Suicidality in Adults with Autism Spectrum Disorder: The Role of Depressive Symptomatology, Alexithymia, and Antidepressants.

Costa et al. (2020) asked 150 adults with autism about suicide thoughts, mood, and medicine use.

They used quick checklists to spot high suicide risk, depression, alexithymia, and antidepressant use.

Six in ten adults scored above the high-risk cutoff for suicide thoughts.

Depression, alexithymia, and taking antidepressants each raised suicide risk on their own.

Kovačič et al. (2020) ran a similar survey and also found depression—not personality traits—drives suicide risk in autistic adults.

Petry et al. (2007) reviewed earlier trials and saw antidepressants slightly cut aggression and self-injury in fewer than half of adults with intellectual disability.

The two papers seem to clash: one says antidepressant use is a warning sign for suicide, the other says the pills can calm behavior. The gap is in the outcome—P et al. track suicide thoughts, K et al. track behavior change.

Lunsky (2004) showed one in three adults with intellectual disability already endorsed suicide thoughts, so high numbers are not new, but P et al. now confirm the same burden in autistic adults without intellectual disability.

If you support autistic adults, add two quick screens to your intake: a mood checklist and an alexithymia scale. Flag anyone already on antidepressants for closer watch—the pills are not protective against suicide in this group. When risk is high, link directly to crisis care, not just a medication change.