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Case Report: Antidepressant Discontinuation Linked to a Suicide Attempt

a pharmacist counts out medication for a patient over a clipboard

Understanding the possible connection between stopping medication and suicide risk

A recent case report published in the Journal of Clinical Psychology is the first known report of antidepressant discontinuation syndrome (ADS) and a suicide attempt.

The patient in question was a 22-year-old woman with a history of major depressive disorder (MDD), generalized anxiety disorder (GAD), alcohol use disorder (AUD), and anorexia nervosa (AN). She had been taking escitalopram, a selective serotonin reuptake inhibitor (SSRI) best known by the brand name Lexapro, for two years, before discontinuing the medication seven days before the suicide attempt.

While this is the first known, documented instance of an actual suicide attempt related to discontinuing antidepressants, previous studies have shown a link between ADS and suicidal ideation. More research is needed, but there is enough evidence to raise red flags that discontinuing antidepressants may increase the risk of suicide.

What is antidepressant discontinuation syndrome?

Antidepressant discontinuation syndrome (ADS), sometimes called antidepressant withdrawal, is a medical condition that occurs in people who stop taking an antidepressant after continuously using it for at least a month. The risk is higher for those who have been taking the medication for longer, and it can be reduced but not eliminated by tapering — that is, slowly reducing the dosage of the medication instead of stopping it all at once. Symptoms of ADS can include:

  • Flu-like symptoms (nausea, vomiting, headaches, sweating).
  • Sleep disturbances, such as insomnia and nightmares.
  • Sensory and movement disturbances, such as tremors and vertigo.
  • Mood disturbances, such as anxiety and agitation.
  • In rare instances, acute psychosis.

ADS is usually mild, with symptoms ending in one to four weeks. However, especially in patients already at elevated risk of suicide, there is a risk of much more severe consequences, including increased suicidality.

Doctors need to be aware of suicide risk and monitor patients appropriately.

ADS is just one example of a condition that may put a patient at an elevated risk of suicide during treatment. Other high-risk moments include medication changes more broadly, transitions from inpatient to outpatient care, and discharges from a psychiatric hospital or emergency room when mental health has been evaluated. In these situations, medical professionals need to be aware of the elevated risk of suicide and respond appropriately. That may include proactively scheduling follow-up appointments and check-ins, ensuring that patients have support resources in place, and communicating thoroughly during discharges and transitions to ensure that the patient doesn’t slip through the cracks.

Unfortunately, when medical professionals do not meet this standard of care, preventable tragedies can occur. If you lost a loved one to death by suicide, we would be honored to listen to your story and explain your rights and options. Our conversation is confidential, and there is no obligation, just answers. Contact the Law Offices of Skip Simpson for a free consultation. We’re based in Texas and represent families throughout the United States.

Could Folic Acid Help Prevent Suicide?

Open hand holding round pink pill.

A surprising medication may have a role to play in suicide prevention

A recent study has shown a surprising conclusion: people who take folic acid supplements may be at reduced risk of suicidal ideation and suicide attempts.

That’s according to researchers at the University of Chicago, who first became aware of a possible connection when a previous study looked at the effects of 922 medications on suicide risk. Most of the medications that were found to affect suicidality were what the researchers expected: antidepressants, antipsychotics, and so on. But surprisingly, folic acid (vitamin B9) also popped up in the study as a medication associated with reduced suicide risk.

“When we first saw this result, we thought it was pregnancy. Pregnant women take folic acid, and pregnant women tend to have a low suicide rate, so it’s just a false association. So, we just did a quick analysis to restrict it to men. But we saw exactly the same effect in men,” said Dr. Robert Gibbons, lead author of the study. After controlling for confounding factors, such as age, gender, other medications, and mental health conditions, the link between folic acid and reduced suicide attempts persisted.

The researchers also speculated that people who take a vitamin supplement might be trying to improve their health, and perhaps that means they’re less likely to be suicidal. But when they looked at another vitamin supplement, B12, they found no correlation — there really does seem to be something unique to folic acid.

The study results highlight the reality that suicide is preventable.

It’s important not to make too much of these results. This is only a single study, and while that study found a correlation, there is still no proof of a causal relationship between folic acid and reduced risk of suicide. More research needs to be done to determine whether folic acid is an effective suicide prevention tool.

