@article{ref1,
title="Assessment of suicidal behaviors among individuals with autism spectrum disorder in Denmark",
journal="JAMA network open",
year="2021",
author="Erlangsen, Annette and Wood, Stephen James and Nordentoft, Merete and Fitzgerald, Cecilie and Kolves, Kairi",
volume="4",
number="1",
pages="e2033565-e2033565",
abstract="IMPORTANCE: There is limited evidence supporting an association of autism spectrum disorder (ASD) with suicidality and the risk factors for suicide attempt and suicide  among people with ASD. Existing research highlights the need for national cohort  studies. <br><br>OBJECTIVES: To analyze whether people with ASD have higher rates of suicide  attempt and suicide compared with people without ASD using national register data,  identify potential risk factors for suicide attempt and suicide among those with  ASD, and examine associations with comorbid disorders. DESIGN, SETTING, AND  PARTICIPANTS: In this cohort study, nationwide register data from January 1, 1995,  to December 31, 2016, were gathered on 6 559 266 individuals in Denmark aged 10  years or older. Statistical analysis was performed from November 20, 2018, to  November 21, 2020. MAIN OUTCOMES AND MEASURES: Rates of suicide attempt and suicide  among persons with ASD were compared with rates among persons without ASD, using  Poisson regression models to calculate incidence rate ratios adjusted for sex, age,  and time period. <br><br>RESULTS: Of the total study population of 6 559 266 individuals,  35 020 individuals (25 718 male [73.4%]; mean [SD] age at diagnosis, 13.4 [9.3]  years) received a diagnosis of ASD. A total of 64 109 incidents of suicide attempts  (587 [0.9%] among individuals with ASD) and 14 197 suicides (53 [0.4%] among  individuals with ASD) were recorded. Persons with ASD had a more than 3-fold higher  rate of suicide attempt (adjusted incidence rate ratio [aIRR], 3.19; 95% CI,  2.93-3.46) and suicide (aIRR, 3.75; 95% CI, 2.85-4.92) than those without ASD. For  individuals with ASD, the aIRR for suicide attempt among female individuals was  4.41-fold (95% CI, 3.74-5.19) higher compared with male individuals; for individuals  without ASD, the aIRR for female individuals was 1.41-fold (95% CI, 1.39-1.43)  higher compared with male individuals. Higher rates of suicide attempt were noted  across all age groups for those with ASD. Persons with a diagnosis of ASD only had  an aIRR of 1.33 (95% CI, 0.99-1.78) for suicide attempt, whereas those with other  comorbid disorders had an aIRR of 9.27 (95% CI, 8.51-10.10) for suicide attempt  compared with those without any psychiatric disorders. A total of 542 of 587  individuals with ASD (92.3%) who attempted suicide had at least 1 other comorbid  condition and 48 of 53 individuals with ASD (90.6%) who died by suicide had at least  1 other comorbid condition. <br><br>CONCLUSIONS AND RELEVANCE: This nationwide retrospective  cohort study found a higher rate of suicide attempt and suicide among persons with  ASD. Psychiatric comorbidity was found to be a major risk factor, with more than 90%  of those with ASD who attempted or died by suicide having another comorbid  condition. Several risk factors are different from the risk factors in the general  population, which suggests the need for tailored suicide prevention strategies.<p /> <p>Language: en</p>",
language="en",
issn="2574-3805",
doi="10.1001/jamanetworkopen.2020.33565",
url="http://dx.doi.org/10.1001/jamanetworkopen.2020.33565"
}