背景:自杀和自残在自闭症患者中不成比例地常见。在一般人群中观察到自残和自杀风险的性别差异,但是自闭症患者的发现好坏参半。自我切割可能是自闭症患者自杀的特别危险的自我伤害行为。我们旨在探讨自闭症和非自闭症青少年和年轻人在自我伤害与自杀之间的关系中的性别差异和自我伤害方法的差异。
方法:我们使用了280万瑞典居民的总人口登记册。由于自我伤害,参与者从12岁到2021年12月接受治疗。和自杀死亡。我们使用Cox比例风险回归模型来计算自残后自杀死亡风险的风险比(HR)和95%置信区间(CI)。和互动导致的相对过度风险(RERI)来探索女性和男性自残与自闭症之间的相互作用。
结果:我们确定了85,143名自闭症患者(31,288名女性;53,855名男性)和2,628,382名非自闭症患者(1,286,481名女性;1,341,901名男性),年龄在12-37岁。自残后自杀的发生率在自闭症男性中(每100,000风险年的发生率=169.0[95%CI135.1,211.3])高于女性(125.4[99.4,158.3])。自闭症女性的相对风险(HR26.1[95%CI20.2,33.7])高于自闭症男性(12.5[9.9,15.8])。在女性(RERI=9.8)和男性(2.0)中均观察到自闭症和自我伤害的累加效应。通过切割自我伤害的自闭症患者自杀死亡的风险最大(HR25.1[17.9,35.2]),与其他方法相比。
结论:自闭症男性和女性在严重自残后自杀死亡的风险增加,尤其是自我切割。
BACKGROUND: Both suicide and self-harm are disproportionately common in autistic people. Sex differences in risk of self-harm and suicide are observed in the general population, but findings are mixed for autistic people. Self-cutting may be a particularly risky self-harm behaviour for suicide in autistic people. We aimed to explore sex differences and differences in method of self-harm in the association between self-harm and suicide in autistic and non-autistic adolescents and young adults.
METHODS: We used a total population register of 2.8 million Swedish residents. Participants were followed from age 12 until December 2021 for medical treatment because of self-harm, and death from suicide. We used Cox proportional hazard regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of death from suicide following self-harm, and Relative Excessive Risk due to Interaction (RERI) to explore the interaction between self-harm and autism in females and males.
RESULTS: We identified 85,143 autistic individuals (31,288 female; 53,855 male) and 2,628,382 non-autistic individuals (1,286,481 female; 1,341,901 male) aged 12-37 years. Incidence of suicide following self-harm was higher in autistic males (incidence per 100,000 risk-years = 169.0 [95% CI 135.1, 211.3]) than females (125.4 [99.4, 158.3]). The relative risk was higher for autistic females (HR 26.1 [95% CI 20.2, 33.7]) than autistic males (12.5 [9.9, 15.8]). An additive effect of both autism and self-harm was observed in both females (RERI = 9.8) and males (2.0). Autistic individuals who self-harmed through cutting were at greatest risk of death from suicide (HR 25.1 [17.9, 35.2]), compared to other methods.
CONCLUSIONS: Autistic males and females are at increased risk of death from suicide following severe self-harm, particularly self-cutting.