However, this study drives home the point that suicidality is a medical condition like any other, and it can be treated with appropriate interventions. Medication is one piece of the puzzle, as is therapy and proper mental health care, including competent patient monitoring and frequency of visits.

People at risk of suicide need access to resources when they are most in danger and ongoing support from family, friends, and healthcare providers. Suicide is a preventable tragedy.

If you lost a loved one to suicide, we can fight for accountability.

There are many interventions that we know help to prevent suicide: therapy, support from loved ones, medication, mental health treatment, and, when necessary, inpatient treatment.

Physicians and other healthcare providers need to follow standards of care and take immediate action to protect patients at risk of suicide. When they do not, lives are put at risk — and accountability must be pursued.

If you have lost a loved one to suicide, we would be honored to listen to your story and explain your legal rights and options. Our conversation is confidential, and there is no obligation, just answers. Contact the Law Offices of Skip Simpson for a free consultation. We’re based in Texas and represent families throughout the United States.

5 Action Steps to Help Prevent Suicide

woman consoling a man who looks upset

How friends, family, and care providers should communicate with someone who may be suicidal

As Suicide Prevention Month comes to a close, it’s important to take a moment to reflect on what we all can do to protect our loved ones and people in our care from suicide. These five steps can make all the difference when it comes to speaking to someone who may be at risk of suicide.

Step 1: Ask – and listen to the answer

One of the most persistent myths about suicide is that bringing up the topic can actually push someone toward suicide. There is no evidence this is true. It’s important to name the issue and ask directly: “are you thinking about suicide?” Frame the question in a non-judgmental way to start an effective and potentially life-saving dialogue. (Remember, though, that you should never promise to keep their thoughts of suicide a secret – that’s a secret that you simply cannot keep if they are in danger.)

Then, listen to the answer. Take what they say seriously, focusing on the reasons they feel this way. Remember, the suicidal mind is deeply ambivalent; people who have thoughts of suicide also have strong reasons to go on living. The best way to respond is to emphasize and reinforce their reasons to go on living, not to impose someone else’s reasons on them.

Step 2: Be there for them

A significant reason people become suicidal is feelings of isolation. The way to combat isolation is with connectedness; ideally, that means physical presence, but speaking with someone on the phone or staying in contact with them in other ways is helpful too. The key is the follow-through: don’t commit to actions you can’t accomplish. Instead, help to connect the suicidal person with the resources they need.

Feeling connected to others is critical not just to lower feelings of suicidality in general but specifically to stop thoughts of suicide from escalating to action. Research has shown that connectedness is a key protective factor to avoid escalation and to guard against hopelessness.

Step 3: Put immediate safety first

If someone is at immediate risk of a suicide attempt, then their short-term safety has to be the top priority. Have they already attempted suicide? Do they have a specific plan to do so? If so, what’s the timing and method? Do they have access to their planned method? If the answer to most of those questions is “yes,” then immediate intervention is needed, such as calling for emergency services or, with their calm agreement, taking them to the emergency room. Exercise caution if you are taking an “at risk for suicide person” to the emergency room. It is possible the suicidal patient may, en route, have a change of heart, deciding they don’t want to go to the emergency room. The person may become combative or leap from the car.

The goal at this stage is to put as much distance as possible between the at-risk person and their chosen suicide method, especially if they have chosen a particularly lethal method. (As we’ve discussed previously, this is why access to firearms is such a critical factor.) The idea that once someone has a plan and they’ll just come up with a new plan is another myth; research has shown that if you can put safety measures in place to prevent an individual suicide attempt, you dramatically increase the chances of long-term survival.

Step 4: Connect with ongoing supports

Once a person’s immediate suicide risk is addressed, the next step is to connect them with ongoing support. That includes a safety plan: what will they do if they feel suicidal again? The 988 Lifeline is one such resource, along with local mental health resources and friends and family who can be contacted in a crisis.

It also includes finding ongoing resources, whether that’s a mental health professional, peer support, or community or spiritual resources. The key is to ensure that the at-risk person has access to resources who are trained and experienced in suicide prevention.

Step 5: The follow-up

The research is clear that following up with suicidal people after acute care is finished significantly reduces the risk of suicide. It’s important to check in, see how the person is doing, and ask if there is more you can do to help. Again, the key is maintaining that feeling of connectedness.

