Taking action when someone is suicidal is critical to saving a life. This article will identify warning signs and what you can do to help.
Background
Research shows that autistic persons are at a higher risk of suicide than the general population.1 A recent study found that the risk of suicide attempts is three times higher in autistic persons than in the general population.2 For autistic persons who have co-occurring disorders such as depression, anxiety, or psychoses, the rate is nine times higher.3 Suicidal thoughts occur in roughly 72% of the population of autistic persons.4 It is important to note that thoughts of suicide typically do not translate to the action of suicide; however, such thoughts may be a sign of underlying depression which does require treatment. And what might cause such a serious depression in an autistic individual?
“Physical and sexual abuse, bullying, and changes in routine are precipitating events associated with suicide risk. Autistic persons present risk factors inherent to their diagnosis (deficit in expression of feelings and thoughts), along with risk factors pertaining to the general population (abuse, depression, anxiety, etc.).”
Clearly, these statistics compel us to take the issue of suicide in the autistic population very seriously indeed.
Warning Signs
Some warning signs in autistic individuals may be the same as in the general population, while some may appear differently due to individual differences in the expression of emotions. Parents, teachers, and other professionals interacting with the individual should pay close attention to these warning signs, according to the National Institutes for Mental Health (NIMH):6
Talking about:
- Wanting to die, wishing to be dead
- Great guilt or shame
- Being a burden to others
Feeling:
- Empty, hopeless, trapped, or having no reason to live
- Extremely sad, more anxious, agitated, or full of rage
- Unbearable emotional or physical pain
- Loneliness
Changing behavior, such as:
- Making a plan or researching ways to die
- Withdrawing from friends, saying goodbye, giving away important items
- Taking dangerous risks such as driving extremely fast
- Displaying extreme mood swings
- Eating or sleeping more or less
- Using drugs or alcohol more often
Sometimes these signs can be very clear and easy to observe; at other times the signals are veiled. Close observation by family and professionals is encouraged. What else can you do?
Steps to Take Towards Safety
1. Listen.
Active listening includes asking questions. Contrary to popular opinion, asking someone “Are you thinking of killing yourself?” will not cause someone to start thinking about suicide. You must be clear, direct, and willing to hear the response. If the answer is “Yes,” do not offer empty reassurances, like “everything is going to be ok” or “just stop thinking about it,” as these are ineffective. Rather, “I’m concerned. Let’s see how we can figure this out together,” will be more helpful. Accept their stated feelings. You don’t have to agree, but it is important to acknowledge that you truly hear how desperate and hopeless they feel.
2. Take it seriously.
A suicide threat is not a bid for attention; it is a declaration of deep emotional pain. Do not dismiss it. The majority of people who commit suicide tell someone first. Believe them.
3. Get more information.
Ask these key questions:
- How would you go about killing yourself (such as pills, weapons, bridge jumps)?
- Do you have the means to kill yourself (access to the above)?
- When and where would you do it?
- Have you tried to kill yourself before? (If yes, this is a higher-risk threat.)
4. Get help.
Recognize your limits. If you are not a medical or mental health professional, it’s okay to say so and to bring in professional help. If the threat is immediate (for example, the individual is holding a weapon), call the police. Don’t worry about the person being “mad” at you; you want them to be alive, and alive and angry is better than dead. If there is time for intervention, suggest a call or text to a suicide prevention hotline. Let the individual know you will not think less of them for asking for help; rather, it is courageous to say that you need help.
5. Stay close.
Never leave a suicidal person alone. If you cannot stay present until help arrives, find someone who can. Assembling a support team of family and friends may be necessary in the short term until a treatment plan can be developed and initiated. In some cases, the individual may need to be admitted to a hospital in order to be safe.
6. Assist in finding treatment
If the individual has not been evaluated for diagnosis of a co-occurring disorder, clearly now is the time to take that step. Accurate diagnosis is essential to effective treatment. Is there depression, anxiety, psychosis, or other disorder contributing to the person’s suicidal thoughts and feelings? Treatment may take the form of medication, and in the case of a suicidal individual, ongoing therapy is strongly recommended. Because loneliness is at epidemic proportions in the U.S., and autistic persons are often isolated and marginalized by peers, finding support groups or social clubs designed for autistic persons can be very important.
Conclusion
No one wants to be faced with the terrifying crisis of a family member, student, or client who wishes to be dead. Knowing that autistic persons are at higher risk, it is wise to be informed about the facts of suicidality, and the steps you can take to prevent suicide. Many people don’t share their feelings with family and friends, and autism may create even more withholding of information; don’t take that personally. Find a mental health professional who can help. Use your knowledge of the individual’s strengths and limitations in interacting with them, and craft an intervention that fits that person best.
References:
1. Hedley, D., Uljarević, M. Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. Curr Dev Disord Rep 5, 65–76 (2018). https://doi.org/10.1007/s40474-018-0133-6
2. Kõlves, K.; Fitzgerald, C.; Nordentoft, M.; Wood, S. J.; and Erlangsen, A. Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark. JAMA Network Open. 2021;4(1):e2033565. doi:10.1001/jamanetworkopen.2020.33565
3. Ibid.
4. Hedley, D., Uljarević, M. Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications. Curr Dev Disord Rep 5, 65–76 (2018). https://doi.org/10.1007/s40474-018-0133-6
5. Richa, S., Fahed, M., Khoury, E., and Mishara, B. Suicide in Autism Spectrum Disorders. Archives of Suicide Research, 18:327–339, 2014 Copyright # International Academy for Suicide Research ISSN: 1381-1118 print=1543-6136 online DOI: 10.1080/13811118.2013.824834
6. Retrieved August 23, 2021, from https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide
