The Bereaved Voices Project: A protocol for community-based psychological autopsy research to understand and prevent suicide in autistic people

BackgroundSince 2011, there has been a threefold increase in suicide deaths amongst autistic mental health patients in the UK. Autistic people report negative experiences of help-seeking for suicidal thoughts and behaviours, which increase hopelessness and suicidal intent. Suicide theories originating in non-autistic people are less accurate in explaining suicidal thoughts and behaviours in autistic people, but such theories have not yet been applied to explore suicide deaths in autistic adults.MethodsThis community-based psychological autopsy study harnesses a novel multi-disciplinary team of bereaved people, autism and suicide experts and practising psychiatrists to identify: (i) risk and protective factors for death by suicide and/or self-inflicted injury amongst autistic people; (ii) service-level improvements to avoid future deaths; and (iii) the feasibility and acceptability of research methods to inform future research in this area. Mixed-methods quantitative and qualitative analyses will inform the development of: (i) a conceptual model of pathways to suicide in autistic people; (ii) future service pathways and models; and (iii) methods guidance for the conduct of safe future research on this topic. DiscussionGiven scant previous research in this area, this project is the first to take a systematic approach to understand the experiences of autistic people who lost their lives to suicide from the perspective of those closest to them in life. Study outcomes will lead to: (i) increased conceptual understanding to inform future research and clinical practice; (ii) specific proposals for service level improvements, such as adaptations to processes such as mental health admission, removal of liberty, individual risk formulation and support; and (iii) the safe inclusion of bereaved autistic people in future research. Taken together, this novel study will significantly advance our understanding of suicide in autistic people to inform targeted prevention strategies and clinical improvements to practice.