We all have a responsibility to do what we can to protect the people in our lives from suicide. The greatest responsibility, however, falls on medical professionals and mental health professionals who care for people at risk of suicide. If you lost a loved one to suicide completion, we would be honored to listen to your story and pursue accountability. Contact the Law Offices of Skip Simpson today for a free consultation. We’re based in Texas and serve families throughout the United States.

LGBTQ Youth Trauma and Suicide Risk

two people wrapped in a rainbow pride flag, holding hands while staring out into a foggy field.

A growing tragedy for our most vulnerable youth

LGBTQ youth have long been known to be at elevated risk of suicide, but recent research indicates a disturbing trend: that risk is getting even worse.

According to a survey published by the Trevor Project, an LGBTQ youth mental health nonprofit, 45% of young LGBTQ people seriously considered attempting suicide in 2021. Furthermore, the organization notes that this is the third consecutive year this figure has increased — a trend that notably predates the COVID-19 pandemic.

The organization surveyed nearly 34,000 LGBTQ people between ages 13 and 24 across the United States. The organization found that the highest rates of suicidality were among transgender and non-binary youth as well as Native/Indigenous youth, Black youth, and multiracial youth.

“We must recognize that LGBTQ young people face stressors simply for being who they are that their peers never have to worry about,” CEO and executive director of the Trevor Project Amit Paley said in a statement. The organization noted that there is nothing intrinsic to LGBTQ people that makes them more at risk of suicide; rather, the problem is the stigma and mistreatment they face at home, at school, and in society.

The findings show that suicide prevention must be inclusive.

The research highlights the need for affirming and inclusive suicide prevention. Public health initiatives that aim to reduce suicide risk must allow youth to “participate in treatment as their full selves,” as the Trevor Project researchers put it. In addition, suicide risk assessments must screen for trauma and consider the demonstrably higher risk among LGBTQ youth with a history of trauma.

More broadly, these findings highlight the critical importance of safe, secure, and supportive environments for LGBTQ youth, both to reduce suicide risk and improve mental health more generally. In safe, accepting communities, the number of suicide attempts among LGBTQ youth is significantly lower. Unfortunately, nearly 40% of LGBTQ youth say they live in somewhat or very unaccepting communities, putting them at increased risk.

Another critical issue is access to mental health services for LGBTQ youth who are struggling. According to the Trevor Project survey, most LGBTQ youth struggle with symptoms of anxiety or depression, yet 60% of those who said they wanted mental health care were unable to get it.

Parents, educators, and medical professionals must take LGBTQ youth suicide risk seriously.

The Trevor Project survey is part of a large body of research that sends a clear message: affirming, including, and supporting LGBTQ youth is a matter of life and death. Parents and caregivers of LGBTQ youth need to provide a supportive environment by talking respectfully with their children about their identity, welcoming their LGBTQ friends and partners, and educating themselves about LGBTQ issues. Teachers, coaches, and other professionals who work with LGBTQ youth need to be aware of the particular challenges they face and respond in a supportive manner. And medical professionals who treat LGBTQ youth must be mindful of the elevated risk of suicide and take all necessary steps to reduce that risk.

The Law Offices of Skip Simpson is proud to stand up for families who lose children or loved ones to suicide, including members of the LGBTQ community. If you have lost a loved one to suicide completion, we would be honored to discuss your legal rights and options in a free consultation. We are based in Texas but serve families nationwide.

Study: Cyberbullying Linked to Suicide Risk in Adolescents

teen girl sitting on bridge on cell phone near sunset

Youth suicide prevention has to include addressing bullying online

The connection between bullying, mental health, and suicide risk has been known for some time. In 2008, for instance, a Yale review of studies from 13 countries found that bullying was linked to suicide risk. But the link between specifically online bullying and suicide has been more difficult to pin down. Now, a recent study suggests that online bullying may pose suicide risks above and beyond offline bullying.

According to new research from the Lifespan Brain Institute (LiBI) of Children’s Hospital of Philadelphia (CHOP) and the University of Pennsylvania, young adolescents (between ages 10 and 13) who are victims of cyberbullying are more likely to report suicidal thoughts and suicide attempts. The study defined cyberbullying as “purposefully trying to harm another person or be mean to them online, in texts or group texts, or on social media (like Instagram or Snapchat).”

