05 _Suicide risk factors

Our research has identified a number of key risk factors for suicide, and especially for autistic individuals.

 RECENT LOSS OR CHANGE

  • Relationship break-up

  • Job loss

  • Money loss

  • Health deterioration/diagnosis

  • Good reputation

 

Potential negative consequences of disclosing autism

 

Potential negative experiences of coming out as LGBTIQA+ (loss of family relationships)

INTENSE EMOTION

  • Shame, guilt, humiliation, disgrace (e.g. being found out for doing something culturally inappropriate)

  • Hopelessness

  • Worthlessness

 

Autistic people can often feel like they are a burden to others and feel their impact on others outweighs their worth which can lead to suicide ideation.

  • Anger

  • Feeling trapped  

 

Fear of losing everything if a person was to be their true self (i.e., come out as LGBTIQA+ and lose their community or stay hidden not lose this)

MENTAL HEALTH

  • Diagnosis of a mental illness: depression, OCD, bipolar, schizophrenia, PTSD and borderline personality disorder are some of the disorders associated with higher suicide risk.

 

Neurodevelopmental conditions: autism spectrum condition (ASC) (9x more likely to suicide than non-autistic people), ADHD, intellectual disability.

Most of the increased risk associated with these conditions are due to a lack of understanding, advocacy and support for the individual within their families, schools, medical appointments, communities and/or workplaces.

HISTORY

  • Previous trauma

  • Previous suicide attempt or self-harm

  • Family member who died by suicide

  • Impulsive/limited self-control  

SITUATIONAL

  • Harassment

  • Discrimination or rejection

  • Chronic pain

  • Medical illness

  • Substance use

  • Recent discharge from psychiatric inpatient care

  • Domestic violence victim  survivor

  • Unemployed

  • Isolated

 

Autistic people often struggle with making and keeping friends more than their neuro-typical peers and can experience a sense of isolation more strongly. They can interpret their lack of friendships as a personal flaw which can lead to suicide ideation.

  • Living alone

  • Bullying

 

Bullying is a particularly important risk factor for autistic people. Autistic people are much more likely to experience bullying than neurotypical peers, and bullying significantly contributes to suicidal thinking. If this is not visible or known for an autistic person, its important to ask them if they experience bullying (at school, work, university, etc.).
If they are an adult, ask something like: ‘Does anyone at your work/uni/social groups ever do or say anything that makes you feel uncomfortable, scared, sad?’
If they are a child, ask something like: ‘Is anyone ever mean to you at school?’
If they reply yes, follow the next steps in the tool.

  • Harassment

  • Discrimination or rejection

 

People in the LGBTIQA+ community can experience discrimination up to 60x/day – e.g. , treated unfairly at work, rejected by family, being made to feel unwelcome or like an outsider, dealing with daily microaggressions.

  • Chronic pain

  • Medical illness

  • Substance use

  • Recent discharge from psychiatric inpatient care

 

Loss of family acceptance/family connection

IDENTITY

  • Male (although the suicide rate in females is rising)

 

Note that in autism, the female to male ratio is more equivalent than the general population. This means that being female may be more of a risk factor for suicide for autistic people than non-autistic people.   

LGBTIQA+ orientation. Not because of their identify but because of discrimination.

Sistergirl or brotherboy identity

• Sistergirl is a term used to describe Aboriginal and Torres Strait Islander gender diverse people who were classified male at birth while having a female spirit and taking on female roles within their community.

• Brotherboy is a term used to describe Aboriginal and Torres Strait Islander gender diverse people who were classified female at birth while having a male spirit and taking on male roles within their community.

• A lack of inclusion of indigenous LGBTIQA+ people in suicide prevention strategies is evident.

• Limited information is available to health practitioners on working with Aboriginal and Torres Strait Islander LGBTIQA+ people.

• Sistergirls and brotherboys face multiple structural inequalities which affects their access to mental health support.

• Sistergirls and brotherboys can experience heightened suicidality, serious assault, homelessness, exclusion and psychological distress.

