Autistic Traits and Suicidal Thoughts, Plans, and Self-Harm in Late Adolescence: Population-Based Cohort Study
Autistic Traits and Suicidal Thoughts, Plans, and Self-Harm in Late Adolescence: Population-Based Cohort Study
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DOI：
10.1016/j.jaac.2018.01.023
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发表时间：
2018-05-01
影响因子：
13.3
通讯作者：
Rai, Dheeraj
中科院分区：
文献类型：
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作者：
Culpin, Iryna;Mars, Becky;Rai, Dheeraj
目的：检验儿童时期自闭症谱系障碍 (ASD) 的诊断和特征与 16 岁时的自杀想法、计划和自残相关的假设，并且任何观察到的关联都可以用 12 岁时的抑郁症来解释。方法：我们研究了 ASD 诊断和 4 种二分 ASD 特征（社交沟通、实用语言、重复行为和社交能力）与自杀和自残之间的关联。 雅芳父母和儿童纵向研究对英国出生队列的 5,031 名成员进行了非自杀性自残、自杀想法和 16 岁时自杀计划的调查。我们评估了是否有任何关联可以通过 12 岁时的短期情绪和情感问卷测量的青春期早期抑郁症状来解释。 结果：社交沟通受损的儿童有较高的自杀意图（相对风险 [RR] = 2.14，95% CI = 1.28-3.58）和自杀念头（RR = 1.42，95% CI = 1.06-1.91），以及 16 岁时有自杀计划（RR = 1.95，95% CI = 1.09-3.47）的人与没有自杀计划的人相比。没有证据表明自闭症谱系障碍的诊断和结果之间存在关联，尽管这些分析由于数量较少而不够精确。也没有证据表明其他自闭症特征与结果之间存在关联。社交沟通障碍和自残之间的总估计关联中，大约 32% 可以用 12 岁时的抑郁症状来解释。结论：社交沟通障碍是与自杀相关的重要自闭症特征。早期识别和管理抑郁症可能是一种预防机制，未来研究确定其他潜在可改变的机制可能会导致针对这一高危人群的自杀行为进行干预。
Objective: To examine the hypothesis that autism spectrum disorders (ASD) diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any observed associations are explained by depression at 12 years.Method: We examined associations between ASD diagnosis and 4 dichotomized ASD traits (social communication, pragmatic language, repetitive behavior, and sociability) with suicidal and nonsuicidal self-harm, suicidal thoughts, and suicidal plans at age 16 years in 5,031 members of the United Kingdom based birth cohort study the Avon Longitudinal Study of Parents and Children. We assessed whether any associations were explained by depressive symptoms in early adolescence measured by the Short Moods and Feelings Questionnaire at 12 years.Results: Children with impaired social communication had a higher risk of self-harm with suicidal intent (relative risk [RR] = 2.14, 95% CI = 1.28-3.58), suicidal thoughts (RR = 1.42, 95% CI = 1.06-1.91), and suicidal plans (RR = 1.95, 95% CI = 1.09-3.47) by age 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and outcomes, although these analyses were imprecise because of small numbers. There was also no evidence of an association between other autism traits and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at 12 years.Conclusion: Social communication impairments are an important autistic trait in relation to suicidality. Early identification and management of depression may be a preventative mechanism, and future research identifying other potentially modifiable mechanisms may lead to interventions against suicidal behavior in this high-risk group.