The same study also asked about offline bullying, which included behaviors such as threatening, hitting, being deliberately left out of activities, and spreading rumors or gossip. Notably, the researchers found that online and offline bullying only partially overlap; that is, while there are certainly some kids who are victims of both types of bullying, they are distinct behaviors — and cyberbullying itself is an independent suicide risk factor, not merely an extension of offline bullying.

Notably, the study found that while victims of cyberbullying are at an increased risk of suicidality, perpetrators of online bullying are not. This is distinct from offline bullying, where both victims and perpetrators are known to be at increased risk of suicide.

“For policy makers wishing to optimize youth suicide prevention efforts, this study should further encourage interventions for those who are being bullied online,” said senior study author Ran Barzilay, MD, Ph.D., an assistant professor at LiBI.

Black youth may be particularly at risk

Online bullying is a problem for youth of all races, but the evidence says it affects certain demographics more than others. For instance, a study published in the Journal of the American Academy of Child & Adolescent Psychology found that over the course of 2020, Black youth experienced increases in online racial discrimination, and those experiences were linked to poorer mental health. The study’s authors noted that White nationalist and online terror groups became more active online in the wake of the killings of Breonna Taylor, George Floyd, and other Black Americans; that Black youth experienced more online racism during this time; and that there may be a critical period following racial discrimination experiences, as same-day and next-day mental health were particularly adversely affected.

While this study did not examine suicidality specifically, other research has shown that suicides are on the rise among Black youth, and given that we now know there is a link between cyberbullying and suicide risk, it seems likely that online racism is a contributing factor. Youth suicide prevention efforts must include training on racial trauma and targeted interventions to report and address the effects of online hate speech.

A growing potential risk in a rapidly changing world

As young adolescents spend more time online than ever before — a trend accelerated by the COVID-19 pandemic — cyberbullying presents a growing threat. Unfortunately, it’s also a difficult threat to manage. While offline bullying usually ends at the end of the school day, children who are cyberbullied may feel like there is no escape; their bullies are on social media 24 hours a day, seven days a week. And adult intervention to stop cyberbullying may be more difficult: social media accounts can be hidden behind privacy settings, and adults may not be familiar enough with online norms and culture to even recognize that bullying is happening.

These problems are not unsolvable, however. Adults have a responsibility to our children to intervene and prevent cyberbullying as well as other behaviors that increase suicide risk. That starts with parents talking to their kids about what they’re experiencing online and schools enforcing anti-bullying policies on the ground and online. It also includes social media platforms, government officials, and medical professionals who screen children for suicidality or treat youth mental health issues.

More must be done to protect our youth, and that includes seeking accountability and justice when the system fails to protect a child. If you lost a child to suicide completion, the Law Offices of Skip Simpson would be honored to listen to your story in a free consultation. We are based in Texas and serve families nationwide.

Decline in Teen Mental Health May Increase Suicide Risk

A depressed teenager gazes stoically while she sits in a large gray chair.

The hidden impact of the pandemic on young Americans

It’s clear that the COVID-19 pandemic has affected most people’s mental health to one extent or another, but a recent survey sheds a light on a particularly vulnerable segment of the population: adolescents.

According to the Centers for Disease Control and Prevention (CDC), a national survey showed that more than four in 10 teens reported feeling “persistently sad or hopeless” in the first half of 2021, and a truly alarming one in five said they had contemplated suicide. The CDC found that the impact was disproportionately felt by female youth, LGBTQ students, and those who were treated unfairly because of their race.

The CDC attributes this mental health crisis to traumatic stressors from the pandemic that erode mental well-being.

“These data echo a cry for help,” said Debra Houry, a deputy director at the CDC.

But the survey results also offered a ray of hope: when schools are functioning at their best, they can provide that help.

Feeling connected and supported at school helps to prevent suicide

For young people who spend the majority of their waking hours at school, it’s unsurprising that there is a strong link between mental health and education. This is a self-reinforcing relationship: students with good mental health do better in school, and doing better in school improves mental health. The danger of a mental health crisis among teens is that it can become a vicious cycle, with poor mental health leading to worse school outcomes that further damage mental health. However, a safe and supportive school environment can be a bulwark against mental health problems in general and suicidality in particular.

