Generic placeholder image

Adolescent Psychiatry


ISSN (Print): 2210-6766
ISSN (Online): 2210-6774

Research Article

Gender Differences in the Suicide Attempts of Adolescents in Emergency Departments: Focusing on Individuals with Autism Spectrum Disorder

Author(s): Katsunaka Mikami*, Seiji Inomata, Yuichi Onishi, Yasushi Orihashi, Kenji Yamamoto and Hideo Matsumoto

Volume 9, Issue 3, 2019

Page: [232 - 240] Pages: 9

DOI: 10.2174/2210676609666190617144453


Background: Few studies on gender-based diagnostic characteristics of adolescent suicide attempters in emergency departments (EDs) have included individuals with autism spectrum disorder (ASD).

Objective: This study aimed to examine the clinical features of adolescent suicide attempts in EDs, focusing on gender differences and considering individuals with ASD.

Methods: Ninety-four adolescent patients, aged less than 20 years, who had attempted suicide and had been hospitalized in an emergency department, participated in this study. Psychiatric diagnoses according to DSM-IV criteria and clinical features were compared between male and female patients.

Results: The number (%) of males was 15 (16.0), and that of females was 79 (84.0). The mean age (SD) of males was 17.1 (1.5), and that of females was 16.9 (1.6). The attempt methods were more serious, length of stay in the emergency room longer, and rate of outpatient treatment lower in males. In addition, suicide attempters with ASD were significantly more frequent in male. Adjusting for age and gender, adjustment disorder was significantly associated with the presence of suicide attempters with ASD using a multivariable logistic regression.

Conclusion: Males were less likely to visit psychiatric service previous to attempting suicides, and may be likely to complete suicides. In addition, suicide attempters with ASD are characteristic in male, and likely to have comorbid adjustment disorder. ED visits offer a window of opportunity to provide suicide prevention interventions for adolescents, and therefore, psychiatrists in EDs have a crucial role as gatekeepers of preventing suicide reattempts, especially in adolescent males including individuals with ASD having adjustment disorder.

Keywords: Suicide, adolescence, gender, autism spectrum disorder, emergency department, suicidal predisposing factor.

