Autism spectrum disorders as a risk factor for adolescent self-harm: a retrospective cohort study of 113,286 young people in the UK

Emily Widnall, Sophie Epstein*, Catherine Polling, Sumithra Velupillai, Amelia Jewell, Rina Dutta, Emily Simonoff, Robert Stewart, Ruth Gilbert, Tamsin Ford, Matthew Hotopf, Richard Hayes, Johnny Downs

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
56 Downloads (Pure)

Abstract

Background
Individuals with autism spectrum disorder (ASD) are at particularly high risk of suicide and suicide attempts. Presentation to a hospital with self-harm is one of the strongest risk factors for later suicide. We describe the use of a novel data linkage between routinely collected education data and child and adolescent mental health data to examine whether adolescents with ASD are at higher risk than the general population of presenting to emergency care with self-harm.

Methods
A retrospective cohort study was conducted on the population aged 11–17 resident in four South London boroughs between January 2009 and March 2013, attending state secondary schools, identified in the National Pupil Database (NPD). Exposure data on ASD status were derived from the NPD. We used Cox regression to model time to first self-harm presentation to the Emergency Department (ED).

Results
One thousand twenty adolescents presented to the ED with self-harm, and 763 matched to the NPD. The sample for analysis included 113,286 adolescents (2.2% with ASD). For boys only, there was an increased risk of self-harm associated with ASD (adjusted hazard ratio 2·79, 95% CI 1·40–5·57, P<0·01). Several other factors including school absence, exclusion from school and having been in foster care were also associated with a higher risk of self-harm.

Conclusions
This study provides evidence that ASD in boys, and other educational, social and clinical factors, are risk factors for emergency presentation with self-harm in adolescents. These findings are an important step in developing early recognition and prevention programmes.
Original languageEnglish
Article number137
Number of pages14
JournalBMC Medicine
Volume20
Issue number1
DOIs
Publication statusPublished - 29 Apr 2022

Bibliographical note

Funding Information:
This work utilised the Clinical Record Interactive Search (CRIS) platform funded and developed by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity (grant number BRC-2011-10035). EW was supported by the MRC Pathfinder award (MC_PC_17214) at Kings College London. JD received support from a NIHR Clinician Scientist Fellowship (CS-2018-18-ST2-014) and Psychiatry Research Trust Peggy Pollak Research Fellowship in Developmental Psychiatry. CP was funded by a Wellcome Trust Research Training Fellowship (105757/Z/14/Z). SE was funded by an MRC Clinical Research Training Fellowship (MR/T001437/1) and previously received salary support from an MQ Data Science Award and from the Psychiatry Research Trust. RS is part-funded by an NIHR Senior Investigator Award and by the NIHR Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. RG receives funding from the NIHR. ES, SV, JD, RD, RS, MH, RH and SE received additional funds by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. This research was funded in whole, or in part, by the Wellcome Trust [105757/Z/14/Z]. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Funding Information:
RH has received research funding from Roche, Pfizer, Janssen and Lundbeck. The other authors declare that they have no competing interests.

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Child and adolescent mental health
  • Epidemiology
  • Autism spectrum disorders
  • Education
  • Data linkage

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