That starts with school personnel. Teachers and school administrators can cultivate a safe and supportive environment in many ways, from better classroom management to making sure all students feel welcome regardless of gender, race, or sexual orientation. Schools that cultivate safe environments also connect students with strong support systems, including their parents, teachers, coaches, other adult caregivers, and peers.

Healthcare professionals, too, need to be aware of this growing youth mental health crisis and respond accordingly when treating young patients. That includes asking teens about their family and school relationships in routine health screenings, educating parents, and encouraging positive parenting practices. It also includes recognizing that teens are at elevated risk right now, and they need to take any warning signs of suicide seriously.

Accountability is key to helping prevent teen suicide

While the COVID-19 pandemic certainly did not help, America was facing a youth mental health crisis long before the pandemic. According to the CDC, the percentage of teens who reported “persistent feelings of sadness and hopelessness” increased from 26 percent in 2009 to 37 percent in 2019. The pandemic put this in stark relief: in the realm of mental health, we are failing our youth, and much more needs to be done to promote good mental health and prevent suicide.

Part of that work is fighting for answers and accountability when young lives are cut far too short by suicide. If you lost a child or any loved one to suicide, give us a call for a free and confidential consultation. The Law Offices of Skip Simpson is based in Texas and serves families nationwide.

Study: First-Time Gun Ownership Increases Suicide Death Risk in Cohabitants

handgun in holster lying on a dark floorExamining the safety consequences of bringing a handgun into the home

In the United States, we have the Second Amendment right to keep and bear arms. It’s always important to remember that this right comes with responsibilities, and one of those responsibilities is to be mindful of all the safety risks associated with a gun in the home.

Unfortunately, new research puts those risks in stark relief. A new study out of Northeastern University found that a woman’s risk of death by suicide increases by 40% when someone else in her previously gun-free home becomes a first-time handgun owner.

The study focused on adult women who lived with someone — whether a spouse, partner, or roommate — who brought at least one handgun into the home for the first time. None of the 330,000 women in the study owned guns themselves.

While these findings are troubling, they are also consistent with what we know about suicide more broadly: it’s usually an impulsive decision, and access to lethal means is strongly correlated with the risk of death.

Having access to a gun can make all the difference

One of the most common myths about suicide is that someone who is suicidal will eventually find a way, no matter what. If that person didn’t reach for a gun, this line of thinking goes, then they would have reached for something else. That line of thinking glosses over a critical detail: guns are far and away the most lethal commonly used suicide method. About 90% of firearm suicide attempts result in death, which is 50 times higher than the likelihood of death by other common methods like pills and cutting.

“If you reach for pills in that moment of vulnerability, you’re so much more likely to have a second chance at life than if you reached for a gun,” said Northeastern professor Matt Miller, who led the study. Miller added that “more than 90% of the people who survive a suicide attempt don’t go on to die by suicide thereafter. So if you prevent someone from reaching for a gun, you’ve probably saved their life, not only today but also in the long run.”

In short, while having a gun in the home may not increase the risk of a suicide attempt, it dramatically increases the risk that an attempt will end in death. Keeping a gun out of the hands of a suicidal person greatly increases the chances that they will survive, and most people who survive a suicide attempt do not go on to die by suicide. It’s an impulsive decision, and in time, that impulse will pass. Eliminating access to guns is a critical part of safety in those vulnerable moments.

Responsible gun ownership and secure storage of firearms are part of suicide prevention

None of this means that people should never own guns or keep them in their homes. What it means is that lawful gun owners need to think carefully about all the safety implications, including the suicide risk of their housemates, before they decide to bring a gun into the home. Most people who legally buy a gun do so to protect themselves and their households, but the data on suicide shows that this can tragically backfire.

In addition, if a gun is to be kept in the home, it must be safely stored. Indeed, this may be one reason first-time gun ownership is so dangerous: inexperienced gun owners may not know how to store their weapons safely. A study published in the Journal of Epidemiology & Community Health found that storing weapons locked and unloaded significantly reduces the risk of suicide by firearm. Again, this is consistent with what we know about suicide: it’s usually an impulsive decision that often involves reaching for whatever method is close at hand. Without ready access to an unlocked, loaded firearm, suicide by gun becomes much less likely.