Ambrose, A.J.H., Prager, L.M. (2018). Suicide Evaluation in the Pediatric Emergency Setting. Child Adolesc. Psychiatr. Clin. N. Am., 27(3), 387-397.
[] [PMID: 29933789]
Asarnow, J.R., Babeva, K., Horstmann, E. (2017). The Emergency Department: Challenges and Opportunities for Suicide Prevention. Child Adolesc. Psychiatr. Clin. N. Am., 26(4), 771-783.
[] [PMID: 28916013]
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. 4th edition (DSM-IV-TR).. Washington, DC: American Psychiatric Association.
Beautrais, A.L., Joyce, P.R., Mulder, R.T. (1996). Risk factors for serious suicide attempts among youths aged 13 through 24 years. J. Am. Acad. Child Adolesc. Psychiatry, 35(9), 1174-1182.
[] [PMID: 8824061]
Bridge, J.A., Goldstein, T.R., Brent, D.A. (2006). Adolescent suicide and suicidal behavior. J. Child Psychol. Psychiatry, 47(3-4), 372-394.
[] [PMID: 16492264]
Chen, M.H., Pan, T.L., Lan, W.H., Hsu, J.W., Huang, K.L., Su, T.P., Li, C.T., Lin, W.C., Wei, H.T., Chen, T.J., Bai, Y.M. (2017). Risk of Suicide Attempts Among Adolescents and Young Adults With Autism Spectrum Disorder: A Nationwide Longitudinal Follow-Up Study. J. Clin. Psychiatry, 78(9), e1174-e1179.
[] [PMID: 28872268]
Cross, S.E., Hardin, E.E., Gercek-Swing, B. (2011). The what, how, why, and where of self-construal. Pers. Soc. Psychol. Rev., 15(2), 142-179.
[] [PMID: 20716643]
Dumais, A., Lesage, A.D., Alda, M., Rouleau, G., Dumont, M., Chawky, N., Roy, M., Mann, J.J., Benkelfat, C., Turecki, G. (2005). Risk factors for suicide completion in major depression: a case-control study of impulsive and aggressive behaviors in men. Am. J. Psychiatry, 162(11), 2116-2124.
[] [PMID: 16263852]
Gould, M.S., Greenberg, T., Velting, D.M., Shaffer, D. (2003). Youth suicide risk and preventive interventions: a review of the past 10 years. J. Am. Acad. Child Adolesc. Psychiatry, 42(4), 386-405.
[] [PMID: 12649626]
Hannon, G., Taylor, E.P. (2013). Suicidal behaviour in adolescents and young adults with ASD: findings from a systematic review. Clin. Psychol. Rev., 33(8), 1197-1204.
[] [PMID: 24201088]
Health, Labour and Welfare Statistics Association. (2018). Annual Statistical Report of National Health Conditions in Japan., (Vol. 65) Tokyo: Health, Labour and Welfare Statistics Association. In Japanese.
Kato, K., Mikami, K., Akama, F., Yamada, K., Maehara, M., Kimoto, K., Kimoto, K., Sato, R., Takahashi, Y., Fukushima, R., Ichimura, A., Matsumoto, H. (2013). Clinical features of suicide attempts in adults with autism spectrum disorders. Gen. Hosp. Psychiatry, 35(1), 50-53.
[] [PMID: 23141028]
Kocourkova, J., Dudova, I., Koutek, J. (2013). Asperger syndrome related suicidal behavior: two case studies. Neuropsychiatr. Dis. Treat., 9, 1815-1819.
[] [PMID: 24294002]
Mayes, S.D., Gorman, A.A., Hillwig-Garcia, J., Syed, E. (2013). Suicide ideation and attempts in children with autism. Res. Autism Spectr. Disord., 7(1), 109-119.
McKeown, R.E., Garrison, C.Z., Cuffe, S.P., Waller, J.L., Jackson, K.L., Addy, C.L. (1998). Incidence and predictors of suicidal behaviors in a longitudinal sample of young adolescents. J. Am. Acad. Child Adolesc. Psychiatry, 37(6), 612-619.
[] [PMID: 9628081]
Mikami, K., Inomata, S., Hayakawa, N., Ohnishi, Y., Enseki, Y., Ohya, A., Haruki, Y., Kishi, Y., Shinohara, Y., Ichimura, A., Matsumoto, H. (2009). Frequency and clinical features of pervasive developmental disorder in adolescent suicide attempts. Gen. Hosp. Psychiatry, 31(2), 163-166.
[] [PMID: 19269537]
Mikami, K., Ohya, A., Akasaka, K., Matsumoto, H. (2006). Attempted suicide of youth with Asperger's disorder Seishin Shinkeigaku Zasshi, 108(6), 587-596.
[PMID: 16910535]
Mikami, K., Onishi, Y., Matsumoto, H. (2014). Attempted suicide of an adolescent with autism spectrum disorder. Int. J. Psychiatry Med., 47(3), 263-271.
[] [PMID: 25084822]
Mukaddes, N.M., Fateh, R. (2010). High rates of psychiatric co-morbidity in individuals with Asperger’s disorder. World J. Biol. Psychiatry, 11(2 Pt 2), 486-492.
[] [PMID: 19347776] []
National Police Agency and Ministry of Health. Labour and Welfare. (2019). Suicide statistics in 2018. Retrieved from. In Japanese [accessed March 31, 2019
Paquette-Smith, M., Weiss, J., & Lunsky, Y. (2014). History of suicide attempts in adults with Asperger syndrome. Crisis, 35(4), 273-277.
[] [PMID: 20113892]
Raja, M., Azzoni, A., Frustaci, A. (2011). AUTISM Spectrum Disorders and Suicidality. Clin. Pract. Epidemiol. Ment. Health, 7, 97-105.
[] [PMID: 21566670]
Richa, S., Fahed, M., Khoury, E., Mishara, B. (2014). Suicide in autism spectrum disorders. Arch. Suicide Res., 18(4), 327-339.
[] [PMID: 24713024]
Rotheram-Borus, M.J., Trautman, P.D., Dopkins, S.C., Shrout, P.E. (1990). Cognitive style and pleasant activities among female adolescent suicide attempters. J. Consult. Clin. Psychol., 58(5), 554-561.
[] [PMID: 2254501]
Segers, M., Rawana, J. (2014). What do we know about suicidality in autism spectrum disorders? A systematic review. Autism Res., 7(4), 507-521.
[] [PMID: 24798640]
Shain, B.N. American Academy of Pediatrics Committee on Adolescence. (2007) Suicide and suicide attempts in adolescents. Pediatrics, 120(3), 669-676.
[] [PMID: 17766542]
Spencer, L., Lyketsos, C.G., Samstad, E., Dokey, A., Rostov, D., Chisolm, M.S. (2011). A suicidal adult in crisis: an unexpected diagnosis of autism spectrum disorder. Am. J. Psychiatry, 168(9), 890-892.
[] [PMID: 21890803]
Statistics Bureau, Ministry of Internal Affairs and Communications. (2019). Population Estimates. Retrieved from [accessed March 31, 2019
Storch, E.A., Sulkowski, M.L., Nadeau, J., Lewin, A.B., Arnold, E.B., Mutch, P.J., Jones, A.M., Murphy, T.K. (2013). The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders. J. Autism Dev. Disord., 43(10), 2450-2459.
[] [PMID: 23446993]
Takara, K., & Kondo, T. (2014). Comorbid atypical autistic traits as a potential risk factor for suicide attempts among adult depressed patients: a case-control study. Ann. Gen. Psychiatry, 13(1), 33.
[] [PMID: 25328535]
Triandis, H.C. (2001). Individualism-collectivism and personality. J. Pers., 69(6), 907-924.
[] [PMID: 11767823]
Wing, L. (1997). The autistic spectrum. Lancet, 350(9093), 1761-1766.
[] [PMID: 9413479]
World Health Organization. (2018). Global Health Observatory data repository: Suicide rate estimates, crude. Retrieved from [accessed March 31, 2019]
Yamawaki, N. (2012). Within-Culture variations of collectivism in Japan. J. Cross Cult. Psychol., 43(8), 1191-1204.
Zahid, S., Upthegrove, R. (2017). Suicidality in Autistic Spectrum Disorders. Crisis, 38(4), 237-246.
[] [PMID: 28468556]

© 2024 Bentham Science Publishers | Privacy Policy