Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample

Moseley, Rachel L.; Gregory, Nicola J.; Smith, Paula; Allison, Carrie; Cassidy, Sarah; Baron-Cohen, Simon

Abstract

Background
Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one’s fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults.

Methods
Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI.

Results
While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability.

Limitations
Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community.

Conclusions
Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.

Citation

Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., Cassidy, S., & Baron-Cohen, S. (2022). Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample. Molecular Autism, 13, Article 45. https://doi.org/10.1186/s13229-022-00522-5

• Journal Article Type: Article
• Acceptance Date: Nov 1, 2022
• Online Publication Date: Nov 12, 2022
• Publication Date: Nov 12, 2022
• Deposit Date: Jul 5, 2023
• Publicly Available Date: Jul 10, 2023
• Journal: Molecular Autism
• Electronic ISSN: 2040-2392
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Article Number: 45
• DOI: https://doi.org/10.1186/s13229-022-00522-5
• Keywords: Psychiatry and Mental health; Developmental Biology; Developmental Neuroscience; Molecular Biology
• Public URL: https://nottingham-repository.worktribe.com/output/13755286
• Publisher URL: https://molecularautism.biomedcentral.com/articles/10.1186/s13229-022-00522-5