Study shows autistic people are more likely to engage in self-harm — but not because of autism

Autistic people are at a much higher risk of self-harm leading to emergency care or suicide, according to a recent study published in JAMA Network Open. In particular, the study found, autistic females had an 83% increased risk of self-harm compared to non-autistic females, while for males, the increased risk compared to non-autistic individuals was 47%.

Although a diagnosis of autism appears to significantly increase the risk of self-harm or suicide, the heightened risk was not linked to autism itself. Rather, the study found that autistic people also have a higher likelihood of having mental illnesses, said Meng-Chuan Lai, professor at the Centre for Addiction Mental Health at the University of Toronto and a lead author of the study.

This suggests that tailored mental health interventions and better access to treatment could significantly reduce the risk of self-harm. The key message to take away from the paper, he said, is the need to pay greater attention to the mental health needs of autistic people.

Combatting stigma against autism

The population-based study was conducted in Ontario, Canada, where single-payer health care data allowed researchers to identify all autism diagnoses in the province between 1988 and 2018. The study looked at a total of 380,000 study subjects, including both autistic and non-autistic people, and compared the incidence of hospitalization for self-harm or death by suicide in both groups, starting at age 10.

The data did not include autistic people who hadn’t visited Ontario’s public health system, or who hadn’t received an autism diagnosis from a physician. (Female patients, in particular, tend to be underdiagnosed.) But the study still offers valuable insight into how vulnerable some autistic people may be to self-harm.

“It is often assumed that being autistic means poor mental health, and while that is currently true for way too many of us, it is far from inevitable,” said Mary Doherty, an anesthesiologist and the founder of Autistic Doctors International, a group representing over 700 autistic medical doctors promoting a neurodiverse approach to their work.

“Lai and colleagues rightly emphasize the need for preventive strategies,” said Doherty, who was not involved with the study. In particular, she said, it’s important that health professionals work to change the broader approach to autism by promoting acceptance as opposed to focusing on correcting behaviors. Some suggestions are outlined in a paper she co-authored on better accommodating the needs of autistic people in health care settings, published earlier this year in the British Journal of Hospital Medicine.

“This must start with how we frame autism,” Doherty said. “When we are raised to believe we are broken and defective, subjected to any number of ways to make us less autistic, is it any wonder we grow up with poor self-esteem and mental ill health?”

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988.