The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021

This publication is included in the Autistic Autism Scholarship Project. one author of this publication is identified as autistic in the project.

About the autistic author marker

Metadata sources used for this reference

OpenAlex Crossref PubMed BibTeX OpenCitations
Learn more about the sources used

Santomauro, D., Hedley, D., Sahin, E., Brugha, T., Naghavi, M., Vos, T., Whiteford, H. A., Ferrari, A., & Stokes, M. A. (2024). The global burden of suicide mortality among people on the autism spectrum: A systematic review, meta-analysis, and extension of estimates from the Global Burden of Disease Study 2021. Psychiatry Research, 341, 116150. https://doi.org/10.1016/j.psychres.2024.116150

Publication date: 22 Aug 2024 Added to AutiHub: 29 Sep 2026 Type: Article Article language: English
Publisher source (DOI) OpenAlex source

This publication is integrated into AutiHub through:

Authors

Publication authors
9
Publication authors identified as autistic
1 / 9 (11.1%)
  1. Damian Santomauro *
  2. Darren Hedley
  3. Ensu Sahin
  4. Traolach Brugha
  5. Mohsen Naghavi
  1. Theo Vos
  2. Harvey A. Whiteford
  3. Alize Ferrari
  4. Mark A. Stokes

Abstract

We aimed to quantify the risk, mortality, and burden of suicide among autistic persons. We searched PubMed, Embase, and PsycINFO on 5th April 2023 for sources reporting the relative risk (RR) of suicide or suicide attempt among autistic persons (PROSPERO registration: CRD42021265313). Autism spectrum prevalence and suicide mortality and years of life lost (YLLs), were sourced from the Global Burden of Disease Study 2021. RRs pooled via meta-regression and health metrics estimates were used to estimate the excess suicide mortality and YLLs among autistic persons. We sourced 983 unique studies of which ten studies met inclusion criteria, consisting of 10.4 million persons. The pooled RR for suicide for autistic persons was 2·85 (95% UI: 2·05-4·03), which was significantly higher for autistic females than autistic males. No evidence of publication bias was detected via inspection of funnel plot and Egger's test. Globally, we estimated 13 400 excess suicide deaths among autistic persons in 2021, equating to 1·8% of all suicide deaths and 621 000 excess YLLs. Studies were limited in number and geographical coverage. Effective suicide prevention strategies for autistic persons may substantially reduce the fatal burden of suicides globally and reduce the health burden experienced within this population.

Bibliography cited by this reference

Cited references are imported from external metadata sources when they are available. The list may be partial.

Cited bibliography overview

These indicators describe the bibliography cited by this publication. An author name is counted each time it appears in one cited reference, so the same person can be counted more than once. Names not yet linked to an author already present in AutiHub are treated as unknown, not as non-autistic. Last computed: 2 Oct 2026 01:01.

