Suicidality in autistic adults: The role of social adversity, trauma, and protective factors

This project directly addresses autistic community priorities on adult mental health and the Interagency Autism Coordinating Committee’s call for research to reduce premature mortality (i.e. suicide). Autistic adults are at heightened risk for suicidal ideation (SI) and suicidal behaviors (SB). As many as 50% of autistic adults report experiencing SI and over 40% report SB in the past 12 months, with the peak incidence of risk occurring in early adulthood. Yet, little else is known about which autistic adults are at the most risk or which risk and protective factors may moderate this heightened risk. Autistic adults experience disproportionate exposure to traumatic events and social adversity (hereafter collectively referred to as “adversity”) due to their marginalized social status. Adversity is associated with SI and SB in other populations but has yet to be tested in autism. Further, negative neurocognitive processes common in autism likely increase vulnerability for SI/SB following adversity, and it is unclear if established protective factors of suicide in non-autistic adults are similarly protective in autism. Taken together, we lack understanding of factors that increase and reduce the risk for suicide in this population. Using a community engaged-approach, we comprehensively test the relationship between adversity and suicidality in autistic adults. We will enroll a sample of 250 autistic adults (age 18-40) into a longitudinal study that tests the relationship between adversity and SI/SB. At least half of our sample will be at high-risk for suicide (i.e. active SI or SB in the past 6 months). Our design focuses on multiple temporal scales with a comprehensive longitudinal assessment battery (i.e. baseline, 6-months, 12-monts) and collection of brief daily diaries for 8- consecutive weeks at baseline. We will identify the most salient proximal (i.e. daily) and longitudinal indicators of adversity (i.e. traumatic events, discrimination, invalidation, victimization, stigma social rejection) that predict SI and SB. Further, our project will identify risk and protective factors that moderate the relationship between adversity and suicidality. Specifically, Aim 1 will establish the longitudinal relationship between adversity and SI/SB in autistic adults. In Aim 2, we will determine how daily adverse experiences relate to proximal risk for SI in autistic adults. We will integrate these findings in Aim 3 to create latent class groups of suicide risk trajectories, which we will characterize to identify groups of autistic adults that are most at risk for suicide. Our premier environment at the University of Pittsburgh will ensure that our project successfully engages autistic adults from groups that have been marginalized, ultimately enriching our sample, outcomes, and overall impact. Findings will identify which factors contribute to the most risk of suicide, which will ultimately advance our identification of mechanistic targets for suicide intervention development and testing. We will rapidly disseminate this information to the autistic and healthcare communities with our established network of partners to speed the translation of this important work. Project Number: 1R01MH139961-01 | Fiscal Year: 2025 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: Kelly Beck | Institution: UNIVERSITY OF PITTSBURGH AT PITTSBURGH, PITTSBURGH, PA | Award Amount: $792,006 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 BP-D (02)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11106386