Parent-Reported Suicidal Ideation in Three Population-Based Samples of School-Aged Korean Children With Autism Spectrum Disorder and Autism Spectrum Screening Questionnaire Screen Positivity

Abstract

Objectives

Higher prevalence of suicidality has been reported in individuals with ASD. This study aimed to (1) Estimate the prevalence of suicidal ideation (SI) in epidemiologically-ascertained, population-based, samples of children with ASD or Autism Spectrum Screening Questionnaire (ASSQ) Screen Positivity (ASP); (2) Determine whether ASD/ASP is an independent risk factor for SI, controlling for known SI risk factors; and, (3) Develop an explanatory model for SI in children with ASD/ASP.

Methods

Participants came from three epidemiologically-ascertained samples of school-aged Korean children (n = 14,423; 3,702; 4,837). ASSQ ≥ 14 was the cutoff for ASP. A subsample (n = 86) was confirmed to have ASD. SI was based on parents’ endorsement of items on the Behavioral Assessment System for Children-2-Parent Report Scale-Children. Logistic regressions were used to assess associations between SI and ASD/ASP, controlling for demographics, peer victimization, behavior problems, and depression. To develop an explanatory model for SI within ASD/ASP, the associations between SI and child characteristics (comorbid conditions, ASD symptoms, IQ, adaptive function) were tested.

Results

SI was higher in children with ASD (14%) and ASP (16.6–27.4%) than ASSQ Screen Negative (ASN) peers (3.4–6.9%). ASD/ASP was strongly predictive of SI (ORs: 2.87–5.67), after controlling for known SI risk factors compared to ASN. Within the ASD and ASP groups, anxiety was the strongest predictor of SI.

Conclusions

SI prevalence was higher in non-clinical samples of children with ASD and ASP, relative to ASN peers. These results underscore the need for routine screening for SI in children with ASD and social difficulties, particularly those with high anxiety.

Highlights

• Population-based, epidemiologically-ascertained, school-aged children

• ASD and ASP are independent risk factors for SI in school-aged children

• Anxiety is an independent risk factor for SI in children with ASD or ASP

Keywords:

• Anxiety
• ASD
• ASP
• epidemiological sample
• suicidality

DISCLOSURE STATEMENT

The authors have no conflicts of interest to disclose.

Additional information

Funding

This work was supported by the Ministry of Environment, Korea, NIMH under Career Award Grant to YSK [5K01MH079317-02] and VB [K23MH1151166], NIEHS under R01 Grant [R01 ES021462-01], SFARI under Pilot Grant [137032 M134793], NCRR under CTSA Grant [UL1 RR024139], Autism Speaks under Pilot Research Grant and Supplement Grant [7996] and Brain Research Foundation under Research Grant.

Notes on contributors

Vanessa H. Bal

Vanessa H. Bal, PhD, earned her M.Sc. in neuroscience from the University of Oxford and her Ph.D. in psychology from the University of Michigan. She also completed her clinical psychology internship at the University of Michigan and a postdoc in human genetics at the University of California, San Francisco. Dr. Bal's research program emphasizes a lifespan perspective to furthering understanding of autism spectrum disorder (ASD) in adulthood. She employs a variety of approaches to measure and track outcomes and predictors of outcome at different stages of development. Additionally, Dr. Bal is leading several projects to develop and refine methods to assess and quantify clinical phenotypes. By emphasizing a multidimensional, lifespan perspective, her research aims to delineate relationships between dimensions of social-communication, language, cognition, and emotion in the context of neurodevelopmental disorders to inform the development of targeted interventions that capitalize on individual strengths to promote the well-being of individuals with ASD across the lifespan. Currently Dr. Bal is the Karmazin and Lillard Chair in Adult Autism and Associate Professor in the Graduate School of Applied and Professional Psychology at Rutgers University and the Director of the Rutgers Center for Adult Autism Services Psychological Services Clinic.

Bennett L. Leventhal

Bennett L. Leventhal, MD, received his medical degree from Louisiana State University School of Medicine in New Orleans and completed his child and adolescent psychiatry training at Duke University, serving there as chief resident and junior faculty member. Dr. Leventhal joined the University of Chicago where he served as Professor of Psychiatry & Pediatrics and, as Director of Child and Adolescent Psychiatry for more than two decades. Dr. Leventhal then moved to the University of Illinois College of Medicine and the Institute for Juvenile Research where he was Professor and Director of the Center for Child Mental Health and Developmental Neuroscience. After 5 years as Deputy Director, Nathan S. Kline Institute of Psychiatric Research, in 2014, Dr. Leventhal moved the University of California San Francisco where he is Professor of Psychiatry and Deputy Director of the Center for Autism Spectrum and Neurodevelopmental Disorders. He has extensive clinical, training and research experience in the area of developmental psychopathology, neurodevelopmental disorders (NDDs) including especially Autism Spectrum Disorder (ASD), and roles of environmental factors in risks for NDDs. He is an author of more than 200 peer-reviewed publications.

