Identifying Suicidality in Autistic People and Discussing It with Them: A Qualitative Study

Background:Autistic adults have an increased risk of suicidal thoughts and behaviors, yet little is known about how those supporting them identify or discuss suicide risk. Research suggests that autistic individuals experience unique risk factors, including autistic burnout, sensory overload, and difficulties accessing appropriate mental health support. Despite their elevated risk, autistic individuals are often overlooked in suicide prevention strategies, and their needs are poorly understood in clinical practice. Methods:We used semistructured interviews and focus groups to explore how suicidal thoughts and behaviors are identified and discussed with autistic adults. Participants (N = 15) included parents of autistic adults, voluntary sector staff, and health care professionals. We analyzed the collected data using grounded theory methodology, ensuring an in-depth understanding of participant experiences and the generation of a theoretical model. Results:We found that conversations about suicidal thoughts and behaviors occurred when autistic individuals were overwhelmed, often triggered by routine changes, interpersonal difficulties, sensory overload, or barriers in navigating support systems. Participants described that they sought to provide a safe environment, demonstrating autism knowledge, engaging in problem-free talk, and considering sensory needs. Risk identification was often based on direct disclosure or targeted questioning. Supporters engaged in immediate responses (e.g., sensory regulation, reassurance, structured problem-solving) and collaboratively developed accessible safety plans, incorporating the individual’s focused interests. Risk assessment was an ongoing parallel process. Conclusion:Our research highlights the need for autism-informed approaches to responding to suicide, recommending that supporters recognize triggers such as sensory overload and disrupted routines. Communication should use clear language, structured conversations, and visual or written aids where helpful. Safe environments can be created by considering sensory needs and building trust through problem-free talk. Safety planning must be practical, personalized, and coproduced. Finally, clinicians require autism-specific training so that suicide prevention strategies are effectively tailored.