Paper: "A Scoping Review of Warning Signs
for Suicide Among Autistic People"
This paper was published in 2026, in the journal Current Developmental Disorders Reports.
The authors were Dr Teal Benevides, Dr Mirabel Pelton, Dr Rachel Moseley, Dr Brenna Maddox, Dr Mary Donahue, & Ms Lisa Morgan. (author links will open in separate tabs)
You can click HERE to download a PDF of the paper. We also
produced a guide for professionals, autistic people and
those who support them (click the image to download it).
Read on for a plain English summary of the research!
Please note that the page might look better on a computer than
a phone (sorry about this!)
Why is this an important issue?
Suicide is a leading cause of premature death in autistic people. To prevent it, we need to know how to recognise signs that a person may soon engage in suicidal behaviour, including suicide attempts.
Warning signs are indicators that a person may soon attempt suicide. They might be things people say or do, or thoughts or feelings that they have. Warning signs can also include events that might trigger people to attempt suicide.
We don't know what warning
signs for suicide look like in
autistic people. Knowing this
can help others to intervene
to save lives.
The author team: Dr Teal Benevides, Dr Mirabel Pelton, me, Dr Brenna Maddox, Dr Mary Donahue, and Ms Lisa Morgan.
What was the purpose of this study, and what did the researchers do?
We did a scoping review to learn whether there was any research about warning signs for suicide in autistic people. A scoping review is when researchers systematically search the internet, as well as books, for articles about a given topic. We restricted our review to include only peer-reviewed scientific or clinical articles (rather than blogs, for instance), all of which needed to be in English.
As a group, we screened just over 200 papers, and reviewed 98 in depth. Fifteen were relevant to include in our write-up of warning signs for suicide in autistic people.
What were the results of the study?
We found that there is very little published information about warning signs for suicide in autistic people. Some of the information was quite vague and did not define warning signs clearly.
Nevertheless, the available information led us to identify the below warning signs as behavioural indicators that a person might soon engage in suicidal behaviour:
Increased withdrawal/isolation, beyond the person's 'normal'. It might be that they need more alone time than usual to self-regulate or recover, or that they are unable to recover/regulate despite taking more time.
Increased difficulty with change, finding it harder to move from one thing to another ('perseveration').
Experiencing shutdowns (perhaps more than usual), or having times when you can't communicate - for instance, losing the power of speech.
Changes in energy; decreased energy might be reflected in increased tiredness, fatigue, sleep disturbance. A person might alternatively show increased energy (when depression improves, it may enable them to act on suicidal desires).
Increased self-harm. The person might hurt themselves more frequently, more severely, and/or in more diverse ways. This may reflect that self-harm isn't helping as a way of self-regulating.
Losing pleasure or interest in usual activities and passions ('anhedonia'). This is a key sign of depression in autistic people. The person might stop engaging in their passions, or keep doing so, possibly at a decreased rate, without getting the same enjoyment out of it.
Seeking means to end their lives or making a suicide plan. The person may not physically write a plan, but there may be signs they are making preparations to die. For example, they might stockpile medication; buy weapons or tools to hurt themselves with; give away prized possessions or pets. They may seem happier, having made the decision to die.
Increased expressions of sadness or anger. The person might display more emotive behaviour, like tearfulness or shouting.
We also identified warning signs related to how people feel / their emotions:
Changes in mood. The person's mood might get markedly worse (i.e. more distressed, depressed). Alternatively, it might be that in people whose mood has been very low, their mood suddenly seems to improve, possibly indicating relief at making a decision to die.
Feelings of hopelessness about the world and the future. The person might feel that nothing will ever get better and there is no future for them.
Increased anxiety, guilt or anger. Anxiety might be a common experience for autistic people, but increased anxiety (and related symptoms, like racing thoughts) may indicate a person close to crisis. A person might alternatively, or addition, experience strong feelings of guilt (e.g. feeling like a burden) and/or anger.
Increased dysregulation or distress. The person might get overwhelmed and dysregulated more quickly and easily, for instance triggered by small things in their environment.
Warning signs related to things people say, and what they think, were much less common in published literature.
People might say that things are hopeless, that life is meaningless or pointless. They might say they want to die, go to sleep and not wake up, or that they don't want to be here anymore, or want to leave or go. They might indirectly say that they won't be here for upcoming events.
People might have 'obsessive negative' thoughts, 'repetitive and rigid suicide-orientated thinking' (meaning that thoughts of suicide keep intruding). People's thoughts might keep coming back to suicide, they might be fascinated by it and think deeply about ways and means of dying by suicide.
Warning signs related to precipitating events - things that happened before a person attempted suicide, and might have triggered them - were:
Very stressful events, deaths of important people or animals, or changes in circumstances (e.g. a relationship ending, becoming unemployed)
Importantly, sometimes people who knew an autistic person who died by suicide were unaware of any precipitating events before the person attempted or died by suicide. This might mean that there were no precipitating events, or that there were precipitating events which were very significant to the autistic person, but not significant to people around them.
There were sometimes warning signs that didn't fit neatly into behaviour, emotions, thoughts or talk, like changes in physical state. And sometimes, studies indicated that there were no warning signs, or none that were observable, preceding autistic people's suicide attempts or deaths.
What can we take from this?
1. Identifying warning signs that an autistic person might engage in suicidal behaviour is difficult. One of these signs, alone, may not indicate that the person is at risk. For example, increased anxiety might be situational, for instance related to an exam.
2. We need to look for constellations and context.
The person might not show every warning sign, but are multiple signs present?
What is this person's normal? Are they more anxious or withdrawn than usual? What is their normal behaviour like? Are there unusual circumstances going on?
To help professionals and loved ones identify warning signs for suicide in autistic people, we put together a guide.
It is based on what we learnt in our review, and on our expertise and experience: as researchers, clinicians, autistic people with experience of suicidal feelings, and/or supporters of autistic people with suicidal feelings.
Click on the image to download it!
It contains scenarios to illustrate each warning sign...
... and each scenario is explained with reference to research. We also point to further resources for clinicians, loved ones and autistic people, such as safety planning - a collaborative approach which includes helping people to identify their own warning signs (see this site for videos and guides).
Our guide is not an exhaustive list of warning signs!
We know that we don't know enough about warning signs for suicide in autistic people. People have to be vigilant for other individual ways that suicidal distress might be reflected in behaviour, emotions, speech, thoughts and other signs.
What are potential weaknesses in the study?
It's very hard to study warning signs because many studies are unclear about when things happened in relation to a suicide attempt. We did our best to interpret the information, but we need more information and more precise science.
We only included published sources that were peer-reviewed, meaning that we missed information we could have learnt from sources such as blogs. There are many more publications from high-income countries than low- or middle-income countries, because people in low- and middle-income countries have less opportunities to do research and publish their findings. We don't know if warning signs look different in autistic people from different countries and cultures, or if they look different in autistic people with different ethnic or racial backgrounds, sexes or genders.
How will these findings help autistic adults now or in the future?
It isn't always possible to spot the signs that a person is going to try to end their life. It is no one's fault when this happens. However, we hope that raising awareness about how suicidal distress might look outwardly in autistic people might help professionals and loved ones to support them before it is too late. Recognising warning signs might be an opportunity to save a life.
Thank you for reading!
If you found this interesting, you may like to read:
If you are struggling with feeling suicidal, I am deeply sorry. Please, please look at the resources page, just in case there is anything helpful for you
there.