Gregory Carter

Gregory Carter, MBBS, FRANZCP, Cert Child Psych., PhD, is currently the Senior Staff Specialist and Acting Director of Consultation-Liaison Psychiatry, Calvary Mater Newcastle Hospital, Waratah; and Conjoint Professor in Psychiatry in the Faculty of Health Sciences, University of Newcastle, Australia. He received his medical degree from the University of New South Wales, his PhD from the University of Newcastle and his qualifications as a Psychiatrist and Child and Aodlescent Psychaitrist from the RANZCP. He is Lead Clinician for Psycho-Oncology in the Hunter New England Cancer Network. He is also a Principal Researcher in the Center for Brain and Mental Health Research, University of Newcastle. He was Chair of the Deliberate Self-Harm Clinical Practice Guidleines for the RANZCP (Royal Australian and New Zealand College of Psychiatrists). His current areas of clinical and research interest include; deliberate self-poisoning, suicide prevention, epidemiology of suicidal behaviors, attitudes to euthanasia, delirium, toxicology of psycho-active drugs, post-stroke depression, organ donation, and psycho-oncology.

Hosanna Kim

Hosanna Kim, MD graduated from Korea Institute of Science and Technology (KAIST), South Korea with a BS in Biological Science and received her medical degree from Kyunghee University School of Medicine, South Korea. Her research interest is in understanding brain circuits of people with ASD. Currently, she is a post-doc at UCSF Center for ASD and NDD, studying gene and environment interactions related to the onset and progression of ASD.

Yun-Joo Koh

Yun-Joo Koh, PhD, graduated from Yonsei University, South Korea with a BS in Child & Family Studies and an MS in Developmental Psychology. She received her PhD from Koeln University, Germany and completed postdoctoral training at McGill University, Canada. As the Director of the Korea Institute for Children’s Social Development (KICSD), she has been conducting a series of international collaborative research, including prevalence and incidence studies of Autism Spectrum Disorders (ASD) in Korean school-aged children, genetic epidemiology of ASD and gene-environment (GE) interaction research of ASD.

Mina Ha

Mina Ha, MD, PhD, received her MD and PhD in public health from Seoul National University, South Korea. She completed her training in Preventive Medicine and Industrial/Occupational Medicine at Seoul National University Hospital, South Korea. Dr. Ha is currently a Professor at Dankuk University, Southe Korea. Her research interests are in the epidemiology of environmental diseases, the effects of stress at work and shift work on health, and the impact of environmental risk factors on child health outcomes.

Ho-Jang Kwon

Ho-Jang Kwon, MD, PhD, received his degrees from Seoul National University, South Korea. He studied the effect of air pollution on daily mortality in Seoul. He also worked on the effect of air pollution and dust storm on health in Karolinska Institutet in Sweden. His main interest is in children’s environmental health and assessment of toxic substances in food.

Patricia Hong

Patricia Hong, BA, graduated from Wake Forest University with a BA in Art History. Her research interest is global mental health. She has worked on projects examining gene-environment interactions in neurodevelopmental disorders and attitudes toward NDDs and mental illness in Korean American communities.

Young Shin Kim

Young Shin Kim, MD, PhD, MPH, is a child and adolescent psychiatrist who focuses on the distribution of childhood-onset neuropsychiatric disorders and disruptive behavioral problems, including autism and bullying. Her research examines the genetic and environmental risk factors of these conditions, as well as their interactions and psychosocial correlates. The core of Dr. Kim's research is built on community outreach efforts for communities in need of services, provision of services and advocacy for children with psychiatric illnesses and their families, and public awareness campaigns. She is committed to demonstrating that delivering reliable, evidence-based knowledge and skills to communities can lead to reductions in stigma, changes in policy, and improvement in the lives of youth and families facing ASD and other conditions. Dr. Kim is currently Director of the UCSF Center for ASD and NDDs, Director of the Psychiatric Genetic Epidemiology Program, and Associate Professor of Psychiatry at UCSF.