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Sunday, January 29, 2023

Suicide and Self-Injuiry

In The Politics of Autism, I write about the many challenges facing people on the spectrum.  Among many other things, they are at high risk for suicide. (In July, the United States transitioned from 10-digit National Suicide Prevention Lifeline to 988 – an easy-to-remember three-digit number for 24/7 crisis care. "

 At Autism, Theodoros V Giannouchos and colleagues have an article titled "Suicide and non-fatal self-injury-related emergency department visits among individuals with autism spectrum disorder."  The lay abstract:

This study used data for 14.4 million individuals with 43.5 million emergency department visits from all hospitals in the state of New York to explore the association between suicide and non-fatal self-injury-related (self-injury) emergency department visits and autism spectrum disorder. Overall, we found that individuals with autism spectrum disorder had more emergency department visits and admissions through the emergency department, more years of emergency department utilization, and higher prevalence of mental health-related comorbidities. Individuals with autism spectrum disorder were also significantly more likely to have at least one self-injury-related emergency department visit compared to those without autism spectrum disorder. These results emphasize the need to raise awareness across both family caregivers and healthcare providers on the increased suicide and self-injury risks that individuals with autism spectrum disorder face and to improve care delivery practices. In addition, effort to promote and increase timely access to mental health care is an urgent priority for individuals with autism spectrum disorder.

From the article:

Combined, our results suggest that while the high and growing suicide, and non-fatal self-injury rate in the United States is a concern for the entire population, it is a particular concern in the ASD community and notably among younger children and adolescents (Healthcare Cost and Utilization Project, 2020). Given existing documented issues for individuals with ASD in accessing needed care in a timely manner, many are forced to seek treatment from EDs that are often overwhelmed and not well equipped to address the specific needs of individuals with ASD (Muskat et al., 2015; Nageswaran et al., 2011; Nicolaidis et al., 2013). Our findings suggest that identifying ways to increase timely access to outpatient care—and mental health care in particular given the observed and increased prevalence of ED visits for mental health conditions among those with ASD which is consistent with previous work—is an urgent priority for individuals with ASD to provide continuous and supportive care and to prevent suicidal and non-fatal self-injurious attempts (Lytle et al., 2018). This is emphasized by previous work that found more than half of individuals who leave the ED after a suicide attempt never attend their first outpatient appointment (Lai et al., 2019). Increasing access to outpatient care will require policy changes to overcome both the shortage of mental health care providers in certain parts of the country as well as the large proportion of mental health care professionals who do not accept health insurance, such as expansion of virtual appointments, higher reimbursement rates, and reduced administrative and contractual complexity (Bishop et al., 2014; Thomas et al., 2009).