About the Author
Megan Winderbaum is a LifeNet senior clinical supervisor and a licensed independent clinical social worker who earned her MSW from Boston University. She specializes in trauma, suicide prevention, emotion regulation, eating disorders, and autism. In her free time, Megan enjoys riding both motorized and analog bicycles, birdwatching, and snuggling dogs.
Additional Crisis Resources:
988 National Suicide and Crisis Lifeline:
Warning: This article discusses the topic of suicide and suicide prevention.
According to CDC statistics, in 2021, suicide was among the top 9 leading causes of death for people ages 10-64. Suicide was the second leading cause of death for people ages 10-14 and 20-34. Nearly 48,000 people died by suicide in 2021, which equates to one death every 11 minutes. This is more than the number of people who died by car accidents, boat accidents, drowning, and lightning strikes combined in that same year. And yet, despite the fact that we all live with this incredible risk, it is still a difficult (if not impossible) topic for many Americans to discuss.
I began at AANE’s LifeNet case management program over three years ago, in part to assess and improve the system for matching Autistic adults with the program for success over the long term. Part of this process involved understanding risk in a number of areas, including suicide and mental health. In my time at LifeNet, I have had the great pleasure of speaking with dozens and dozens of Autistic adults who are interested in joining the program. One question I always ask is about whether they have ever experienced thoughts of suicide. This is a challenging question to ask, but I can count on one hand the number of Autistic adults who were unable to share their thoughtful answers with me. It has been my resounding experience that in the right environment, with the right supports, most people are open to opportunities where they can share their thoughts and experience on this topic, even with a person they have just met.
This is important because there is a small but solid body of research that points to an increase in suicide risk for Autistic children and adults over the past 20 years compared with the general population. These studies also point to a particularly high risk associated with Autistic women (as opposed to the general population, where men are more likely than women to complete suicide.) This elevated risk is supported by several studies including in the US, UK, and Sweden.
Additionally, we have striking evidence both domestically and internationally that suicide prevention works, both on the granular, community level and as a public health measure.
The message is that we all can and should be doing more to normalize discussion around suicide risk in our families and communities and learn how to address suicide risk in an informed way when it arises. Here are some ideas:
Be ready. In order to have honest and caring conversations about suicide, we need to be well ourselves and ready to hear the answer, even if it is scary and concerning. Our own fears (about the wellness of those we love, about our ability to be helpful) may keep us from engaging even if we know something is wrong. Understanding resources that exist in your community to assist those in suicide crisis is the first step to feeling prepared to handle concerns related to the people you love. If you are in the United States, a good place to start is The American Foundation for Suicide Prevention or the Suicide Prevention Resource Center. Additionally, in 2020, a national suicide prevention hotline (988, both call and text) was authorized in the United States and it is now fully functional. Individuals concerned about their own wellness and friends and family members of those at risk may call or text to receive free and confidential guidance. It is important to note that these are not autism-specific resources, and it may be helpful to disclose during the call if the individual calling (or being called about) is Autistic. Over the long term, it will be important to continue to engage in advocacy so that these resources become more inclusive and supportive for Autistic individuals.
Know what to look for. I have found in my work with adults and children at risk of suicide that the following list from the American Foundation for Suicide Prevention is a helpful and accurate guide. They outline three categories of warning signs including verbal (people describing or mentioning suicide, hopelessness, no reason to live, feeling like a burden or that they are trapped or that they are in pain), behavioral (increased substance use, researching or discussing suicide methods, unusual withdrawal or isolation, significant changes in sleep behavior [comparatively sleeping too much or too little], saying goodbye, giving away possessions, and increased aggression), and mood (changes in depression, anxiety, loss of interest, irritability, shame, agitation, anger, and relief or sudden marked improvement of mood).
Ask the question. In training clinicians, direct care staff, and community members across many years in suicide prevention, I have found that the single most important and most difficult thing is to be prepared to ask directly about suicide. People are often worried about introducing the topic for fear of increasing suicide risk, but we have no data that speaking directly about suicide increases risk. In fact, the majority of evidence in suicide prevention suggests that asking directly, clearly, and honestly about suicide is the best way to connect someone with resources that prevent suicide. If you have concerns, ask one of the following:
“Are you thinking of ending your life?”
“Have you been having thoughts about suicide?”
“Have you thought about killing yourself?”
As challenging as it is to ask these questions, it shows the person the severity of your concern, that you are willing and able to name the concern, and you could be a safe person to talk with. If a person has not been thinking about suicide, it is my experience that they will clearly let you know. If they have, you may have opened the door to connect them with resources that they otherwise would not have accessed and at the very least can feel less alone.
Summary. Suicide risk affects all of us and is a significant public health and community concern. Suicide risk may disproportionately affect Autistic adults and children. We can all be a part of the solution. Being prepared to pay attention to and directly discuss suicide risk with people we love and understanding resources in our community that are available are key ways than everyone can contribute to suicide prevention.
1 CDC Facts About Suicide: https://www.cdc.gov/suicide/facts/index.html
2 United States Department of Transportation, Newly released estimates show traffic fatalities reached a 16-year high in 2021: https://www.nhtsa.gov/press-releases/early-estimate-2021-traffic-fatalities
3 National Safe Boating Council 2021 Recreational Boating Statistics: https://www.safeboatingcouncil.org/2021-recreational-boating-statistics-available/
5 National Weather Service Lightning Fatalities 2021: https://www.weather.gov/safety/lightning_fatalities21
6 Cassidy S, Bradley P, Robinson J, Allison C, McHugh M, Baron-Cohen S. “Suicidal ideation and suicide plans or attempts in adults with Asperger’s syndrome attending a specialist diagnostic clinic: a clinical cohort study.” Lancet Psychiatry 2014; 1: 142–47.
7 Hirvikoski T, Mittendorfer-Rutz E, Boman M, Larsson H, Lichtenstein P, Bölte S. “Premature mortality in autism spectrum disorder.” The British Journal of Psychiatry 2016; 208: 232–38.
8 Coope C, Gunnell D, Hollingworth W, et al. “Suicide and the 2008 economic recession: who is most at risk? Trends in suicide rates in England and Wales 2001–2011.” Social Science & Medicine 2014; 117: 76–8
9 Segers M, Rawana J. “What do we know about suicidality in autism spectrum disorders? A systematic review.” Autism Research 2014; 7: 507–21.
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10 Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019). “A 20‐year study of suicide death in a statewide autism population.” Autism Research, 12(4), 658–666.
11 National Action Alliance for Suicide Prevention: Transforming Health Systems Initiative Work Group. (2018). “Recommended standard care for people with suicide risk: Making health care suicide safe.” Washington, DC: Education Development Center, Inc.
12 Suicide Prevention Resource Center: https://sprc.org/
13 American Foundation for Suicide Prevention: https://afsp.org/
14 American Foundation for Suicide Prevention: Risk factors, protective factors, and warning signs: https://afsp.org/risk-factors-protective-factors-and-warning-signs
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