包括将其视为一种有益的应对机制，这促使我们调查自残与自杀意念和尝试之间的联系，这种联系在典型发展个体中已有报道。
103 名自闭症参与者在两项在线研究中完成了非自杀性自我伤害评估工具（NSSI-AT）、自杀行为问卷（SBQ-R）和人际社会评价清单（ISEL-12）。采用逻辑回归分析方法，根据对自杀意念相关问题的回答来预测自残状态，并预测某些自残行为（如割伤）是否与自杀意念和尝试有特别关联。非参数相关分析检查了自杀意念/尝试与可能特别描述高自杀风险自残者的其他变量之间的关系。这些变量包括感知到的社会支持程度、自残的目的或原因、从事的不同自残行为的数量、自残的持续时间和终身发生率以及个体对自身自残的感受。
虽然自残状态可由自杀意念和尝试相关问题的回答来显著预测，但自杀意念/尝试与个体对自身自残的个人感受之间并无关系。割伤的方法也可由自杀意念和尝试来预测，但在自闭症个体中常见的其他方法则处于边缘显著水平。使用自残来调节如抑郁等低能量情绪状态、自我惩罚或阻止自杀，以及获得感官刺激，与自杀意念和尝试有关，参与的自残行为数量也与自杀意念和尝试有关。自杀意念/尝试与自残的持续时间和终身发生率或社会支持之间并无显著关系。
这些初步数据表明，虽然个体可能将其自残描述为积极或中性的事情，但自残与自杀意念之间仍存在令人担忧的关系，这种关系独立于个体对自残的感受。这与自残可以成为个体获得致命自杀行为能力的“门户”的理论观点一致。这些数据强调了某些方法（割伤）和自残原因可能特别值得关注，但这些信息对临床医生可能具有极高价值，需要进一步调查和验证。