Cited references
33
With a DOI
28
Without a DOI, from raw bibliography text
5
5 / 33 (15.2%) cited references include at least one author identified as autistic.
References with data to complete
4 / 33 (12.1%)
References with detected author names
29 / 33 (87.9%)
Without detected author names
4
Without a structured title
1
Without a stable identifier
5
References with raw author names still to review
1
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
3550
From DOI or external metadata
3550
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
347 / 3550 (9.8%) names are linked to an author already present in AutiHub. 3203 / 3550 (90.2%) names are not yet linked.
Names linked to a person identified as autistic
5 / 3550 (0.1%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 5 / 347 (1.4%). Distinct people identified as autistic: 2 / 2407 (0.1%).
  1. Kiyoharu Takara , Tsuyoshi Kondo (2014). Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: a case–control study . Annals of General Psychiatry, 13(1), 33. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/s12991-014-0033-z OpenAlex: https://openalex.org/W1986606080
    Crossref OpenAlex OpenCitations
  2. (2013). Diagnostic and Statistical Manual of Mental Disorders . Diagnostic and statistical manual of mental disorders.
    Type: Other
    Crossref
  3. Sami Richa , Mario Fahed , Elias Khoury , Brian Mishara (2014). Suicide in Autism Spectrum Disorders . Archives of Suicide Research, 18(4), 327-339. Informa UK Limited.
    Type: Article DOI: 10.1080/13811118.2013.824834 OpenAlex: https://openalex.org/W2036103084
    Crossref OpenAlex OpenCitations
  4. Patricia Howlin , Philippa Moss , Sarah Savage , Michael Rutter (2013). Social Outcomes in Mid- to Later Adulthood Among Individuals Diagnosed With Autism and Average Nonverbal IQ as Children . Journal of the American Academy of Child & Adolescent Psychiatry, 52(6), 572-581.e1. Elsevier BV.
    Type: Article DOI: 10.1016/j.jaac.2013.02.017 OpenAlex: https://openalex.org/W2005094520
    Crossref OpenAlex OpenCitations
  5. Ashley Blanchard , Stanford Chihuri , Carolyn G. DiGuiseppi , Guohua Li (2021). Risk of Self-harm in Children and Adults With Autism Spectrum Disorder . JAMA Network Open, 4(10), e2130272. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jamanetworkopen.2021.30272 OpenAlex: https://openalex.org/W3207044150
    Crossref OpenAlex OpenCitations
  6. Darren Hedley , Mirko Uljarevic (2018). Systematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications . Current Developmental Disorders Reports, 5(1), 65-76. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s40474-018-0133-6 OpenAlex: https://openalex.org/W2788605551
    Crossref OpenAlex OpenCitations
  8. Meng-Chuan Lai , Caroline Kassee , Richard Besney , Sarah Bonato , Laura Hull , Will Mandy et al. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis . Lancet Psychiatry, 6(10), 819. Elsevier BV.
    Type: Article DOI: 10.1016/s2215-0366(19)30289-5 OpenAlex: https://openalex.org/W2936336589
    Crossref OpenAlex OpenCitations
  9. Patricia Howlin , Susan Goode , Jane Hutton , Michael Rutter (2004). Adult outcome for children with autism . Journal of Child Psychology and Psychiatry, 45(2), 212-229. Wiley.
    Type: Article DOI: 10.1111/j.1469-7610.2004.00215.x OpenAlex: https://openalex.org/W2046265374
    Crossref OpenAlex OpenCitations
  10. Bury (2020). It defines Who I Am" or "It's Something I Have": what language do [Autistic] Australian adults [on the Autism Spectrum] prefer? J. Autism. Dev. Disord..
    Type: Other
    Crossref
  11. Koji Kato , Katsunaka Mikami , Fumiaki Akama , Keigo Yamada , Mizuki Maehara , Keitaro Kimoto et al. (2013). Clinical features of suicide attempts in adults with autism spectrum disorders . General Hospital Psychiatry, 35(1), 50-53. Elsevier BV.
