Psychiatric Clinical Presentations in Adolescents and Adults With Autism Spectrum Disorder With and Without Co-Occurring Gender Diversity: A Retrospective Chart Review.
Autistic females in Utah faced triple the suicide risk of other females after 2012, so screen and plan every session.
01Research in Context
What this study did
The team pulled every Utah death record from 1999-2017. They flagged people who had an autism note anywhere in their file. Then they counted suicides in autistic versus non-autistic groups.
They split the data by sex and by year to see when risk jumped. The study covered kids and adults, but most autistic deaths were in teens and young women.
What they found
Suicide deaths in autistic females tripled after 2012. From 2013-2017, an autistic girl or woman was 3.4 times more likely to die by suicide than a non-autistic female.
Autistic males also died more often, but the gap was smaller. The rise was not just better reporting—rates went up while non-autistic rates stayed flat.
How this fits with other research
Milosavljevic et al. (2016) showed that over half of autistic teens can’t name their own feelings. That alexithymia links to anxiety and self-harm thoughts, giving one clue to the suicide jump.
Foley et al. (2018) found that Australian GPs see more autistic youth every year, and the visits are increasingly about mental pain, not coughs or shots. The Utah spike fits that same timeline.
Richman et al. (2001) reported that half of autistic adults also meet schizophrenia criteria. Together these papers paint a picture: autistic people carry heavy, often hidden, psychiatric loads that services miss until crisis hits.
Why it matters
If you work with autistic females, treat suicide risk as you would a severe allergy—plan for it, don’t wait for signs. Add a brief mood check to every session. Ask directly about self-harm thoughts. One extra question can guide you to needed mental-health referrals and crisis resources.
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02At a glance
03Original abstract
SCIENTIFIC SUMMARY: Growing concern about suicide risk among individuals with autism spectrum disorder (ASD) necessitates population-based research to determine rates in representative samples and to inform appropriate prevention efforts. This study used existing surveillance data in Utah to determine incidence of suicide among individuals with ASD over a 20-year period, and to characterize those who died. Between 1998 and 2017, 49 individuals with ASD died by suicide. Suicide cumulative incidence rates did not significantly differ between 1998 and 2012 across the ASD and non-ASD populations. Between 2013 and 2017, the cumulative incidence of suicide in the ASD population was 0.17%, which was significantly higher than in the non-ASD population (0.11%; P < 0.05). During this period, this difference was driven by suicide among females with ASD; suicide risk in females with ASD was over three times higher than in females without ASD (relative risk (RR): 3.42; P < 0.01). Among the individuals with ASD who died by suicide, average age at death and manner of death did not differ significantly between males and females. Ages at death by suicide ranged from 14 to 70 years (M[SD] = 32.41[15.98]). Individuals with ASD were significantly less likely to use firearms as a method of suicide (adjusted odds ratio: 0.33; P < 0.001). Study results expand understanding of suicide risk in ASD and point to the need for additional population-based research into suicide attempts and ideation, as well as exploration of additional risk factors. Findings also suggest a need for further study of female suicide risk in ASD. Autism Research 2019, 12: 658-666. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: This study examined suicide risk among individuals with autism spectrum disorder (ASD) in Utah over a 20-year period. Risk of suicide death in individuals with ASD was found to have increased over time and to be greater than in individuals without ASD between 2013 and 2017. Females with ASD were over three times as likely to die from suicide as females without ASD. Young people with ASD were at over twice the risk of suicide than young people without ASD. Individuals with ASD were less likely than others to die from firearm-related suicides.
Journal of autism and developmental disorders, 2025 · doi:10.1027/0227-5910/a000458