Blanchard Ashley, Chihuri Stanford, Ing Caleb, DiGuiseppi Carolyn, Li Guohua
Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, 10032, USA.
Inj Epidemiol. 2025 Aug 7;12(1):47. doi: 10.1186/s40621-025-00591-z.
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent challenges in communication and social interaction and, often accompanied by restricted and repetitive patterns of behavior and interests. The reported prevalence of ASD in the United States has tripled in the past two decades. Recent studies indicate that ASD is associated with increased self-injurious behaviors. The purpose of this study is to assess the excess risk of intentional self-harm associated with ASD.
Using a repeated cross-sectional study design, we analyzed data from the 2016-2020 Nationwide Emergency Department Samples (NEDS), the largest all-payer emergency department (ED) database in the United States. ED visits for intentional self-harm were identified using the ICD-10-CM external cause-of-injury matrix. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ED-treated intentional self-harm associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) and/or intellectual disability (ID) were estimated through multivariable logistic regression.
The 2016-2020 NEDS recorded an unweighted total of 159,590,866 ED visits, of which 2,570,446 (1.6%) were related to intentional self-harm. Using weighted data, intentional self-injury accounted for 2.3% of ED visits made by patients with a diagnosis of ASD, 3.9% of ED visits by patients with a diagnosis of ADHD, and 3.3% of ED visits by patients with a diagnosis of ID. Compared to patients without ASD or ADHD/ID, patients with ASD alone had a 65% increased odds of intentional self-harm (aOR = 1.65; 95% CI: 1.60, 1.70); in addition, patients with ADHD/ID but no ASD a 186% increased odds (aOR = 2.86; 95% CI: 2.83, 2.88), and patients with both ASD and ADHD/ ID a 170% increased odds (aOR = 2.70; 95% CI: 2.58, 2.82) of intentional self-harm. Poisoning accounted for 82.3% of the intentional self-harm-related ED visits among patients without ASD and 61.0% of intentional self-harm-related ED visits among patients with ASD.
ASD is associated with a significantly increased risk of ED-treated intentional self-harm, particularly in patients with co-occurring ADHD or ID. Poisoning from psychotropic and other pharmaceutical drugs is the leading mechanism of intentional self-harm.
自闭症谱系障碍（ASD）是一种神经发育障碍，其特征是在沟通和社交互动方面持续存在挑战，并且常常伴有行为和兴趣的受限及重复模式。据报道，美国自闭症谱系障碍的患病率在过去二十年中增长了两倍。最近的研究表明，自闭症谱系障碍与自伤行为增加有关。本研究的目的是评估与自闭症谱系障碍相关的故意自我伤害的额外风险。
采用重复横断面研究设计，我们分析了2016 - 2020年全国急诊科样本（NEDS）的数据，这是美国最大的全付费者急诊科数据库。使用国际疾病分类第十次修订本临床修正版（ICD - 10 - CM）伤害外部原因矩阵来识别因故意自我伤害而进行的急诊科就诊。通过多变量逻辑回归估计在存在或不存在共病注意力缺陷多动障碍（ADHD）和/或智力残疾（ID）的情况下，与自闭症谱系障碍相关的经急诊科治疗的故意自我伤害的调整优势比（aORs）和95%置信区间（CIs）。
2016 - 2020年全国急诊科样本记录了未加权的总计159,590,866次急诊科就诊，其中2,570,446次（1.6%）与故意自我伤害有关。使用加权数据，故意自我伤害占诊断为自闭症谱系障碍患者急诊科就诊的2.3%，诊断为注意力缺陷多动障碍患者急诊科就诊的3.9%，以及诊断为智力残疾患者急诊科就诊的3.3%。与没有自闭症谱系障碍或注意力缺陷多动障碍/智力残疾的患者相比，仅患有自闭症谱系障碍的患者故意自我伤害的几率增加了65%（aOR = 1.65；95% CI：1.60，1.70）；此外，患有注意力缺陷多动障碍/智力残疾但没有自闭症谱系障碍的患者故意自我伤害的几率增加了186%（aOR = 2.86；95% CI：2.83，2.88），而同时患有自闭症谱系障碍和注意力缺陷多动障碍/智力残疾的患者故意自我伤害的几率增加了170%（aOR = 2.70；95% CI：2.58，2.82）。中毒占没有自闭症谱系障碍患者中与故意自我伤害相关的急诊科就诊的82.3%，以及自闭症谱系障碍患者中与故意自我伤害相关的急诊科就诊的61.0%。
自闭症谱系障碍与经急诊科治疗的故意自我伤害风险显著增加相关，特别是在同时患有注意力缺陷多动障碍或智力残疾的患者中。精神药物和其他药物中毒是故意自我伤害的主要机制。