    Type: Article DOI: 10.1016/j.genhosppsych.2012.09.006 OpenAlex: https://openalex.org/W2050697845
    Crossref OpenAlex OpenCitations
  12. Mu-Hong Chen , Tai-Long Pan , Wen-Hsuan Lan , Ju-Wei Hsu , Kai-Lin Huang , Tung-Ping Su et al. (2017). Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder . The Journal of Clinical Psychiatry, 78(9), e1174-e1179. Physicians Postgraduate Press, Inc.
    Type: Article DOI: 10.4088/jcp.16m11100 OpenAlex: https://openalex.org/W2747034110
    Crossref OpenAlex OpenCitations
  13. Mohsen Naghavi , Kanyin Liane Ong , Amirali Aali , Hazim S Ababneh , Yohannes Habtegiorgis Abate , Cristiana Abbafati et al. (2024). Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 . The Lancet, 403(10440), 2100-2132. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(24)00367-2 OpenAlex: https://openalex.org/W4393858312
    Crossref OpenAlex OpenCitations
  14. Tatja Hirvikoski , Ellenor Mittendorfer-Rutz , Marcus Boman , Henrik Larsson , Paul Lichtenstein , Sven Bölte (2016). Premature mortality in autism spectrum disorder . British Journal of Psychiatry, 208(3), 232-238. Royal College of Psychiatrists.
    Type: Article DOI: 10.1192/bjp.bp.114.160192 OpenAlex: https://openalex.org/W2168424072
    Crossref OpenAlex OpenCitations
  15. (2020). R: A Language and Environment for Statistical Computing . R: A Language and Environment for Statistical Computing..
    Type: Other
    Crossref
  16. * (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 . The Lancet Psychiatry, 9(2), 137-150. Elsevier BV.
    Type: Article DOI: 10.1016/s2215-0366(21)00395-3 OpenAlex: https://openalex.org/W4205208574
    Crossref OpenAlex OpenCitations
  17. Lorcan Kenny , Caroline Hattersley , Bonnie Molins , Carole Buckley , Carol Povey , Elizabeth Pellicano (2016). Which terms should be used to describe autism? Perspectives from the UK autism community . Autism, 20(4), 442-462. SAGE Publications.
    Type: Article DOI: 10.1177/1362361315588200 OpenAlex: https://openalex.org/W2227393071
    Crossref OpenAlex OpenCitations
  18. Gretchen A. Stevens , Leontine Alkema , Robert E. Black , J. Ties Boerma , Gary S. Collins , Majid Ezzati et al. (2016). Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement . PLOS Medicine, 13(6), e1002056. Public Library of Science (PLoS).
    Type: Article DOI: 10.1371/journal.pmed.1002056 OpenAlex: https://openalex.org/W2463986804
    Crossref OpenAlex OpenCitations
  19. Alize Ferrari , Damian Santomauro * , Amirali Aali , Yohannes Habtegiorgis Abate , Cristiana Abbafati , Hedayat Abbastabar et al. (2024). Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 . The Lancet, 403(10440), 2133-2161. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(24)00757-8 OpenAlex: https://openalex.org/W4394894573
    Crossref OpenAlex OpenCitations
  20. Damian Santomauro * , Ana M Mantilla Herrera , Jamileh Shadid , Peng Zheng , Charlie Ashbaugh , David M Pigott et al. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic . The Lancet, 398(10312), 1700-1712. Elsevier BV.
    Type: Article DOI: 10.1016/s0140-6736(21)02143-7 OpenAlex: https://openalex.org/W3203310594
    Crossref OpenAlex OpenCitations
  21. Darren Hedley , Susan M Hayward , Kathleen Denney , Mirko Uljarevic , Simon Bury , Ensu Sahin et al. (2021). The association between COVID ‐19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults . Autism Research, 14(12), 2663-2676. Wiley.
    Type: Article DOI: 10.1002/aur.2614 OpenAlex: https://openalex.org/W3200644286
    Crossref OpenAlex OpenCitations
  22. Dheeraj Rai , Hein Heuvelman , Christina Dalman , Iryna Culpin , Michael Lundberg , Peter Carpenter et al. (2018). Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood . JAMA Network Open, 1(4), e181465. American Medical Association (AMA).
    Type: Article DOI: 10.1001/jamanetworkopen.2018.1465 OpenAlex: https://openalex.org/W2892187963
