Occurrence and Correlates of Suicidal Thoughts Among Young Autistic Users of a Mental Health App.

The 365 people in the study chose to answer an app survey, so they are not a cross-section of autistic young people. The authors say the sample is likely to be weighted towards people with mental health difficulties, which will push the 63% figure up. Everyone lived in the United Kingdom and the group was mostly cisgender girls and women and gender minority young people, so the findings may not hold for other groups or other countries. Everything was measured at one point in time. The study can show what goes together but not what causes what, and the authors say the neurodiversity finding in particular needs caution and further research. Suicidal thoughts were recorded only as yes or no, so the study says nothing about how often, how intense, how recent or when they started, and participants were not asked about suicide plans or attempts. Mental health symptoms, autism-related traits and adverse life experiences were each measured with single simplified questions rather than established questionnaires. Age was recorded as a range rather than an exact figure, and the 19 and over group may have included a few people older than 25. The answers were anonymous and self-reported, so they are open to reporting bias and to people interpreting the questions differently. Nine participants were missing at least one demographic item and dropped out of the regression analyses, which used 356 people. The survey was not designed to study suicidality, so these questions were only part of a survey intended mainly to understand how the app was used.

Two authors, K.C. and S.G., are the founders and co-CEOs of Tellmi, the app that ran the survey and supplied the data being analysed. The work was funded by Autism Action, and S.B.-C. also reports funding from the Wellcome Trust, SFARI, the Templeton World Charitable Fund, the MRC and the Innovative Medicines Initiative 2 Joint Undertaking, which receives support from the European Union Horizon 2020 programme, EFPIA, Autism Speaks, Autistica and SFARI; other support came from the NIHR Cambridge Biomedical Research Centre, the NIHR Applied Research Collaboration East of England and anonymous donations through Cambridge University Development and Alumni Relations. The authors state that the funders had no role in the design, data collection, analysis, interpretation, writing or the decision to publish.

Do not read the 63% as the rate of suicidal thoughts among autistic young people generally. Everyone in the study was a self-selected user of a mental health app who chose to answer a survey, and the authors say the group is likely weighted towards people with mental health difficulties, so the figure cannot be generalised. Do not read the neurodiversity result as proof that the language protects anyone either. Everything was measured at a single point in time, so the study cannot show which came first, and the authors themselves say this finding should be treated with caution.