What is the research about?
Rates of suicide have increased significantly over the past two decades. Suicide is now the second most common cause of death among young people between the ages of 15-24. Compared to the general population, autistic people* are up to nine times more likely to think about suicide, up to five times more likely to attempt suicide, and over seven times more likely to die by suicide. Autistic individuals have identified suicide prevention as a top research priority; however, little is known about how to best help autistic youth at risk for suicide. This project is designed to fill this gap.
To help autistic youth at risk for suicide, it is necessary to adapt suicide prevention treatments that have been shown to work with neurotypical individuals for autistic individuals. An important next step is to compare different adapted interventions to learn which are the most helpful and for whom. The research team, which includes autism and suicide prevention researchers, clinicians, and autistic individuals and their families, aims to compare the helpfulness of two suicide prevention strategies tailored for autistic individuals: the Safety Plan Intervention tailored for autistic youth (SPI-ASD) and SPI-ASD plus structured follow-up care (SPI-ASD+).
Who can this research help?
Findings from this study will help clinicians and health systems learn how to help lower suicide risk in autistic youth. The findings of this study will be shared widely to ensure that more autistic youth experiencing suicidal thoughts and behaviors have access to treatments that work.
What is the research team doing?
The research team is working with four diverse health systems across the United States. At these sites, 150 clinicians who care for autistic youth in diagnostic clinics, primary care, and specialty medical settings will be randomly assigned to deliver one of the two study treatments described below with their autistic patients at risk for suicide:
Clinicians who are assigned to the SPI-ASD group will collaborate with patients to create a written safety plan to help them:
- Recognize signs of a suicidal crisis
- Identify coping strategies and sources of distraction
- Identify people who can provide support
- Keep themselves safe by limiting access to things they could use to harm themselves
Clinicians who deliver SPI-ASD+ will provide SPI-ASD, followed by at least two brief contacts either by phone or text, based on the patient’s preference.
Patient participants will be 1,500 autistic youth (ages 15-24) who engage in either SPI-ASD or SPI-ASD+ with a clinician during a visit to one of the participating clinics. Participants will meet with the research team right after the clinic visit, and then again by phone. Participants will be asked about suicidal thoughts and behaviors, engagement in mental health care, social well-being, skills to manage suicidal thoughts and behaviors, and the use of emergency services for suicidal thoughts or behaviors.
To see if the interventions are acceptable to various stakeholders, the team will also recruit clinicians and health system leaders. A total of 60 patients, 40 clinicians, and 15 leaders will also participate in an interview to learn more about their perspectives on the intervention.
Autistic individuals, family members, and clinicians will be involved in each phase of the study, including serving on a community advisory board; reviewing study protocols; participating in the development of new study materials and/or providing feedback; designing and implementing clinician training, and disseminating findings.
The team will share its findings widely to so that any helpful discoveries can reach those in need to reduce suicide in autistic youth.
*The team uses identity-first language (e.g., “autistic adult”) instead of person-first language (e.g., “adult with autism”) because many of the patient partners prefer language that does not separate their experience of autism from who they are.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.