Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating Scale
Authors: Schwartzman Jessica M , Muscatello Rachael A , Corbett Blythe A 
Published: April 2023

Suicidal thoughts and behaviors and nonsuicidal self-injury are more common in autistic adolescents than non-autistic adolescents, per parent- and self-report. Clinician-rated measures of suicide risk (e.g. Columbia Suicide Severity Rating Scale) have not been investigated with autistic youth despite high parent–child rating discrepancies. In the present study, the Columbia Suicide Severity Rating Scale was employed to assess suicidal thoughts and behaviors and nonsuicidal self-injury in 239 early adolescents (10:0–13:9 years old) without intellectual disability, of whom 138 youth were autistic. Analyses tested diagnostic- and sex-based differences in suicidal thoughts and behaviors and nonsuicidal self-injury, and youth consistency in reporting across self- and clinician-rated measures. A greater proportion of autistic youth reported lifetime suicidal ideation (33 of 138, 23.9%) and nonsuicidal self-injury (12 of 138, 8.7%) than non-autistic youth (7 of 101, 6.9% suicidal ideation; 2 of 101, 2.0% nonsuicidal self-injury); however, there were no sex-based differences. Non-autistic youth were consistent in reporting suicidal thoughts across measures, but nearly one in five autistic youth disclosed suicidal thoughts on a self-report measure, but not on the clinician-rated Columbia Suicide Severity Rating Scale. Findings suggest that autism diagnostic status, but not sex, confers significant risk for suicidal thoughts and behaviors and nonsuicidal self-injury in early adolescents and that the Columbia Suicide Severity Rating Scale may be a useful measure of suicide risk for some autistic youth, but it may not detect all autistic youth experiencing suicidal thoughts.

Lay abstract

Autistic adolescents are more likely to experience suicidal thoughts and behaviors and nonsuicidal self-injury than non-autistic adolescents, per caregiver- and self-report on single-item questionnaires. Comprehensive, clinician-rated measures of suicide risk have not been used to measure suicidal thoughts and behaviors and nonsuicidal self-injury in autistic youth despite greater parent–child rating discrepancies among autistic youth than their non-autistic peers. The Columbia Suicide Severity Rating Scale is a widely used, clinician-rated measure of suicide risk that has not been tested with autistic youth. In this study, the Columbia Suicide Severity Rating Scale was employed to assess suicidal thoughts and behaviors and nonsuicidal self-injury in a community sample of 239 early adolescents (10:0–13:9 years old), of whom 138 youth were autistic and 101 were not autistic. Multiple analyses examined diagnostic (autistic vs non-autistic) and sex-based (male vs female) differences in suicidal thoughts and behaviors and nonsuicidal self-injury, as well as youth consistency in reporting across self- and clinician-rated measures. Findings show that a greater proportion of autistic youth reported lifetime suicidal thoughts and nonsuicidal self-injury than non-autistic youth; however, there were no sex-based differences. The majority of non-autistic youth were consistent in reporting suicidal thoughts on self- and clinician-rated measures; however, nearly one in five autistic youth disclosed suicidal thoughts on a self-report measure but not to a psychiatrist on the Columbia Suicide Severity Rating Scale. Findings suggest that autism diagnostic status, but not sex, confers significant risk for suicidal thoughts and behaviors and nonsuicidal self-injury in early adolescents and that the Columbia Suicide Severity Rating Scale may be a useful measure of suicide risk for some autistic youth, but it may not detect all autistic youth experiencing suicidal thoughts.