Life Transitions and Interpersonal Conflicts Common Antecedents for Suicidal Ideation
An exploratory study out of Canada is the first to examine clinical presentations of suicidal thoughts and behaviors (STB) in adults with autism spectrum disorder (ASD). In order to conduct this study, a research team performed a retrospective chart review of visits to a psychiatric emergency department (ED) in Toronto. These visits occurred during a 10-week period from October 2016-January 2017. During this time, a total of 24 adults with autism were seen. These individuals ranged in age from 17 to 31 years old, with the mean age being 22.5 years. By far, life transitions were the most common reason for those with ASD to end up at the ED, followed by interpersonal conflicts. Sixteen of the 24 adults with autism presented with STB. However, only eight presented with STB as their chief complaint. The other eight individuals had their STB identified by health care providers (HCPs) through secondary screening and mental status exam. The research team suggested that social-communication difficulties along with challenges in processing and expressing thoughts as well as feelings, which are hallmarks of autism, were hurdles when trying to diagnose STB. The study’s authors recommend regular screening for STB during visits to the ED for adults with ASD due to these challenges. They feel that these screenings will ultimately lower the risk of suicide for people on the spectrum. The study provided four suggestions to support people with autism in the ED. These include:
- Individuals on the spectrum or their families should bring a health information document to the ED which provides information on medical history and potential behavioral triggers.
- HCPs should seek out collateral information on caregivers, support workers, and the patient’s other HCPs. Engaging these professionals during the height of a crisis may help manage the critical situation.
- HCPs should conduct an exit interview before discharge as a tool to facilitate communication between HCPs and the patient about their visit. This exit interview may be helpful to share with caregivers, support workers, and other HCPs.
- HCPs should share mental health resources developed by people with autism for crisis support and navigating healthcare services. These should include resource guides for crisis workers who work with people with ASD, mental health literacy guides, and safety plans for adults with autism.
In the end, the research team discovered that STB is common in the ED for adults on the spectrum. They encourage efforts to recognize STB in a timely manner and for it to be adequately understood considering the unique characteristics and challenges associated with the disorder.
