Social Connection as a Protective Factor against Suicidality for individuals with ASD and Social Anxiety
Utah Conference on Undergraduate Research 2023
Suicidality in young adults is a major public health problem. Suicidal ideation and attempts in the United States were 30% higher in 2020 than they were in 2000 according to statistics released by the Centers for Disease Control and Prevention. (CDC, 2022) Suicide attempts- for approximately 40% of the population of teens and young adults (ages 13 to 24) cannot be explained alone by precipitating events such as increased stress and pressure from relationships, works, or finances (Beautrais A.L, et al, 1997). This makes it difficult to asses ones risk for suicidality because the scientific community is not certain of all of the risk factors and all of the protective factors for suicide prevention. The scientific community has studied several risk factors, as well as protective factor; however, protective factors are less studied than risk factors (Ati, N.A.L, et al 2020) Additionally, many of these studies on suicidality among adolescents and young adults were cross-sectional in design; thus they cannot predict the risk and preventive factors as accurately or as precisely as longitudinal studies that are attempting to answer the same question ( Franklin, J.C et al, 2016).
There are several things that we believe to be risk and protective factors in the choice to attempt suicide. These protective factors are inclusive of coping and problem-solving skills, having supportive relationships with care providers, limited access to lethal means among people at risk, positive parent child interactions, mental reframing of self and meaningful life, healthy supportive connections to others, availability of consistent high quality physical and mental health care, strong sense of cultural identity, and reasons for living. ( CDC, 2022 ; Ati N.A.L, et al 2020). Social connection is a protective factor that I want to focus on throughout this paper. Social connection is a well-established protective factor; however, much of the research establishing social connection has been completed in a neurotypical population. This means that the findings establishing social connection as a protective factor cannot be extended to a neurodiverse population. This study operated in a population of individuals with Autism Spectrum Disorder to see if the findings extended to them as well. In addition to this sample of people with ASD that were involved in this study there also was a group of socially anxious individuals as well as a group of neurotypical individuals to act as a control group. Both of these groups, ASD and social anxiety, are at significant risk of suicide (Richa, et al., 2014; Nock, et al., 2013)
Autism Spectrum Disorder (ASD) or more commonly known as “Autism” is characterized by persistent deficits in social communication and social interaction across multiple contexts. (Mayes S.D. et. al, 2013; American Psychiatric Association, 2013). Folks with ASD tend to have different priorities in friendship than their neurotypical peers (Finke, E. H., 2022) making who they would consider to be friend or social support a more complex question.
What we know about protective factors for those with ASD and suicidality is extremely limited. It is thought that certain socioeconomic factors in people with ASD are protective against suicide include being White or Asian, younger ages, and being female etc. (Mayes S.D. et al 2012) However, besides these sociodemographic factors there is limited research on the protective factors against suicide among those with ASD. A large amount of the research that is done focusing on protective factors with relation to ASD, is done on their parents or caregivers. Out of the limited literature that we found, it can be said that perceived social support from multiple sources (i.e from parents, classmates, and close friends) is a protective factor against loneliness among those with ASD (Lasgaard, M. et al 2009). Loneliness is a known risk factor for suicidality (Caleti, R et al., 2019) but loneliness and suicidal behaviors are not the same thing. Suicidal behaviors tend to involve more risk factors than just being lonely. The link between suicidality and social support in people that have ASD must be clarified in order to further the research in this field, and to help to potentially improve people's lives.
Another condition that complicates social support as a protective factor, is social anxiety which situations accompanied by severe dread or anxiety because of the possible judgement/ scrutiny from others. (American Psychiatric Association, 2013) Social anxiety is a known to be a predictor of loneliness and suicide (Mahon, N.E., 2006; X Zhu, et al. 2019; Brook, C.A & Schmidt L.A., 2008). Those with social anxiety report fewer friendships as well. (Franklin, J. C., et. Al, 2016). Peer functioning/ relationships are affected in almost every aspect by social anxiety (Chiu K et al, 2021). In addition to these things, there has also been strong correlation between social anxiety and peer support. In other words, the more support one has then the less likely they are to be socially anxious ( Erath, S.A. et. Al. 2007; La Greca, A. M.,& Harrison, H.M., 2005)
Because both of these groups deal with difficult circumstances with developing supportive networks, it can be brought into question: How protective is social support for individuals who are socially anxious and those on the Autism Spectrum?
