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New research published in Nature Mental Health suggests that higher rates of suicidal thoughts and self-harm among older adults with autistic traits are not directly caused by the traits themselves. Instead, this increased risk appears to be driven by accompanying challenges, such as depression, trauma, and social isolation. These findings provide evidence that targeted mental health support and fostering social connections could help protect this vulnerable population.
If you or someone you know is experiencing suicidal thoughts or a mental health crisis, help is available. Call or text 988 to reach the free and confidential Suicide & Crisis Lifeline, or chat live at 988lifeline.org.
Much of autism research has focused heavily on children and young adults. This focus leaves a scarcity of information about how the condition affects people in midlife and older age.
Older autistic adults have been found to have worse outcomes in terms of reduced life expectancy. They also face a disproportionate risk of mental health difficulties, such as anxiety and depression, compared to non-autistic adults. Epidemiological data suggests that up to ninety percent of autistic adults over the age of fifty in the United Kingdom remain undiagnosed or misdiagnosed.
At the same time, earlier studies have shown that diagnosed autistic people face a much higher risk of dying by suicide compared to the general population. Understanding the factors that influence suicide risk in older populations is a high priority in public health. Older adults generally face a higher risk of suicide overall, and the unique social and mental health challenges experienced by people with autistic traits may compound this risk.
“Suicide has been identified as a leading cause of death in autistic populations, and the risk of suicide in the general population sharply increases in older age,” explained study authors Gavin Stewart and Josh Stott, a senior research fellow at King’s College London and a professor of ageing and clinical psychology at University College London, respectively.
“Our previous work has found that middle-aged and older autistic people have very high rates of suicidal ideation (thoughts of death or dying) and suicidal self-harm. Despite this, the causes of these suicidal behaviors are understudied in older autistic populations.”
For their new study, the researchers analyzed data from an ongoing online health study in the United Kingdom known as the PROTECT study. The sample included 9,979 adults between the ages of 50 and 97. Roughly seventy-five percent of the participants were female.
Because autism is so frequently undiagnosed in older generations, the scientists used a ten-question survey to measure autistic traits rather than relying on official medical diagnoses. Participants who scored highly on this survey were placed in a high autistic traits group, which consisted of 672 people. The remaining 9,307 participants formed the low autistic traits group.
The participants completed several questionnaires designed to measure their current mental health and social well-being. These surveys screened for symptoms of depression, anxiety, and post-traumatic stress disorder. The term post-traumatic stress disorder refers to a mental health condition triggered by experiencing or witnessing a terrifying event.
The surveys also measured two distinct social concepts: loneliness and social isolation. Loneliness is defined as a person’s subjective, negative feeling of being alone. Social isolation is defined as an objective lack of regular contact with friends or family members. Finally, the researchers asked participants if they had ever experienced thoughts that life was not worth living or if they had ever harmed themselves with the intention of ending their life.
The researchers used a statistical technique called path analysis to look for indirect relationships between the variables. This method helps scientists understand if an intermediate factor, known as a mediator, explains the connection between a starting point and an endpoint.
The scientists found that adults in the high autistic traits group reported higher rates of suicidal thoughts. Specifically, twenty-nine percent of the high traits group had experienced suicidal thoughts more than once, compared to just sixteen percent of the low traits group. Self-harm with suicidal intent was also twice as common in the high traits group, affecting six percent of those participants compared to three percent of the others.
When the researchers looked closer using their statistical model, they found that the direct link between autistic traits and suicidal behaviors was actually quite weak. Instead, the higher rates of suicidal thoughts were almost entirely mediated by symptoms of depression, anxiety, post-traumatic stress disorder, loneliness, and social isolation. This provides evidence that these associated mental and social struggles explain the higher risk, rather than the autistic traits themselves.
The pathway for suicidal self-harm was slightly different. The researchers found that suicidal self-harm was mediated by depression, post-traumatic stress disorder, social isolation, and being male. Symptoms of anxiety and subjective feelings of loneliness did not mediate the relationship between autistic traits and suicidal self-harm.
“Overall, our findings suggest that improving mental health support and social connection for autistic adults, particularly those over 50, could help reduce the risk of suicidal behaviors,” Stewart and Stott told PsyPost.
While each individual mental health or social problem had a relatively small effect on its own, the researchers noted that these factors often occur together. In their analysis, as one mental health issue increased in severity, the others tended to increase as well. This cumulative burden tends to have a meaningful impact, eventually pushing individuals toward a state of crisis.
“The main takeaway of our study is that higher rates of suicidal ideation and suicidal self-harm in adults with high autistic traits are not directly associated with autism itself,” Stewart and Stott explained. “Instead, they are largely linked to other challenges that autistic adults may experience, especially mental health difficulties and social isolation.”
“Problems such as being depressed, being anxious, having experienced trauma, being lonely, and being socially isolated explain the increased risk of suicidal behaviours. Although each of these problems have a small effect on its own, together they can have a meaningful impact on someone, making them reach periods of crisis like suicide.”
The researchers caution against a potential misinterpretation of their study regarding formal autism diagnoses. Because the study focused on people with high autistic traits rather than officially diagnosed autism, it is not possible to confirm that all participants in the high-trait group would meet strict clinical criteria for autism.
“Our study looks at people with high autistic traits, rather than autism diagnoses,” Stewart and Stott said. “We used this approach because we see very high rates of underdiagnosis of autism in adult populations, particularly in midlife and old age. We want to caveat that while using autistic trait measures can be a powerful way to explore the experiences of populations where underdiagnosis is high, it is not a replacement for examining these experiences in populations with autism diagnoses.”
Another limitation of the study is its cross-sectional design, meaning the data was collected at a single point in time. This prevents scientists from proving a strict cause-and-effect relationship between mental health challenges and suicidal behaviors.
Future research could to track individuals over time to clarify how mental health symptoms and suicidal thoughts unfold chronologically. The researchers plan to continue exploring the experiences of middle-aged and older adults on the autism spectrum.
“Our research groups (the ReSpect Lab at KCL and the ADAPT Lab at UCL) have a range of studies underway looking at the experiences of middle-aged and older autistic people,” the researchers explained. “Together, we have a particular interest in improving identification of undiagnosed autistic people, as well as improving access to mental health support for autistic people more broadly. We’re also interested in age-related conditions and how to improve identification and care for people living with dementia.”
The study, “Autistic traits and suicidality in midlife and old age: investigating mediating effects of mental health and social connectedness,” was authored by Eleanor Nuzum, Radvile Medeisyte, Aphrodite Eshetu, Sarah Hoare, Anne Corbett, Clive Ballard, Adam Hampshire, Elizabeth O’Nions, Amber John, Gavin R. Stewart, and Joshua Stott.
