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Key points
- Autistic adults face four times higher deaths by suicide compared to the general population.
- The 988 Lifeline lacks specific training for responding to callers with disabilities, such as autism.
- Protective factors to prevent suicidality among autistic individuals include access to mental health care.
- Building connections with family and community support is a crucial protective factor against suicidality.
I love research. I love to read it, and I love to conduct it. I use research to guide my work as a clinician and educator. And sometimes, research just breaks my heart.
Over the last five years or so, I've been watching study after study documenting the prevalence of suicidality in autistic adults. Each study demonstrates, again and again, the higher prevalence rate of death by suicide and suicide attempts for autistic adults.
Death by suicide among autistic people is four times higher when compared to the general population (Kolves et al., 2021), and suicide attempts are seven times more common for autistic adults (Hirovoski et al., 2020). Add in the intersection of being a woman on the spectrum and we find that for autistic women, there is an even more heightened risk of suicide and suicide attempts (Kirby et al., 2019).
Each of these studies reports the problem. Everyone wants a solution.
One of the first things the general public thinks about to address suicide is the national hotline: 988 Lifeline. The primary goal of the 988 Lifeline is to provide support for people in suicidal crisis or mental health-related distress in the moments they need it most and in a manner that is person-centered.
Throughout 2023, I participated as a member of the Autism Society's Suicide Prevention Task Force; participants of the task force included people like me, professionals who sit on the panel of professional advisors, and autistic adults with lived experience who are members of the Council of Autistic Advisors for the Autism Society.
One of the recommendations from the task force was to require a national training curriculum for 988 call center staff to understand how to respond to callers with intellectual and developmental disabilities, such as autism. Research about the need for this training was conducted in collaboration with Florida Atlantic University. The Autism Society hosted a panel to discuss implementing targeted autism training for 988 call centers.
We can do better when autistic people are in crisis, and the 988 Lifeline is a valuable resource for the community, including members of the autism community. However, specific training and support are necessary to ensure that the 988 Lifeline meets the specific needs of the autistic community.
Given my interest in well-being, I was also curious about protective factors to prevent suicidality. How do we support autistic people so they do not experience the hopelessness and despair that leads to suicide? The American Foundation for Suicide Prevention lists these five protective factors:
- Access to mental health care and being proactive about mental health
- Feeling connected to family and community support
- Problem-solving and coping skills
- Limited access to lethal means
- Cultural and religious beliefs that encourage connecting and help-seeking discourage suicidal behavior or create a strong sense of purpose or self-esteem.
Of these five, the one that jumps out to me is "feeling connected to family and community support." Relationships are one of the five building blocks of the PERMA theory of well-being (Positive Emotions, Engagement, Relationships, Meaning, and Accomplishment) (Seligman, 2018). Relationships are to connect with others, to love and be loved (Seligman, 2011).
Hari Srivinasan, an autistic scholar, just wrote a piece for Time magazine on The Pervasive Loneliness of Autism. Srinivasan describes his experience as an autistic person and what contributes to his loneliness and the loneliness of disabled people and then implores us all to understand that "All humans, disabled or not, yearn for human connections that enrich their lives beyond a mere fulfillment of basic needs."
Loneliness is a national issue. In an attempt to address the epidemic of loneliness, the U.S. Surgeon General Vivek Murthy has created the "5-5" challenge.
- Step 1: Commit to connect. Pick five actions and five days to connect with people in your life.
- Step 2: Connect each day for five days. Each day, take one simple action of your choice to express gratitude, offer support, or ask for help.
I want to ask that one of your five actions includes a connection and an action with an autistic person. Murthy said, “Our relationships are a source of healing and well-being hiding in plain sight—one that can help us live healthier, more fulfilled, and more productive lives.”
If you or someone you love is contemplating suicide, seek help immediately.
To find a therapist near you, visit the Psychology Today Therapy Directory.
References
Hirvikoski, T., Boman, M., Chen, Q., D'Onofrio, B. M., Mittendorfer-Rutz, E., Lichtenstein, P., Bölte, S., & Larsson, H. (2020). Individual risk and familial liability for suicide attempt and suicide in autism: a population-based study. Psychological medicine, 50(9), 1463–1474. https://doi.org/10.1017/S0033291719001405
Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019). A 20-year study of suicide death in a statewide autism population. Autism research : official journal of the International Society for Autism Research, 12(4), 658–666. https://doi.org/10.1002/aur.2076
Kõlves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A. (2021). Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark. JAMA network open, 4(1), e2033565. https://doi.org/10.1001/jamanetworkopen.2020.33565
Seligman, M. (2011). Flourish. New York, NY: Free Press.
Seligman, M. (2018). PERMA and the Building Blocks of Well-Being. The Journal of Positive Psychology.
