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Stanley IH, Marx BP, Fina BA, Young-McCaughan S, Tyler HC, Sloan DM, Blankenship AE, Dondanville KA, Walker JL, Boffa JW, Bryan CJ, Brown LA, Straud CL, Mintz J, Abdallah CG, Back SE, Blount TH, DeBeer BB, Flanagan J, Foa EB, Fox PT, Fredman SJ, Krystal J, McDevitt-Murphy ME, McGeary DD, Pruiksma KE, Resick PA, Roache JD, Shiroma P, Taylor DJ, Wachen JS, Kaplan AM, López-Roca AL, Nicholson KL, Schobitz RP, Schrader CC, Sharrieff AFM, Yarvis JS, Litz BT, Keane TM, Peterson AL. Psychometric Properties of the Self-Injurious Thoughts and Behaviors Interview-Short Form Among U.S. Active Duty Military Service Members and Veterans. Assessment 2023; 30:2332-2346. [PMID: 36644835 DOI: 10.1177/10731911221143979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We assessed the interrater reliability, convergent validity, and discriminant validity of the Self-Injurious Thoughts and Behaviors Interview-Short Form (SITBI-SF) in a sample of 1,944 active duty service members and veterans seeking services for posttraumatic stress disorder (PTSD) and related conditions. The SITBI-SF demonstrated high interrater reliability and good convergent and discriminant validity. The measurement properties of the SITBI-SF were comparable across service members and veterans. Approximately 8% of participants who denied a history of suicidal ideation on the SITBI-SF reported suicidal ideation on a separate self-report questionnaire (i.e., discordant responders). Discordant responders reported significantly higher levels of PTSD symptoms than those who denied suicidal ideation on both response formats. Findings suggest that the SITBI-SF is a reliable and valid interview-based measure of suicide-related thoughts and behaviors for use with military service members and veterans. Suicide risk assessment might be optimized if the SITBI-SF interview is combined with a self-report measure of related constructs.
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Affiliation(s)
- Ian H Stanley
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- University of Colorado, School of Medicine, Aurora, USA
| | - Brian P Marx
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Brooke A Fina
- University of Texas Health Science Center at San Antonio, USA
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Hannah C Tyler
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Denise M Sloan
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | | | | | - James L Walker
- University of Texas Health Science Center at San Antonio, USA
| | - Joseph W Boffa
- Southeast Louisiana Veterans Health Care System, New Orleans, USA
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Craig J Bryan
- The Ohio State University Wexner Medical Center, Columbus, USA
| | | | - Casey L Straud
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | - Chadi G Abdallah
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sudie E Back
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | | | - Bryann B DeBeer
- University of Colorado, School of Medicine, Aurora, USA
- Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Julianne Flanagan
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Edna B Foa
- University of Pennsylvania, Philadelphia, USA
| | - Peter T Fox
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John Krystal
- VA Connecticut Healthcare System, West Haven, USA
- Yale University, New Haven, CT, USA
| | | | - Donald D McGeary
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
| | - Kristi E Pruiksma
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
| | | | - John D Roache
- University of Texas Health Science Center at San Antonio, USA
| | - Paulo Shiroma
- Minneapolis VA Medical Center, MN, USA
- University of Minnesota, Minneapolis, USA
| | | | | | | | | | - Karin L Nicholson
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, CA, USA
| | | | | | - Allah-Fard M Sharrieff
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
- U.S. Department of Homeland Security, Miami, FL, USA
| | - Jeffrey S Yarvis
