Lopez-Arvizu Carmen, Steelesmith Danielle L, Hand Brittany N, Huang Rui, Thompson Amanda J, Llamocca Elyse N, Quinn Bridget A, Fontanella Cynthia A, Campo John V
Kennedy Krieger Institute, Baltimore, Maryland.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAACAP Open. 2025 Jan 15;3(3):477-484. doi: 10.1016/j.jaacop.2024.09.012. eCollection 2025 Sep.
To identify correlates of deliberate self-harm (DSH) in youth with autism and/or intellectual disability (ID).
This retrospective longitudinal cohort analysis used claims data for youth ages 5 to 24 years continuously enrolled in Medicaid in a midwestern state for 6 months and diagnosed with autism and/or ID between 2010 and 2020 (N = 41,230). Cox proportional hazards regression examined associations between demographic and clinical variables and time to DSH for study cohorts with autism and/or ID.
Autism was diagnosed in 34.3% of the sample, ID was diagnosed in 30.6%, and both autism and ID were diagnosed in 35.1%. Sample youth were predominantly male (73.4%) and had an internalizing (74.8%) or externalizing (62.1%) mental health condition. At least 1 DSH event was identified for 734 youths (2.6%) with autism and 686 youths (2.7%) with ID during follow-up. Increased risk of DSH was associated with older age; female sex; history of abuse or neglect; and co-occurring externalizing problems, internalizing problems, substance use, and thought problems for the autism cohort and ID cohort and with the presence of a chronic complex medical condition in the autism cohort. Risk of DSH was significantly lower for youth with moderate ID and youth eligible for Medicaid via disability and foster care.
Risk factors for DSH in youth with autism and ID are similar to those in neurotypical youth and include increasing age, trauma, mental health conditions, substance use, and female sex. Clinician and consumer education regarding suicide risk and its correlates in youth with autism and ID warrants study.
确定患有自闭症和/或智力残疾（ID）的青少年故意自伤（DSH）的相关因素。
这项回顾性纵向队列分析使用了中西部一个州连续6个月参加医疗补助计划的5至24岁青少年的索赔数据，这些青少年在2010年至2020年期间被诊断患有自闭症和/或ID（N = 41,230）。Cox比例风险回归分析了患有自闭症和/或ID的研究队列中人口统计学和临床变量与DSH发生时间之间的关联。
样本中34.3%被诊断患有自闭症，30.6%被诊断患有ID，35.1%同时被诊断患有自闭症和ID。样本中的青少年以男性为主（73.4%），患有内化性（74.8%）或外化性（62.1%）心理健康状况。在随访期间，734名患有自闭症的青少年（2.6%）和686名患有ID的青少年（2.7%）至少发生了1次DSH事件。DSH风险增加与年龄较大、女性、虐待或忽视史以及自闭症队列和ID队列中同时存在的外化问题、内化问题、物质使用和思维问题有关，并且与自闭症队列中存在慢性复杂医疗状况有关。中度ID的青少年以及通过残疾和寄养照顾符合医疗补助计划资格的青少年发生DSH的风险显著较低。
患有自闭症和ID的青少年DSH的风险因素与神经典型青少年相似，包括年龄增长、创伤、心理健康状况、物质使用和女性性别。针对患有自闭症和ID青少年的自杀风险及其相关因素的临床医生和消费者教育值得研究。
