Protective and risk factors associated with suicidal behavior in individuals with autism spectrum disorder: a systematic review

Objectives Autistic individuals face a substantially elevated risk of suicidality, including suicidal ideation, planning, and attempts compared to the general population. This heightened vulnerability is often linked to co-occurring psychiatric conditions, social exclusion, and unmet support needs. The objective of this systematic review was to synthesize evidence on risk and protective factors for suicidality in autistic individuals, focusing exclusively on studies that reported Odds Ratios or Relative Risks.Methods The protocol was registered in the PROSPERO database (registration number: The PROSPERO registration number will be provided at a later stage.) and conducted under PRISMA guidelines (Page et al. Citation2021). A comprehensive search was carried out on SCOPUS, Web of Science, and PubMed. Eighteen studies met the inclusion criteria and were analyzed using qualitative synthesis.Results Across studies, up to 90.6% of autistic individuals who died by suicide had at least one psychiatric comorbidity. Suicide attempt risk was consistently higher in autistic women than in autistic men. Key protective factors included fewer support needs, stronger academic performance, family and social support, access to adequate mental health care, and developing coping and resilience skills. Risk factors identified included psychiatric comorbidities (e.g. depression, anxiety, personality disorders, attention deficit hyperactivity disorder), later diagnosis of autism, social communication difficulties, and experiences of marginalization.Conclusions Identifying and addressing both risk and protective factors associated with suicidality in autistic individuals is essential for designing tailored suicide prevention strategies. These findings highlight the importance of nuanced assessment and intervention approaches considering comorbidity profiles and support needs.PROSPERO registration number CRD42024541633.