The effectiveness, cost-effectiveness and experiences of interventions to reduce suicidality for autistic people: A scoping review.

Abstract

Autistic people and people with elevated autistic traits are at a higher risk of suicidality (suicidal ideation, suicide plans, suicide attempts) than the general population, with over a third of autistic and possibly autistic people experiencing suicidal ideation, suicidal attempts and/or behaviour. The high prevalence of suicidality has been associated with lack of support and interventions to meet the specific needs of autistic people. This scoping review aimed to better understand the quantity and nature of existing primary research evaluating interventions to support autistic people experiencing suicidality, to inform the commissioning of future primary research. Twenty-seven studies were included: 18 focused on evaluating or developing interventions to reduce suicidality, and nine on evaluating/developing screening procedures to identify autistic people potentially at risk of dying by suicide. Findings suggest researchers are adapting and testing interventions to reduce suicidality in partnership with autistic people, but there is still work needed to enable autistic people to communicate suicidal thoughts and behaviours and develop clinician knowledge and understanding. While the number of completed studies using robust methods such as randomised controlled trials was small, this review indicates a nascent body of research evidence on interventions to reduce suicidality in the autistic population.Lay abstractAutistic, or potentially autistic, people are at higher risk of experiencing suicidality than the general population. This has been linked to a lack of support and treatments that meet the specific needs of autistic people. This scoping review brings together research developing or evaluating strategies that aim to reduce the risk of autistic people dying by suicide. We reviewed 27 studies and found that there is a small but growing number of research projects that involve autistic people to develop treatments to reduce suicidality. For example, we found a study that has adapted and tested safety planning for autistic people. Other research has been testing tools that identify and assess suicidality and understanding healthcare professionals' perspectives on assessing suicidality. More work is needed to develop training for professionals and on adapting assessment tools so that autistic people find it easier to talk about suicidal thoughts. Future research should also aim to be inclusive of the autistic population and ensure gender and cultural diversity in those that participate in research projects. Larger trials will be needed in the future to investigate the effectiveness of treatments for autistic people and build on existing evidence.