New display assesses suicidality in autistic adults | Spectrum
Five questions: Autistic people helped adapt a questionnaire to assess suicidality in the general population.
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A short questionnaire, which was created in consultation with autistic people, is the first of its kind to accurately assess suicidal thoughts and behavior in adults in the spectrum.
The tool called Suicidal Behaviors Questionnaire-Autism Spectrum Conditions (SBQ-ASC) is freely available online and could advance research on suicide and autism.
“We needed this tool,” says Senior Investigator Sarah Cassidy, Assistant Professor of Psychology at the University of Nottingham in the UK. “We cannot do good research without valid measures.”
Autistic people are at increased risk of having thoughts of suicide and of dying from suicide, previous studies suggest. But the suicidality screening tools used to gather this evidence had yet to be validated for use in people with autism.
“It’s a huge topic, both for clinical practice and for research,” says Cassidy.
Cassidy and her colleagues decided to adapt the Suicidal Behaviors Questionnaire-Revised (SBQ-R), which is widely used for suicide research in the general population. This survey contains four multiple choice questions that examine the frequency of suicidal thoughts and behavior.
Autistic adults interpret these questions differently than non-autistic people, and as a result, the tool does not accurately capture suicidality in this group, according to a 2020 study by Cassidy’s team.
Discussions with autistic participants from this study led to the development of a new survey with five assessed questions. Nine of the 2020 study participants checked the questions for clarity, and a second group of 234 autistic adults and 17 potentially autistic adults waiting for a diagnostic evaluation also provided feedback. The survey also includes optional, unrated follow-up questions that ask about suicide plans and non-suicidal self-harm, among other things.
Review of the survey:
The adapted version covers the same topics as the original, but is clearer for autistic people, the researchers say. For example, one question from the original survey is, “How likely is it that you will attempt suicide one day?” Autistic people said they had a hard time predicting the future, so the bespoke version asks how likely it is instead the person is responding to thoughts of suicide they may have.
The adapted survey is also breaking new ground. One of the original questions explored lifelong suicidal thoughts and behaviors and included multiple choice answers ranging from a passing suicidal thought to a plan, but many autistic people said the options were the lingering or “sticky” thoughts of. They experienced unconsidered suicide before giving it any serious thought. So the researchers added a new question on how long suicidal thoughts lasted, from under five minutes to over eight hours.
The researchers compared the original and customized versions of the questionnaire through an online survey completed by 308 autistic, 113 possibly autistic, and 268 non-autistic adults, some of whom retested the tests two weeks later. Participants also completed surveys on risk factors for suicidal thoughts and behaviors, including anxiety, depression, and camouflaging characteristics of autism.
The results of the participants in the customized survey correlated with the measures of suicide risk factors. For the measures of anxiety, autism and camouflage, the correlation with the SBQ-ASC was stronger than with the original test. Autistic and possibly autistic adults responded similarly to the new screen, and for participants who took the SBQ-ASC twice, the first and second responses were correlated. The researchers used other statistical tests to determine that autistic and non-autistic adults responded differently to the customized test. The results appeared in Molecular Autism in June.
Autistic responses to the adapted questionnaire cannot be directly compared to non-autistic responses to the original questionnaire, says Cassidy. The survey should also only be used in research or considered in a clinical setting among other factors, she says. It should never be used to gauge the likelihood of someone attempting suicide or self-harm in the future, as research has shown that these tests are not good predictions for it.
If you or someone you know has thoughts of suicide, help is available. Here is a global directory of resources and hotlines you can call for assistance.
Quote this article: https://doi.org/10.53053/THFP9417