Investigating Bullying as a predictor of Suicidality in a Clinical Sample of Adolescents with Autism Spectrum Disorder

Rachel Holden, Joanne Mueller, John McGowan, Jyoti Sanyal, Maxim Kikoler, Emily Simonoff, Sumithra Velupillai, Johnny Downs

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For typically developing adolescents, being bullied is associated with increased risk of suicidality. Although adolescents with autism spectrum disorder (ASD) are at increased risk of both bullying and suicidality, there is very little research that examines the extent to which an experience of being bullied may increase suicidality within this specific population. To address this, we conducted a retrospective cohort study to investigate the longitudinal association between experiencing bullying and suicidality in a clinical population of 680 adolescents with ASD. Electronic health records of adolescents (13–17 years), using mental health services in South London, with a diagnosis of ASD were analyzed. Natural language processing was employed to identify mentions of bullying and suicidality in the free text fields of adolescents' clinical records. Cox regression analysis was employed to investigate the longitudinal relationship between bullying and suicidality outcomes. Reported experience of bullying in the first month of clinical contact was associated with an increased risk suicidality over the follow-up period (hazard ratio = 1.82; 95% confidence interval = 1.28–2.59). In addition, female gender, psychosis, affective disorder diagnoses, and higher intellectual ability were all associated with suicidality at follow-up. This study is the first to demonstrate the strength of longitudinal associations between bullying and suicidality in a clinical population of adolescents with ASD, using automated approaches to detect key life events within clinical records. Our findings provide support for identifying and dealing with bullying in schools, and for antibullying strategy's incorporation into wider suicide prevention programs for young people with ASD. Autism Res 2020, 13: 988-997.

Original languageEnglish
Pages (from-to)988-997
Number of pages10
JournalAutism research : official journal of the International Society for Autism Research
Issue number6
Early online date21 Mar 2020
Publication statusPublished - 1 Jun 2020


  • adolescents
  • clinical psychiatry
  • comorbid conditions
  • data-driven techniques
  • epidemiology
  • longitudinal data analysis


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