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

Young autistic people experience disproportionately high rates of mental health challenges, yet little is known about factors associated with suicidality in this group. This study leveraged anonymous self-report data to identify correlates of suicidal thoughts among 365 young users (aged approximately 11-25 years) of a mental health app in the United Kingdom with an autism diagnosis or self-identifying as autistic. The presence of suicidal thoughts was assessed as a binary item. Binary logistic regression was used to explore correlates of suicidal thoughts across three domains: mental health-related symptoms, autism-related factors, and adverse life events/experiences. The final model included all significant correlates from domain-specific models alongside demographic factors. Suicidal thoughts were reported by 63% of participants, with similar rates across age groups. The final model accounted for nearly 50% of variability in the presence of suicidal thoughts (R 2 Nagelkerke = 0.48, p < 0.001). Self-harm and depression showed the strongest positive associations (odds ratio, OR and [95% confidence interval] = 6.41 [3.62, 11.35] and 4.58 [2.51, 8.35], respectively), followed by a history of physical abuse (OR = 3.01 [1.20, 7.56]) and a transgender/gender-diverse identity (OR = 2.13 [1.11, 4.10]). Personal use of the term "neurodiversity" was associated with a lower likelihood of suicidal thoughts (OR = 0.45 [0.24, 0.83]). These findings contribute to evidence of high rates of suicidal thoughts among young autistic people and associations with self-harm, depression, a history of abuse, and a gender minority identity. Self-identification with the term neurodiversity emerged as a potential protective factor, although this novel finding warrants further research. Overall, this study highlights the importance of access to autism-adapted mental health care, addressing trauma and identity-related stressors, and fostering belonging and connection as part of comprehensive suicide prevention strategies for autistic youth.