The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021
Damian Santomauro, Darren Hedley, Ensu Sahin, Traolach Brugha, Mohsen Naghavi, Theo Vos, Harvey Whiteford, Alize J Ferrari, Mark A. Stokes
Abstract
• Autistic persons were almost three times more likely to die by suicide than non-autistic persons. • Autistic persons without intellectual disability were more than five times more likely to die by suicide compared to non-autistic persons. • The risk of death by suicide for autistic females relative to non-autistic females was significantly larger than the risk for autistic males relative to non-autistic males. • Almost 2% of all suicide deaths globally in 2021 could be avoided if the risk for death by suicide was not elevated for autistic persons. • Globally in 2021, there was more fatal health burden due to suicide mortality among autistic persons than for cocaine use disorders, rabies, or testicular cancer among the total population. We aimed to quantify the risk, mortality, and burden of suicide among autistic persons. We searched PubMed, Embase, and PsycINFO on 5 th April 2023 for sources reporting the relative risk (RR) of suicide or suicide attempt among autistic persons (PROSPERO registration: CRD42021265313). Autism spectrum prevalence and suicide mortality and years of life lost (YLLs), were sourced from the Global Burden of Disease Study 2021. RRs pooled via meta-regression and health metrics estimates were used to estimate the excess suicide mortality and YLLs among autistic persons. We sourced 983 unique studies of which ten studies met inclusion criteria, consisting of 10.4 million persons. The pooled RR for suicide for autistic persons was 2·85 (95% UI: 2·05–4·03), which was significantly higher for autistic females than autistic males. No evidence of publication bias was detected via inspection of funnel plot and Egger's test. Globally, we estimated 13 400 excess suicide deaths among autistic persons in 2021, equating to 1·8% of all suicide deaths and 621 000 excess YLLs. Studies were limited in number and geographical coverage. Effective suicide prevention strategies for autistic persons may substantially reduce the fatal burden of suicides globally and reduce the health burden experienced within this population.