Association of self-harm and suicidality with psychiatric co-occurring conditions in autistic individuals: a systematic review and pooled analysis

Abstract

Background Autistic individuals frequently experience psychiatric co-occurring conditions, but the association with self-harm/suicidality according to these conditions was not yet elucidated. We aimed to summarize the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic people. Methods We systematically searched PubMed, Scopus, Embase, Web of Science, and Cochrane Database of Systematic Reviews until June 4, 2024 (PROSPERO registration number: CRD42023412860). Observational studies were included that provided information to calculate the odds ratio (OR) regarding the association between self-harm/suicidality and psychiatric co-occurring conditions in autistic individuals. We summarized the identified fi ed associations by presenting OR range or meta-analyzing when 7 or more estimates are available. Findings The systematic search found 20 eligible studies with 301,841 participants. Our fi ndings suggested that autistic individuals with any psychiatric disorder (k k = 1; OR 3.55; 95% CI 1.27-9.98), - 9.98), ADHD (k k = 3; OR range: 1.07-1.65), - 1.65), or mood disorder (k k = 1; OR 1.26; 95% CI 1.05-1.51) - 1.51) may be associated with higher odds of self-harm than those without these conditions. We identified fi ed potential positive associations between suicidality and the following co-occurring conditions: any psychiatric disorder (k k = 1; OR 11.65; 95% CI 10.68-12.71), - 12.71), psychotic disorder (k k = 4; OR range: 1.95-10.97), - 10.97), mood disorder (k k = 3; OR range: 1.75-9.82), - 9.82), bipolar disorder (k k = 2; OR range: 2.55-4.95), - 4.95), depressive disorder (k k = 10; pooled OR 2.29; 95% CI 1.39-3.77), - 3.77), trauma- and stress-related disorder (k k = 2; OR range: 1.28-10.47), - 10.47), and adjustment disorder (k k = 1; OR 3.52; 95% CI 2.89-4.28). - 4.28). Interpretation We found psychiatric co-occurring conditions that may be associated with higher odds of self-harm/ suicidality in autistic individuals. However, our fi ndings should be interpreted with caution considering the limited number of included studies. We suggested that clinicians should remain vigilant for autistic individuals with psychiatric co-occurring conditions for their potentially higher likelihood of self-harm and suicidality.