We aimed to answer this question of how supportive social relationships are for those in a longitudinal way with the data that we collected over anywhere from 6 weeks to approximately 9 months (The average time of enrollment in the study 89 days). We chose to do a longitudinal approach because data accumulated from longitudinal is typically better and it would show use more of the day-to-day variations of social connection and that impacted suicidality. Two hypothesis guided our research: 1-Support- both in person and digital- will not be as protective against suicidality as it is for their neurotypical peers. 2- Support will be more effective at preventing suicide when it is in person support rather than digital- however- both will have some value when considered as protective factor.
The aim of this research poster is to understand better if social support is a protective factor
against suicide for those with socially anxiety and/or Autism Spectrum Disorder (ASD).
Participants were recruited through flyers, advertisements, and with the help of Brigham Young
University’s Counseling and Psychological Services (CAPS). Those that were recruited needed
to meet certain inclusion criteria: (1) Either a diagnosis of autism spectrum disorder or reported
significant worries about social situations; (2) 18 years or Older; (3) Ownership and use of an
Android or an iPhone; (4) A report of an average thought about suicide at least once a week.
Individuals who met exclusion criteria were not admitted to the study: (1) A diagnosis of
schizophrenia, bipolar disorder, or a personality disorder; (2) Non-fluent English speakers (Due
to language barriers in Metric Wire survey software). Individuals from neurotypical populations
and are non-suicidal were recruited as controls. The study was designed to last 6 months with
optional 3-month extension if the participant met criteria of answering 75% of surveys that were
sent via Metric Wire. Many dropped out of the study, but those that dropped the study may have
their data included if there was significant enough data from those participants to perform
analyses based on our hypothesis. The research techniques used were: Mini International
Neuropsychiatric Interview (MINI), Autism Diagnostic Observation Schedule 2nd Edition,
Module 4 (ADOS-2), Columbia Suicide Severity Rating Scale: Since Last Visit and Lifetime
Versions (CSSRS), and Metric Wire Measures. The MINI was used to determine participant
diagnoses, confirming either inclusion or exclusion of the study. The ADOS-2 was used to
confirm diagnosis of ASD. The CSSRS was used to measure suicidal ideation, the intensity of
that ideation, and suicidal behavior. The Metric Wire measures were used as a daily survey to
obtain self-reports on daily activities such as: diet, sleep, exercise, social support, and how
suicidal they felt throughout the day. The Metric Wire measurement of interest is how much
social support they had each day and how it correlates to their suicidal ideation. Social support is
a protective factor for neurodiverse populations.
Analysis was performed by aggregating participants together by group and plotting their
composite suicidal score against their connection score both in person and digitally. These scatter plots were then represented with a line of best fit shown in the figures. The suicide composite
score is an aggregation of 3 questions regarding the participant’s desire to commit suicide on a
given day, the intensity of their desire, and their ability to resist this desire. Connection in person
and digitally were individual questions gauging how much these participants connected with
other people. Both scores were placed in a range from 0-100. Correlation analysis of data
recorded on social interaction and suicidal ideation show the following trends. The data collected is reliable demonstrated by the control group that was overall not suicidal. The figures show that
this control group has a correlation score very near 0, skewed slightly by 1 or 2 days suicidal
across the entire control population. On the other hand, both the digital and in person figure show that the social anxiety group experience an overall higher level of suicide ideation by over 2X
that of autism groups. When considered with the population as a whole, this trend confirms
previously held conclusions in psychology: both socially anxious and autistic populations are
known to be at risk for suicide but socially anxious individuals' trend higher in their ideation
which further grows our confidence in the data. Both social anxiety and autistic populations have negative correlations between suicide and digital connection/in-person connection, the socially
anxious group achieving a correlation of –0.095 and –0.231 respectively, and the autistic group
achieving a correlation of –0.067 and –0.078 respectively. These correlations show a weak
negative connection between social interaction and suicide. As members of these groups increase their interaction, they trend less suicidal overall. Ultimately, this confirms our hypothesis that socially anxious and autistic populations would experience less suicidal ideation as they increase
in social interaction.
Suicidality is a major problem, especially for those with ASD and social anxiety. The reasons suicidality rate being higher for these populations is not known. We investigated if there were any precursory events or lifestyle factors that went into the increased rate of suicidality. Looking at the factor of connection, we saw that social support is somewhat protective, however less so than we were expecting. The rates were more protective for in-person support rather than digital support, nevertheless, they both were marginally preventive against suicidality. This suggests that there may be more protective factors than social connection for individuals with autism and social anxiety. This study limited by lack of compliance to the study measures, participants withdrawing from the study lead to limited data, and a demographic limitation. More research is needed in order to state anything conclusively.
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