Families who have lost loved ones to suicide have legal recourse

These findings on gun ownership speak to a universal truth: suicide is preventable, and many suicides are unfortunately the result of negligence or malpractice. The Law Offices of Skip Simpson has the experience and knowledge to investigate the circumstances of your loved one’s death by suicide and advise you on your legal rights and options. We are based in Texas and serve families nationwide. If you or anyone you know has lost someone to suicide, contact attorney Skip Simpson today.

Research Shows Increase in Adolescent Suicides During the Pandemic

Texas suicide lawyer

The impact of COVID-19 may have been especially harsh for youth mental health

It’s well known that the COVID-19 pandemic had a dramatic negative effect on mental health, especially among children and adolescents. Indeed, last year, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association declared a national emergency in child and adolescent mental health.

Unfortunately, new research has shone a light on the sobering consequences of this mental health crisis. According to a recently published study, at least five states saw an increase in the absolute number of youth suicides, and the overall proportion of youth suicides increased across the states studied.

Researchers partnered with public health departments in 14 states and reviewed death certificate data to identify adolescent deaths by suicide. In five states — Georgia, Indiana, New Jersey, Oklahoma, and Virginia — the total number of adolescent suicides increased. Those five states, along with California, also saw an increase in the proportion of adolescent suicides as a share of total suicides. Overall, the researchers found that the proportion of youth suicides in those 14 states was higher than before the pandemic.

It’s as yet unclear why the pandemic affected suicide rates in some states more than others. Some reasons might include the death or illness of caregivers in those adolescents’ lives, as well as in-person or virtual schooling.

Adult caregivers and service providers need to protect the youth in their care

Researchers say these findings highlight the importance of watching out for warning signs of suicide in children and adolescents. “We’re all kind of blind within our own families or households,” said Marie-Laure Charpignon, the first author of the study. Sometimes “we see what we want to see, or what we have the opportunity to see in the limited amount of time we have,” according to a CNN report on the study.

Some of the key warning signs of depression and suicidality in children and adolescents include:

  • Changes in routine, such as eating and sleeping habits
  • Developing personality changes or mood swings
  • Loss of interest in school, activities, or social interaction
  • Lack of response to praise
  • Neglecting personal appearance or hygiene
  • Giving away or discarding treasured belongings
  • Alluding to suicide in writing or speech, e.g. “I’m not going to be a problem for much longer” or “if anything happens to me…”
  • Risky or self-destructive behavior
  • Cheeriness after depressive episodes

It goes without saying that the pandemic has been difficult for people of all ages, and it seems entirely likely that adults may have been too consumed with the disruption of their own lives to see warning signs among the children in their care. Parents, guardians, teachers, coaches, and medical and mental health professionals alike have a role to play in preventing youth suicide. Spotting the warning signs is critical, and so is intervening appropriately to prevent suicide when those warning signs emerge.

Families of adolescent suicide victims have legal recourse

The law holds people who care for children at risk of suicide to high standards, and when those standards of care are not met, there must be accountability. The Law Offices of Skip Simpson has the experience and knowledge to investigate the circumstances and advise you on your legal rights and options. We are based in Texas and serve families nationwide. If you or anyone you know has lost a child to suicide, contact attorney Skip Simpson today.

The Link Between Autism Spectrum Disorder and Suicide

puzzle jigsaw heart on brain, mental health concept, world autism awareness day

A new British study has shed more light on the elevated risk of death by suicide among people on the autism spectrum.

The study, first published in the British Journal of Psychiatry, found that 10% of people who died by suicide in the United Kingdom had evidence of likely undiagnosed autism. That is 11 times higher than the rate of autism in the UK.

The results of the British study are in line with previous research on the link between autism and suicide. Last year, a Danish study found that individuals with diagnosed autism spectrum disorder (ASD) had more than three times the risk of suicide attempts and suicide completion compared to the general population. And a meta-analysis conducted by Columbia University and University of Colorado researchers concluded that children and adults with ASD had more than three times the risk of self-harm and a substantially increased risk for suicidality.

“The findings from our systematic review and meta-analysis underscore the need for targeted interventions to reduce the risk of self-harm in people with autism,” said a co-author of the latter study, Dr. Ashley Blanchard, assistant professor of emergency medicine at Columbia College of Physicians and Surgeons.

Within the autistic population, a Swedish study found that death by suicide is more common among individuals with mild autism than severe autism. The same study also found that autistic women are at greater risk than autistic men – notably, this is the reverse of the gender breakdown of suicides in the general population.

