Cognitive Emotion Regulation, Peer Victimisation, and Stress Reactivity as Multidimensional Pathways to Suicidality and Self-Harm in Autistic Individuals Without Intellectual Disability

Autistic individuals without intellectual disabilities show high rates of suicidal thoughts and behaviours (STBs); however, the processes underlying this vulnerability remain still unclear and understudied. This study examined STBs within a multidimensional framework integrating intrapersonal, interpersonal, and environmental factors. Eighty-four autistic adolescents and young adults (aged 12-32 years) were included. Overall, 36.9% of participants reported suicidal ideation, 27.4% reported self-harm, and 42.9% endorsed at least one indicator of STBs. Regression analyses reported that peer victimisation was associated with both suicidal ideation and self-harm, while self-harm also showed a specific association with cognitive emotion regulation strategy. Two canonical correlation analyses were performed, including maladaptive and adaptive cognitive emotion regulation strategies. A positive canonical correlation emerged between maladaptive strategies and the STBs domain, whereas a negative canonical correlation was observed between adaptive strategies and the same outcome. Finally, as a sensitivity analysis, a moderation model examined whether perceived stress reactivity influenced the association between emotion regulation and self-harm, showing that this association varied as a function of stress reactivity. Overall, these findings indicate that STBs in autism reflect a dynamic psychopathological process involving interpersonal, intrapersonal, and stress-related domains, with important implications for clinical assessment and the development of targeted prevention strategies.Lay abstractAutistic adolescents and young adults without intellectual disability are at increased risk of suicidal thoughts and self-harm behaviours, but the factors linked to this risk are still not fully understood. This study examined whether peer victimisation, cognitive emotion regulation, and individual stress reactivity were associated with suicidal thoughts and self-harm in 84 autistic people aged 12 to 32 years. Peer victimisation was related to both suicidal thoughts and self-harm behaviours, suggesting that negative experiences with peers may be an important vulnerability factor. Self-harm also showed a more specific association with emotion regulation. In particular, blaming others was negatively associated with self-harm, especially among participants who reported higher stress reactivity. This suggests that, in some contexts, attributing distress to external causes may have a self-protective function rather than being simply maladaptive. Overall, these findings suggest that suicidal thoughts and self-harm behaviours in autistic people may arise from a combination of social adversity, emotion regulation, and stress-related processes. Clinical assessment and prevention should therefore consider peer victimisation and stress reactivity, as well as the specific function of different emotion regulation strategies.