Suicidality in autistic youth: A systematic review and meta-analysis

Suicidality in autistic youth is a major public health issue. This study aimed to determine global prevalence of, and risk/protective factors for suicidality in autistic youth via systematic review and meta-analysis. We systematically searched Embase, PubMed, PsycINFO, Web of Science, and the Cochrane library for studies from inception to November 22nd, 2021. We selected empirical studies reporting on suicide outcomes (i.e., ideation, behaviors, attempts and deaths) in autistic youth (<= 25 years). Random effects models were used to estimate the pooled prevalence of suicide outcomes with 95% confidence interval (CI). Heterogeneity was investigated with potential moderators using meta-regression analyses. The final selection included 47 papers, 29 of which were included in meta-analyses and 37 were narratively synthesized (sociodemographic, psychiatric, psychological, other factors, and interventions). The pooled prevalence of suicidal ideation was 25.2% (95% CI 18.2-33.8; i.e., one in four), suicide attempts 8.3% (3.6-18.2), and suicide deaths 0.2% (0.05-0.52). Estimates in self-reports were higher than in parent-reports. Age was a significant but inconsistent moderator on suicide outcomes, but substantial heterogeneity remained. Adverse childhood experiences were strong risk factors for suicidality, while resilience was protective. Participatory suicide risk-assessment, early intervention, and resilience promotion should be primary clinical/research goals.