"A combination of everything": a mixed-methods approach to the factors which autistic people consider important in...

Suicide is a leading cause of death for autistic people, but inadequately explained by theories derived in non-autistic populations. Autistic people's perceptions of the factors underpinning suicidal experiences are vital for guiding conceptual understanding, risk assessment, and policy and clinical practice towards preventing suicide.

We recruited 1369 autistic participants for an online survey designed through consultation with autistic people. Participants were 326 cisgender men, 718 cisgender women, and 325 transgender or gender-divergent individuals, ranging from 16-89 years old. We asked them to rate the importance of 19 contributing factors to their suicidal thoughts and feelings, and enter their own explanations of additional factors if desired. Alongside thematically analysing this qualitative data, we examined whether ratings of contributing factors differed by age and gender, and whether ratings statistically predicted levels of lifetime suicidality.

Loneliness, feelings of worthlessness/failure, hopelessness and mental illness were the highest rated contributing factors to suicidal thoughts and feelings, particularly by autistic women and sex/gender minorities; ratings also differed by age. Qualitative responses indicated the complexity of suicidality, wherein autistic status influenced both the nature of the stressors (e.g. societal stigma) and cognitive-emotional states (e.g. feeling disconnected through feeling different to others) that participants identified. Greater perceived importance of bullying, difficulties accessing support and past trauma characterised participants with experience of suicide plans or attempts.

While some of the experiences and mental states identified by participants resembled those identified in non-autistic groups, the psychological profile of autistic participants and their experiences of marginalisation appeared to heavily contextualise expressions of hopelessness, burdensomeness, worthlessness, loneliness and entrapment. Autistic people vary with regards the factors perceived to underpin suicidality. However, associations between suicidality and the perceived importance of bullying, trauma, and inability to access support highlight the necessity of societal and systemic change to prevent suicide.