• Building community is important and online support can be found here: www.facebook.com/groups/sistergirls.brotherboys.

• For more support see the ‘Where to go for more help’ section.

Questioning gender, not feeling like you fit in any gender

  • Aboriginal or Torres Strait Islander background (trauma, social marginalisation and exclusion, disempowerment, grief, loss, racism)

  • Migrants, refugees, asylum seekers (limited social support, trauma, grief, loss, racism, cultural and language barriers)

 

Autistic/person who identifies as being on the autism spectrum (feel different and like they don’t belong) 

LACK OF PROTECTIVE FACTORS

  • Reasons to live

  • Good coping skills

  • Moral objections to suicide  

  • Good social support

  • Employment

 

Or other opportunities to contribute and feel valued

Lack of access to therapeutic support from people with the same neuro-type

  • Medication

  • Good physical health

  • Good mental health

  • High self-esteem

  • Religious affiliations/spirituality

  • Sense of responsibility to family

  • High self-efficacy

  • Good social and communication skills

  • Good problem-solving skills

  • Healthy relationships

  • Children living in home

  • Good frustration and distress tolerance

  • Hope

  • Cognitive flexibility

  • Sense of meaning

  • Sense of purpose

  • High life satisfaction

  • Feeling safe

  • Strong family connections and attachments

 
  •   Support and advocacy
  • Good autistic leaders/role models/representation (leads to positive self-identity)
 
  • Supportive allies
  • Feeling included and accepted

 RISK FACTORS TO BE MORE AWARE OF IF PERSON IS AUTISTIC

 

  • Feeling like a burden to others: financially, practically, emotionally

  •  Exhaustion and frustration from hiding or concealing their autistic traits (camouflaging/masking) 

  •  Feelings of not getting it ‘right’

  •  Female

  •  Non-binary

  •  Outdated medical/traditional model of autism

  •  Outdated public perceptions of autism

  •  Isolation from other people like them

  •  Distress from changes to routine or lack of predictability

  •  Burnout from study, work, family or social commitments

  •  Lack of understanding from others of early signs of a meltdown and how to respond to a meltdown

  •  Bullying

  •  Isolation

  •  Limited support and advocacy

  •  Limited access to mental health providers with expertise in autism or working with autistic people

  •  Feeling that “nothing helps”

  •  High levels of perfectionism and difficulty achieving their own high standards

  •  Hopelessness about anything improving for them or their future

  •  Feeling pressure (demands) from others to behave or perform differently or beyond their capacity:

    •  E.g., engage more with others at social events

    •  E.g., attend more social events

  •  Feeling like others do not understand them or their needs

  •  Feeling alone/lonely and disconnected from others

  •  Lacking a sense of belonging

  •   Alexithymia: difficulty with experiencing emotion (body sensations), identifying emotion (naming and recognising) and expressing emotion (describing and communicating feelings to others).

    •  If someone autistic that you know seems ‘unfazed’ or unaffected by something which would cause distress to anyone else, ask them how they are coping. Ask them to draw or write down how they are feeling. Just because they may not show, describe or name it, doesn’t mean they don’t feel it or are not affected by it. Don’t assume they are okay if they haven’t yet disclosed their feelings.

    •   If they seem more withdrawn or shut down than usual, they may be feeling something but have no idea what it is or how to express it.

     RISK FACTORS TO BE MORE AWARE OF IF THE PERSON IDENTIFIES AS LGBTIQA+

  • Non-affirming parents and family

  •      Non-accepting parents and family

  •      Homelessness (kicked out of home)

  •      Harassment

  •      Discrimination

  •      Physical assault

  •      Sexual assault

  •      Microaggressions (e.g., ‘You look so pretty for a trans girl’, ‘What was your name before'?’)

  •      Burnt out from mixing with the community who are not LGBTIQA+ inclusive where you are constantly correcting people’s assumptions and statements

  •      Queer parents who have to deal with schools, parents, other kids bullying their kids for having queer parents