- Tulane University School of Medicine, New Orleans, LA, USA
- Carl R. Darnall Army Medical Center, Fort Hood, TX, USA
| | - Brett T Litz
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
- Boston University, MA, USA
| | - Terence M Keane
- VA Boston Healthcare System, MA, USA
- Boston University, School of Medicine, MA, USA
| | - Alan L Peterson
- University of Texas Health Science Center at San Antonio, USA
- South Texas Veterans Health Care System, San Antonio, USA
- University of Texas at San Antonio, USA
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A systematic review of predictors of suicidal thoughts and behaviors among autistic adults: Making the case for the role of social connection as a protective factor. Clin Psychol Rev 2023; 99:102235. [PMID: 36459876 DOI: 10.1016/j.cpr.2022.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Autistic adults are a high-risk population for suicidal thoughts and behaviors (STBs). Accordingly, this systematic review aims to review the prevalence of STBs among autistic adults, review the risk and protective factors for STBs in autistic adults, and formulate a disorder-specific conceptualization of risk in this population. We systematically searched PsycINFO and Google Scholar for all studies published prior to March 28th, 2022. We included empirical articles focused on autistic adults, ages 18 years and older, reporting on suicide-related outcomes. In total, 45 peer-reviewed empirical articles were included in the current systematic review. The most frequently studied factors in relation to suicide risk among autistic adults were interpersonal constructs (42.4% of total studies looking at risk/protective factors) and depressive symptoms (36.4% of total studies looking at risk/protective factors). We conclude by summarize two key content areas: exploring social and interpersonal constructs and better understanding the role of depressive symptoms in autism. As researchers continue to explore STBs among autistic adults, it will be necessary to addressing the overreliance on autistic symptoms instead of autism diagnoses, measurement issues of STBs, and a need for treatment adaptations.
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Smith AR, Hunt RA, Grunewald W, Jeon ME, Stanley IH, Levinson CA, Joiner TE. Identifying Central Symptoms and Bridge Pathways Between Autism Spectrum Disorder Traits and Suicidality Within an Active Duty Sample. Arch Suicide Res 2021; 27:307-322. [PMID: 34689709 DOI: 10.1080/13811118.2021.1993398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study employed network analysis to characterize central autism spectrum disorder (ASD) traits and suicide symptoms within an active duty military sample as well as to identify symptoms that may bridge between ASD traits and suicidality (i.e., suicidal ideation and behaviors). METHOD Participants were active duty U.S. military service members (N = 287). Autism spectrum traits, suicidality, depression, and suicide related constructs were assessed online via self-report. RESULTS Within the combined ASD trait-suicidality network, suicide rumination, suicide behaviors, and depression had the highest strength centrality. The most central bridge symptoms between ASD and suicidality were thwarted belongingness, social skills deficits, and depressive symptoms. CONCLUSIONS Social skills deficits and thwarted belongingness may function as a meaningful bridge between ASD symptoms and suicidality within active duty members. Individuals with ASD symptoms who additionally present with high levels of thwarted belongingness and/or considerable social skills deficits may be at increased risk for suicidality.HIGHLIGHTSWithin an ASD-suicidality network, social skills deficits, low belonging, and depression had the greatest bridge strength.Although low belonging emerged as a bridge symptom, perceived burdensomeness did not.Suicide rumination, suicide behaviors, and depression were the most central symptom in an ASD-suicidality network.Symptoms related to social skills deficits may connect ASD traits and suicidality.
