Department of Psychology, Bournemouth University, Talbot Campus, Fern Barrow, Poole, BH12 5BB, Dorset, UK.
Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
Mol Autism. 2022 Mar 21;13(1):14. doi: 10.1186/s13229-022-00495-5.
While there are known risk factors for suicidality in autistic adults, these are often unconnected from theoretical frameworks that might explain why risk is elevated and guide clinical interventions. The present study investigated the relevance of constructs from the Interpersonal Theory of Suicide (ITS), including perceived burdensomeness, thwarted belongingness and acquired capability for suicide, and explored mechanisms through which certain risk factors (relationship status, age at diagnosis) might elevate suicide risk.
Autistic adults (n = 314) completed an online study including measures of depression, anxiety and constructs from the ITS. Linear and multinomial regression analysis disentangled contributions of ITS variables from effects of depression and anxiety for past-year suicide ideation, past-year and lifetime suicide attempts. Mediation analyses examined associations between risk factors and these suicide outcomes via mechanisms proposed by the ITS.
Past-year suicide ideation was associated with burdensomeness, mental rehearsal of suicide plans (a facet of acquired capability), and depression. Greater feelings of burdensomeness, and reduced fear of death, marked out participants who had attempted suicide in comparison to those who had experienced suicide ideation in the past year. Relationship status was indirectly associated with past-year suicide ideation via the mediators of depression and burdensomeness, and was associated with past-year attempts via its effect on ideation. Age at diagnosis was unrelated to any variables.
Cross-sectional research is insensitive to causality and temporal dynamics, which is likely why interaction hypotheses from the ITS were unsupported. Normative measures may be invalid in autistic samples. There was no control group. The autistic sample was unrepresentative of the whole population, particularly autistic people with intellectual disabilities, ethnic/racial minorities, and gender minorities.
Perceived burdensomeness and acquired capability appear potentially important to suicide in autistic people, and may mediate the effects of some risk factors. Future research should explore the temporal dynamics of suicide trajectories in longitudinal, prospective designs.
虽然自闭症成年人的自杀倾向存在已知的风险因素，但这些因素往往与可能解释风险升高的理论框架无关，并指导临床干预。本研究调查了自杀的人际理论（ITS）中的结构的相关性，包括感知负担、归属感受挫和获得自杀能力，以及探索某些风险因素（关系状况、诊断年龄）如何通过某些机制升高自杀风险。
自闭症成年人（n=314）完成了一项在线研究，包括抑郁、焦虑和 ITS 结构的测量。线性和多项回归分析从抑郁和焦虑的影响中分离出 ITS 变量对过去一年自杀意念、过去一年和终生自杀尝试的贡献。中介分析通过 ITS 提出的机制检验了风险因素与这些自杀结果之间的关联。
过去一年的自杀意念与负担感、自杀计划的心理排练（获得自杀能力的一个方面）和抑郁有关。与过去一年有自杀意念的参与者相比，感到更大的负担感和减少对死亡的恐惧，标志着尝试过自杀的参与者。关系状况通过抑郁和负担感的中介变量与过去一年的自杀意念间接相关，并且通过对意念的影响与过去一年的尝试相关。诊断年龄与任何变量都没有关系。
横断面研究对因果关系和时间动态不敏感，这可能是 ITS 的交互假设不支持的原因。自闭症样本中，规范测量可能无效。没有对照组。自闭症样本不能代表整个人群，特别是自闭症的智障人士、族裔/种族少数群体和性别少数群体。
感知负担和获得自杀能力似乎对自闭症患者的自杀很重要，并且可能是某些风险因素的中介因素。未来的研究应该在纵向、前瞻性设计中探索自杀轨迹的时间动态。