    Crossref OpenAlex OpenCitations
  23. Shih-Jen Tsai , Wen-Han Chang , Chih-Ming Cheng , Chih-Sung Liang , Ya-Mei Bai , Ju-Wei Hsu et al. (2023). All-cause mortality and suicide mortality in autistic individuals: An entire population longitudinal study in Taiwan . Autism, 27(8), 2496-2506. SAGE Publications.
    Type: Article DOI: 10.1177/13623613231167287 OpenAlex: https://openalex.org/W4376107645
    Crossref OpenAlex OpenCitations
  24. Rosalind Y. K. Oliphant , Eleanor M. Smith , Victoria Grahame (2020). What is the Prevalence of Self-harming and Suicidal Behaviour in Under 18s with ASD, With or Without an Intellectual Disability? Journal of Autism and Developmental Disorders, 50(10), 3510-3524. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-020-04422-6 OpenAlex: https://openalex.org/W3009930122
    Crossref OpenAlex OpenCitations
  25. Simon Bury , Rachel Jellett , Jennifer R. Spoor , Darren Hedley (2023). “It Defines Who I Am” or “It’s Something I Have”: What Language Do [Autistic] Australian Adults [on the Autism Spectrum] Prefer? Journal of Autism and Developmental Disorders, 53(2), 677-687. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-020-04425-3 OpenAlex: https://openalex.org/W3007056653
    OpenAlex
  26. Anne Huntjens , Annemiek Landlust , Sophie Wissenburg , Mark van der Gaag (2024). The prevalence of suicidal behavior in autism spectrum disorder . Crisis, 45(2), 144-153. Hogrefe Publishing Group.
    Type: Article DOI: 10.1027/0227-5910/a000922 OpenAlex: https://openalex.org/W4386437826
    Crossref OpenAlex
  27. (n.d.). Institute for Health Metrics and Evaluation, 2024. Global Burden of Disease, Injuries, and RIsk Factors Study (GBD) Protocol. https://www.healthdata.org/research-analysis/about-gbd/protocol accessed 18th June 2024.
    Type: Other
    Crossref
  28. L. O'Halloran , P. Coey , Colin Wilson (2022). Suicidality in autistic youth: A systematic review and meta-analysis . Clinical Psychology Review, 93, 102144. Elsevier BV.
    Type: Article DOI: 10.1016/j.cpr.2022.102144 OpenAlex: https://openalex.org/W4221063598
    Crossref OpenAlex OpenCitations
  29. Elina Jokiranta-Olkoniemi , David Gyllenberg , Dan Sucksdorff , Auli Suominen , Kim Kronström , Roshan Chudal et al. (2021). Risk for premature mortality and intentional self-harm in autism spectrum disorders . J. Autism. Dev. Disord., 51(9), 3098-3108. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1007/s10803-020-04768-x OpenAlex: https://openalex.org/W3097778051
    Crossref OpenAlex
  30. Peng Zheng , Ryan Barber , Reed J. D. Sorensen , Christopher J L Murray , Aleksandr Y Aravkin (2021). Trimmed Constrained Mixed Effects Models: Formulations and Algorithms . Journal of Computational and Graphical Statistics, 30(3), 544-556. Informa UK Limited.
    Type: Article DOI: 10.1080/10618600.2020.1868303 OpenAlex: https://openalex.org/W3121059311
    Crossref OpenAlex OpenCitations
  31. Modhurima Moitra , Damian Santomauro * , Louisa Degenhardt , Pamela Y. Collins , Harvey A. Whiteford , Theo Vos et al. (2021). Estimating the risk of suicide associated with mental disorders: A systematic review and meta-regression analysis . Journal of Psychiatric Research, 137, 242-249. Elsevier BV.
    Type: Article DOI: 10.1016/j.jpsychires.2021.02.053 OpenAlex: https://openalex.org/W3133660108
    Crossref OpenAlex OpenCitations
  32. Victoria Newell , Lucy Phillips , Chris Jones , Ellen Townsend , Caroline Richards , Sarah Cassidy (2023). A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability . Molecular Autism, 14(1), 12. Springer Science and Business Media LLC.
    Type: Article DOI: 10.1186/s13229-023-00544-7 OpenAlex: https://openalex.org/W4324354182
    Crossref OpenAlex OpenCitations
  33. (2019). International statistical classification of diseases and related health problems .
    Type: Other
    Crossref