Suicidality in Autistic Adults: The Role of Depressive Symptomatology, Alexithymia and Antidepressants

Recent scientific research consistently shows that people with autism are at higher risk of suicidality, which includes suicidal ideation, suicide planning, and suicide attempts. However, risk and protective factors are not sufficiently studied and guidelines for prevention and intervention measures are still lacking. Thus, the objective of the present study was to explore the relationship between autistic traits, depressive symptomatology, alexithymia and antidepressant use versus suicidality.

Because of the known link between depression and suicide in the general population and given the high prevalence of depression in people with autism, it is important to consider the risk of suicide in people with autism. According to the World Health Organization (WHO), in 2018 suicide was considered the cause of death for 1. 4% of all global deaths, stating that for every adult who dies by suicide, there may be more than 20 other people attempting suicide. Even though there are not many studies regarding suicide in autistic people, the combination of results from previous studies suggests that the frequency of suicide is higher in people with autism compared to the general population. In 2016 it was also reported that 0.31% of all premature deaths among people with ASD are due to suicide, which is significantly higher than in the general population (0.06%).


Among the various psychiatric problems that constitute risk factors for suicide, mood disorders such as depression are among the most common. Considering the generally high rates of depression reported in people with autism, depression should be considered when assessing risk factors for suicide in people with autism. Especially considering the fact that for people with autism, it has been shown that the mere presence of the factor of depression, without the presence of other factors, is enough to increase their risk of suicide.

However, the combination of depression with other additional risk factors may particularly predispose autistic people to suicidality. In adults with autism, it has been found that those with depression have higher cognitive and social abilities, suggesting that being more aware of one’s own challenges, such as difficulty interacting socially, may lead to a higher risk of depression.

Age and sex have also been identified as relevant factors of suicidality with particular characteristics in people with autism. In 2018 the WHO reported that in the general population, suicide rates are lowest among people under 15 years of age and highest among people aged 70 or older. In 2013 other studies showed that for people with autism, being under 10 years old is a protective factor against suicidality. However, a study that was carried out over a 20-year period, based on the autistic population of Utah in the United States, demonstrated in 2019 that  young people with autism  are twice as likely to die by suicide as young people without autism. Regarding gender among autistic people, different studies published between 2009 and 2016 have shown that being a man is a risk factor for suicide, while women with autism and intellectual disabilities have a higher risk of premature mortality. By the same 20-year study previously carried out in Utah, it was also found that in recent years (2013-2017), women with autism  were three times more likely to die by suicide than women without autism.


Although research on the causes of suicide in people with autism can draw on research in the general population, it is possible that the risk factors are different in people with autism. For example, in one of the large-scale clinical studies conducted in England from 2004 to 2013 on suicide in people with Asperger’s syndrome, the rate of suicidal ideation was double (66%) that of people with depression (32%). Therefore, it is necessary to consider other risk factors specific to people with autism and one of these factors could be alexithymia. Alexithymia was first described as a lack of words for emotions and can be defined as a general difficulty in acknowledging, describing and distinguishing one’s own emotions and those of others. Alexithymia disrupts both the experience and expression of emotions and has an impact on an intrapersonal and interpersonal level. While in the general population the rate of alexithymia is estimated at 10%, according to studies published in 2004 and 2005 among people with autism the rate of alexithymia is higher with a prevalence of 40 to 65%.

Research indicates that alexithymia is closely linked to depression. In a study published in 2000 examining the relationship between alexithymia and depression in the general population, it was found that in participants without diagnostic depression, 4.3% had alexithymia, while among participants with depression, 32% had alexithymia. In another study, it was found that people with higher levels of alexithymia also had higher levels of depression. As depression is strongly linked to suicide and alexithymia to depression, the association between alexithymia and suicidality was examined. The results showed that suicidal ideation is more common in alexithymic people than in non-alexithymic people.

Many people with autism have difficulty managing their emotions, identifying facial expressions, reacting to emotions, as well as regulating their emotions. Although some studies have shown that the emotional difficulties of autistic people cannot be attributed solely to alexithymia  , several other studies indicate that the emotional difficulties of people with autism are not specific to their disorder but are rather due to alexithymia.


As discussed before, depression and alexithymia play an important role in explaining suicidality in the general population. However, even though people with autism have higher rates of depression and alexithymia, there are no studies to date and to our knowledge of the potential role that alexithymia and depression may play on suicide in autistic people. The objective of this study was therefore to explore the relationship between suicidality, depressive symptomatology, antidepressant use and alexithymia in adults with autism. In the current study that was created and carried out by researchers in Luxembourg, based on a group of people aged between 18 and 64 years, 150 adults with autism were compared to 189 adults without autism through an online questionnaire.


The results of the present study indicate that adults with autism have a higher rate of suicidality (ideation and attempt), take more antidepressant medications, have higher depressive symptomatology and greater alexithymia than adults without autism. More autistic traits increased depressive symptomatology, and antidepressant use have also been shown to contribute significantly to explaining higher rates of suicidality. In addition, people with high levels of autistic traits have a higher risk of suicide if they have higher levels of alexithymia than if they have lower levels of alexithymia. However, those with low levels of autistic traits have a similar risk of suicide regardless of their level of alexithymia. These findings add to a growing body of research showing that people with autism are more likely to suffer from other disorders in addition to their autism-related difficulties, and that suicide rates among autistic people are high.


In conclusion, the present study made it possible to make important findings on suicidality in the context of people with autism. It showed that autistic people, compared to neurotypical people, have a higher risk of committing suicide and that specific risk factors may be present in people with autism. The main contribution and novelty of this study is that alexithymia, combined with high levels of autistic traits, plays an important role in determining suicide risk. In addition, the present study confirmed once again that antidepressant intake and depressive symptomatology play an important role in predicting suicidality. Thus, suicide prevention and intervention programs for people with autism should take into account the severity of alexithymia, as well as the use of antidepressants and depressive symptomatology. However, more research will be needed to take a closer look at these relationships as well as specific risk factors for suicidality in people with autism.


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