Project Summary

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 Planning Intervention tailored for Autistic individuals (SPI-A) and SPI-A plus structured follow-up care (SPI-A+).

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. Clinician participants will complete a comprehensive training program to support implementation of their assigned treatment protocol (SPI-A or SPI-A+).

Clinicians who are assigned to the SPI-A group will collaborate with patients to create a written safety plan to help them:

  • recognize warning signs of a suicidal crisis;
  • identify sources of distraction, comfort, and support;
  • identify reasons for living;
  • identify available emergency services; and
  • keep themselves safe by limiting access to things they could use to harm themselves. 

Clinicians who deliver SPI-A+ will provide SPI-A, 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-A or SPI-A+ 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 healthcare, social wellbeing, 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, we 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, including people with lived experience with suicidal thoughts and behaviors, 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; collecting and analyzing data; and disseminating findings.

We will share our findings widely to so that any helpful discoveries can reach those in need to reduce suicide in autistic youth.

*We use identity-first language (e.g., “autistic adult”) instead of person-first language (e.g., “adult with autism”) because many of our patient partners prefer language that does not separate their experience of autism from who they are.

Project Information

Brenna Maddox, PhD
Shari Jager-Hyman, PhD
The University of North Carolina at Chapel Hill

Key Dates

July 2021
January 2028


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Last updated: April 15, 2022