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Hedley D, Hayward SM, Denney K, Uljarević M, Bury S, Sahin E, Brown CM, Clapperton A, Dissanayake C, Robinson J, Trollor J, Stokes MA. The association between COVID-19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults. Autism Res 2021; 14:2663-2676. [PMID: 34545706 PMCID: PMC8646719 DOI: 10.1002/aur.2614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/12/2021] [Accepted: 09/10/2021] [Indexed: 12/17/2022]
Abstract
The COVID‐19 pandemic has had a significant impact on the mental health and wellbeing of the world's population, with particularly negative effects on vulnerable populations, including autistic people. Although some consensus regarding specific impact on aspects of wellbeing and mental health in autism is starting to emerge, it is unclear whether the pandemic has increased suicide risk. The goals of this study were to examine (a) potential associations between COVID‐19 impact and depression, personal wellbeing, and suicide risk factors in Australian autistic adults and (b) age and gender effects. The COVID‐19 Impact Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the Suicide Behavior Questionnaire, Revised (SBQ‐R), were administered to 111 autistic adults aged 20 to 71 years during the second wave of the COVID‐19 pandemic in Australia. COVID‐19 impact showed small associations with poorer personal wellbeing (r = −0.224, p = 0.023, [−0.409, −0.016]) and higher depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not associated with the SBQ‐R suicide risk score (r = 0.081, p = 0.418, [−0.118, 0.264). No significant effects were identified for age. Although model results were similar for women and men, the strength of the associations between personal wellbeing and depression (z = −2.16, p = 0.015), and depression and SBQ‐R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. Qualitative analysis of an open response question from the CIS suggested that the pandemic had both positive and negative impacts on participants. The COVID‐19 pandemic has had a large impact on the mental health and wellbeing of the world's population, particularly vulnerable populations such as autistic people. It is not known if these impacts on mental health and wellbeing have increased suicide risk. Our findings suggest that the impact of the COVID‐19 pandemic may be associated with poorer wellbeing and higher depression, but is not associated with suicide risk. Overall, autistic people reported both positive and negative impacts of the pandemic on their lives.
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Affiliation(s)
- Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Susan M Hayward
- School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.,School of Social and Political Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathleen Denney
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Mirko Uljarević
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Bury
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ensu Sahin
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Claire M Brown
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Angela Clapperton
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jo Robinson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark A Stokes
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
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Cassidy SA, Bradley L, Cogger-Ward H, Rodgers J. Development and validation of the suicidal behaviours questionnaire - autism spectrum conditions in a community sample of autistic, possibly autistic and non-autistic adults. Mol Autism 2021; 12:46. [PMID: 34154642 PMCID: PMC8218414 DOI: 10.1186/s13229-021-00449-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 05/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Autistic people and those with high autistic traits are at high risk of experiencing suicidality. Yet, there are no suicidality assessment tools developed or validated for these groups. METHODS A widely used and validated suicidality assessment tool developed for the general population (SBQ-R), was adapted using feedback from autistic adults, to create the Suicidal Behaviours Questionnaire-Autism Spectrum Conditions (SBQ-ASC). The adapted tool was refined through nine interviews, and an online survey with 251 autistic adults, to establish clarity and relevance of the items. Subsequently, 308 autistic, 113 possibly autistic, and 268 non-autistic adults completed the adapted tool online, alongside self-report measures of autistic traits (AQ), camouflaging autistic traits (CAT-Q), depression (PHQ-9), anxiety (ASA-A), thwarted belongingness and perceived burdensomeness (INQ-15), lifetime non-suicidal self-injury, and the original version of the suicidality assessment tool (SBQ-R). Analyses explored the appropriateness and measurement properties of the adapted tool between the groups. RESULTS There was evidence in support of content validity, structural validity, internal consistency, convergent and divergent validity, test-retest validity, sensitivity and specificity (for distinguishing those with or without lifetime experience of suicide attempt), and hypothesis testing of the adapted tool (SBQ-ASC) in each group. The structure of the SBQ-ASC was equivalent between autistic and possibly autistic adults, regardless of gender, or use of visual aids to help quantify abstract rating scales. LIMITATIONS The samples involved in the development and validation of the adapted tool were largely female, and largely diagnosed as autistic in adulthood, which limits the generalisability of results to the wider autistic population. The SBQ-ASC has been developed for use in research and is not recommended to assess risk of future suicide attempts and/or self-harm. The SBQ-ASC has been designed with and for autistic and possibly autistic adults, and is not appropriate to compare to non-autistic adults given measurement differences between these groups. CONCLUSIONS The SBQ-ASC is a brief self-report suicidality assessment tool, developed and validated with and for autistic adults, without co-occurring intellectual disability. The SBQ-ASC is appropriate for use in research to identify suicidal thoughts and behaviours in autistic and possibly autistic people, and model associations with risk and protective factors.
