Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Population Health Sciences, University of Bristol, Bristol, UK.
BMC Med. 2022 Apr 29;20(1):137. doi: 10.1186/s12916-022-02329-w.
Individuals with autism spectrum disorder (ASD) are at particularly high risk of suicide and suicide attempts. Presentation to a hospital with self-harm is one of the strongest risk factors for later suicide. We describe the use of a novel data linkage between routinely collected education data and child and adolescent mental health data to examine whether adolescents with ASD are at higher risk than the general population of presenting to emergency care with self-harm.
A retrospective cohort study was conducted on the population aged 11-17 resident in four South London boroughs between January 2009 and March 2013, attending state secondary schools, identified in the National Pupil Database (NPD). Exposure data on ASD status were derived from the NPD. We used Cox regression to model time to first self-harm presentation to the Emergency Department (ED).
One thousand twenty adolescents presented to the ED with self-harm, and 763 matched to the NPD. The sample for analysis included 113,286 adolescents (2.2% with ASD). For boys only, there was an increased risk of self-harm associated with ASD (adjusted hazard ratio 2·79, 95% CI 1·40-5·57, P<0·01). Several other factors including school absence, exclusion from school and having been in foster care were also associated with a higher risk of self-harm.
This study provides evidence that ASD in boys, and other educational, social and clinical factors, are risk factors for emergency presentation with self-harm in adolescents. These findings are an important step in developing early recognition and prevention programmes.
自闭症谱系障碍（ASD）患者自杀和自杀未遂的风险特别高。因自残而到医院就诊是日后自杀的最强风险因素之一。我们描述了一种新颖的数据链接，用于常规收集的教育数据与儿童和青少年心理健康数据之间，以检验 ASD 青少年自残就诊于急诊的风险是否高于一般人群。
在 2009 年 1 月至 2013 年 3 月期间，对居住在伦敦南部四个行政区、就读于国立中学的 11-17 岁人群进行了一项回顾性队列研究，该研究在全国学生数据库（NPD）中确定。ASD 状态的暴露数据来源于 NPD。我们使用 Cox 回归模型来预测首次到急诊室（ED）自残就诊的时间。
有 1020 名青少年因自残而到 ED 就诊，其中 763 人匹配了 NPD。分析样本包括 113286 名青少年（2.2%患有 ASD）。仅对于男孩，ASD 与自残风险增加相关（调整后的危害比 2.79，95%CI 1.40-5.57，P<0.01）。其他一些因素，包括缺课、被学校开除和被寄养，也与更高的自残风险相关。
本研究提供了证据表明，男孩中的 ASD 以及其他教育、社会和临床因素，是青少年因自残而紧急就诊的风险因素。这些发现是制定早期识别和预防计划的重要一步。
