Autistic traits and suicidality in midlife and old age: investigating mediating effects of mental health and social connectedness

Suicidality is increased among middle-aged and older autistic adults, but little is known about the underlying factors linking autism with suicidality in midlife and older age. Here we report a cross-sectional observational study of 9,979 adults (76% female) aged 50+ years who completed questionnaires measuring autistic traits, current mental health, social connections and suicidality (suicidal ideation and suicidal self-harm). We use path analysis to explore the relationship between autistic traits and suicidality and the mediating effects of current mental health, social connectedness and male/female sex. Our results find that depression, anxiety, post-traumatic stress disorder (PTSD), loneliness and social isolation all significantly mediate the relationship between autistic traits and suicidal ideation, with small effect sizes. For suicidal self-harm, male sex, depression, PTSD and social isolation were found to be mediators. We conclude that mental health difficulties and social isolation mediate higher rates of suicidality in 50+-year-olds with high autistic traits. Targeted and individually tailored interventions for people on the autism spectrum across the lifespan are important.