Why are people on the autism spectrum at elevated risk of suicide?

Among the heaviest emotional burdens carried by many people on the spectrum, especially women, is “camouflaging;” that is, making constant and elaborate effort to hide the signs of autism. A 2021 study found that camouflaging comes with a significant cost: physical exhaustion, anxiety, depression, and erosion of the sense of identity.

People on the autism spectrum may grow up being bullied or isolated socially, and the pain of those experiences can build up over time. Studies have also shown a connection between unmet support needs and suicidality in autistic people. This is a widespread problem: according to the National Institutes of Health, the majority of autistic adults have unmet needs for functional skills services, employment or vocation services, and mental and behavioral health services.

One of the key warning signs of suicide risk is feeling “trapped,” like there is no way out of an overwhelming situation. As the American Association of Suicidology notes, autistic people often have some cognitive inflexibility, meaning they can easily get stuck in a negative thought pattern and have difficulty considering alternatives.

Recognizing suicide warning signs in people on the autism spectrum can be difficult

Autism spectrum disorder affects perception, social interaction, communication, and patterns of behavior. One consequence of ASD is that the warning signs of suicidality may present differently in someone with ASD compared to a neurotypical person.

Much more research is needed to identify the warning signs of suicidality in people on the autism spectrum and develop screening methods and interventions that meet the unique needs of autistic people. For instance, people on the spectrum may not answer standard suicide screening questions as readily as others, or their answers may require more interpretation to assess the true risk of suicide. As an important step forward, the American Association of Suicidology recently released resources on its website for autistic people in crisis.

It’s also clear that the people who know an autistic person best – parents, siblings, partners, and close friends – are best-positioned to recognize that something may be wrong. Medical and mental health professionals need to listen to those voices and take suicide warning signs seriously. We know that people on the autism spectrum carry a high degree of suicide risk, and the healthcare system needs to respond accordingly to mitigate that risk.

Victims’ families may have legal recourse

Additional research and suicide prevention resources for people on the autism spectrum are sorely needed because far too many autistic lives are cut short by suicide. The Law Offices of Skip Simpson has the experience and knowledge to investigate the circumstances of suicide and advise families on how to proceed during an extraordinarily difficult time. Our law firm is based in Texas, but we serve clients nationwide. If you have lost a loved one to suicide completion, contact attorney Skip Simpson today.

Texas Bar Rule Change Allows Attorneys to Disclose Information to Protect Clients from Suicide

One of an attorney’s most serious responsibilities is respecting client confidentiality. However, a still greater responsibility is protecting the client’s life.

Last year, the State Bar of Texas rightly voted to amend the Texas Disciplinary Rules of Professional Conduct to allow lawyers to disclose confidential information “when the lawyer has reason to believe it is necessary to do so in order to prevent the client from dying by suicide.” (Rule 1.05. Confidentiality of Information)

The amended rule went into effect this year, allowing Texas attorneys to help their clients get the assistance they need to prevent suicide.

Here’s what attorney Skip Simpson said in support of the rule change:

“It may be one of the most dangerous situations—a client who is considering killing himself or herself. Should the lawyer reach out for assistance to prevent a suicide attempt? The answer is yes—and the lawyer needs a confidentiality of information exception to permit disclosure to prevent client death by suicide.

Lawyers may be confronted with clients who are so despondent about their circumstances that they state they are considering “leaving this earth,” “just disappearing,” or something else that worries the lawyer.

In those cases it is appropriate to ask the client, “Are you suicidal?”

Once the lawyer has started screening for suicidal thinking, the lawyer cannot be hampered by the notion of confidentiality. Even for mental health specialists, where there are concerns that the patient may be at risk for suicide, confidentiality is trumped by the need to save a life. Information from family, for instance, may be lifesaving; at such times, confidentiality must be broken.

The U.S. surgeon general and the National Action Alliance for Suicide Prevention issued the National Strategy for Suicide Prevention. Goal 7 of the report includes lawyers as professionals whose work brings them into contact with clients with suicide risk. The goal is to train lawyers on how to address suicidal ideations and on how to respond to those affected.

Part of responding to clients affected by suicidal thinking is reaching out for assistance.”

Originally published in the Texas Bar Journal, February 2021.