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Affiliation(s)
- Sarah A Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Louise Bradley
- The International Centre, University of Bedfordshire, Luton, UK
| | - Heather Cogger-Ward
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
- School of Psychology, University of Lincoln, Lincoln, UK
- Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Hedley D, Uljarević M, Cai RY, Bury SM, Stokes MA, Evans DW. Domains of the autism phenotype, cognitive control, and rumination as transdiagnostic predictors of DSM-5 suicide risk. PLoS One 2021; 16:e0245562. [PMID: 33482664 PMCID: PMC7822649 DOI: 10.1371/journal.pone.0245562] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/02/2021] [Indexed: 12/15/2022] Open
Abstract
Suicide is a global health problem affecting both normative and clinical populations. Theoretical models that examine mechanisms underlying suicide risk across heterogeneous samples are needed. The present study explored core characteristics associated with autism spectrum disorder (ASD), a sub-population at high risk of suicide, as well as two dimensional cognitive constructs, as potential transdiagnostic predictors of suicidal ideation in a clinically diverse sample. Participants (n = 1851, 62% female) aged 18 to 89 years completed online questionnaires assessing: social communication difficulties; insistence on sameness; cognitive control; and rumination. Forty-three percent of participants reported the presence of at least one neurodevelopmental or neuropsychiatric disorder. One third of the sample reported some suicidal ideation (SI), and 40 percent met the threshold for concern for depression. All hypothesized constructs were associated with SI and depression and, with the exception of rumination, contributed significantly to SI. Participants reporting SI returned significantly higher social communication difficulties and insistence on sameness, and lower levels of cognitive control than those reporting no-SI. The study was limited by the use of a cross-sectional sample assessed with self-report measures. All diagnoses were self-reported and the study was additionally limited by the use of a single item indicator of suicidal ideation. These findings support a role for constructs associated with the ASD phenotype and associated broad cognitive domains as potential risk factors underlying suicidal ideation in a large clinically diverse sample. Our findings suggest directions for future longitudinal research studies, along with specific targets for suicide prevention and clinical practice.
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Affiliation(s)
- Darren Hedley
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mirko Uljarević
- University of Melbourne, Melbourne, Victoria, Australia
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, United States of America
| | - Ru Ying Cai
- Aspect Research Centre for Autism Practice, Melbourne, Victoria, Australia
| | - Simon M. Bury
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mark A. Stokes
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - David W. Evans
- Bucknell University, Lewisburg, Pennsylvania, United States of America
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Gallyer AJ, Stanley IH, Day TN, Joiner TE. Examining the interaction of autism spectrum disorder-related traits and unit cohesion on suicide risk among military personnel. J Affect Disord 2020; 271:59-65. [PMID: 32312698 PMCID: PMC7812611 DOI: 10.1016/j.jad.2020.03.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/28/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Suicide rates are elevated among United States (U.S.) military service members. Research has found that service members with autism spectrum disorder-related (ASD-related) traits are at increased risk for suicide. Complementary lines of inquiry have suggested that unit cohesion is a protective factor against developing suicidal ideation in military service members. However, given the social difficulties inherent in ASD, it is unclear whether unit cohesion might protect against suicide risk in this population. METHOD Our sample consisted of 285 active duty U.S. military service members recruited online. We examined the interaction between ASD-related traits (as measured by the Autism Spectrum Quotient [AQ]), unit cohesion, and suicide risk (as measured by the Suicidal Behaviors Questionnaire-Revised [SBQ-R]). We also conducted exploratory analyses to examine whether unit cohesion attenuates the association between ASD-related traits and suicidal intent. RESULTS Elevated ASD-related traits were independently associated with higher levels of global suicide risk; however, unit cohesion was not independently associated with suicide risk. Unit cohesion did not significantly interact with ASD-related traits to predict suicide risk. Finally, we found that elevated ASD-related traits and unit cohesion have an independent effect on current suicidal intent. DISCUSSION Our findings suggest that unit cohesion might not buffer the effect of ASD-related traits on suicide risk. However, our results do show that greater unit cohesion may be independently associated with decreased suicidal intent. This study is limited by a cross-sectional design and use of self-report measures.
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