Journal of Autism and Developmental Disorders

, Volume 48, Issue 11, pp 3702–3710 | Cite as

Talking About Death or Suicide: Prevalence and Clinical Correlates in Youth with Autism Spectrum Disorder in the Psychiatric Inpatient Setting

  • Lisa M. HorowitzEmail author
  • Audrey Thurm
  • Cristan Farmer
  • Carla Mazefsky
  • Elizabeth Lanzillo
  • Jeffrey A. Bridge
  • Rachel Greenbaum
  • Maryland Pao
  • Matthew Siegel
  • for the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
S.I. : Autism Inpatient Collection - Studying the Severely Affected


Little is known about suicidal ideation in youth with autism spectrum disorder (ASD), making it difficult to identify those at heightened risk. This study describes the prevalence of thoughts about death and suicide in 107 verbal youth with ASD with non-verbal IQ >55, assessed during inpatient psychiatric admission. Per parent report, 22% of youth with ASD had several day periods when they talked about death or suicide “often,” or “very often.” Clinical correlates included the presence of a comorbid mood (OR 2.71, 95% CI 1.12–6.55) or anxiety disorder (OR 2.32, 95% CI 1.10–4.93). The results suggest a need for developmentally appropriate suicide risk screening measures in ASD. Reliable detection of suicidal thoughts in this high-risk population will inform suicide prevention strategies.


Autism spectrum disorder Suicide Inpatient Suicidal ideation Psychiatric patients Screening Autism Inpatient Collection (AIC) 



The ADDIRC is made up of the co-investigators: Matthew Siegel, MD (PI) (Maine Medical Center Research Institute; Tufts University), Craig Erickson, M.D. (Cincinnati Children’s Hospital; University of Cincinnati), Robin L. Gabriels, PsyD (Children’s Hospital Colorado; University of Colorado), Desmond Kaplan, MD (Sheppard Pratt Health System), Carla Mazefsky, PhD (Western Psychiatric Institute and Clinics; University of Pittsburgh), Eric M. Morrow, MD, PhD (Bradley Hospital; Brown University), Giulia Righi, PhD (Bradley Hospital; Brown University), Susan L Santangelo, ScD (Maine Medical Center Research Institute; Tufts University), and Logan Wink, MD (Cincinnati Children’s Hospital; University of Cincinnati). Collaborating investigators and staff: Jill Benevides, BS, Carol Beresford, MD, Carrie Best, MPH, Katie Bowen, LCSW, Briar Dechant, BS, Tom Flis, BCBA, LCPC, Holly Gastgeb, PhD, Angela Geer, BS, Louis Hagopian, PhD, Benjamin Handen, PhD, BCBA-D, Adam Klever, BS, Martin Lubetsky, MD, Kristen MacKenzie, BS, Zenoa Meservy, MD, John McGonigle, PhD, Kelly McGuire, MD, Faith McNeil, BS, Joshua Montrenes, BS, Tamara Palka, MD, Ernest Pedapati, MD, Kahsi A.Pedersen, PhD, Christine Peura, BA, Joseph Pierri, MD, Christie Rogers, MS, CCC-SLP, Brad Rossman, MA, Jennifer Ruberg, LISW, Elise Sannar, MD, Cathleen Small, PhD, Nicole Stuckey, MSN, RN, Brittany Troen, MA, R-DMT, Barbara Tylenda, PhD, Mary Verdi, MA, Jessica Vezzoli, BS, Deanna Williams, BA, and Diane Williams, PhD, CCC-SLP. We gratefully acknowledge the contributions of the coordinating site advisory group: Donald L. St. Germain, MD and Girard Robinson, MD, and our scientific advisory group: Connie Kasari, PhD., Bryan King, MD, James McCracken, MD, Christopher McDougle, MD, Lawrence Scahill, MSN, PhD, Robert Schultz, PhD and Helen Tager-Flusberg, PhD, the input of the funding organizations and the families and children who participated.


This work was supported by the Intramural Research Program (ZIA MH002914) of the National Institute of Mental Health of the National Institutes of Health. The Autism Inpatient Collection (AIC) phenotypic database and biorepository is supported by a grant from the Simons Foundation Autism Research Initiative and the Nancy Lurie Marks Family Foundation, (SFARI #296318 to M.S.). Dr. Mazefsky was also supported by the National Institute of Child Health and Human Development (R01HD079512; K23HD060601).

Author contribution

LMH, AT and MS conceptualized and designed the study, provided input for statistical analyses, wrote the first draft of the manuscript, provided critical review and revision of the manuscript, wrote the final manuscript, and approved the final manuscript as submitted. CF conceptualized and designed the study, conducted statistical analyses of the data, provided critical review and revision of the manuscript, and approved the final manuscript as submitted. EL contributed to conceptualizing the study, prepared the data set for analysis, provided input for statistical analyses, provided critical review and revision of the manuscript, and approved the final manuscript as submitted. RG, JAB, CM, and MP contributed to conceptualizing the study, provided critical review and revision of the manuscript, and approved the final manuscript as submitted.

Compliance with Ethical Standards

Conflict of interest

Lisa M. Horowitz, Audrey Thurm, Cristan Farmer, Carla Mazefsky, Elizabeth Lanzillo, Jeffrey A. Bridge, Rachel Greenbaum, Maryland Pao and Matthew Siegel declares that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2017

Authors and Affiliations

  • Lisa M. Horowitz
    • 1
    Email author
  • Audrey Thurm
    • 2
  • Cristan Farmer
    • 2
  • Carla Mazefsky
    • 3
  • Elizabeth Lanzillo
    • 1
  • Jeffrey A. Bridge
    • 4
  • Rachel Greenbaum
    • 5
  • Maryland Pao
    • 1
  • Matthew Siegel
    • 6
    • 7
  • for the Autism and Developmental Disorders Inpatient Research Collaborative (ADDIRC)
  1. 1.Office of the Clinical DirectorNational Institute of Mental HealthBethesdaUSA
  2. 2.Pediatrics & Developmental Neuroscience BranchNational Institute of Mental HealthBethesdaUSA
  3. 3.Department of PsychiatryUniversity of PittsburghPittsburghUSA
  4. 4.The Research Unit at Nationwide Children’s Hospital and The Ohio State UniversityColumbusUSA
  5. 5.Children’s Mental Health TeamSurrey Place CentreTorontoCanada
  6. 6.Maine Medical Research InstituteScarboroughUSA
  7. 7.Tufts University School of MedicineBostonUSA

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