Occurrence and Correlates of Suicidal Thoughts among Young Autistic Users of a Mental Health App

Background: Young autistic people experience disproportionately high rates of mental health challenges, yet little is known about factors associated with suicidality in this group. This study leveraged anonymous self-report data to identify correlates of suicidal thoughts.Methods: Secondary analysis was performed on data for 365 young (age 11-19+ years) users of a mental health app in the UK with an autism diagnosis or self-identifying as autistic. The presence of suicidal thoughts was assessed as a binary item. Binary logistic regression was used to explore correlates of suicidal thoughts across three domains: mental health-related symptoms, autism-related factors, and adverse life events/experiences. The final model included all significant correlates from domain models and demographic factors.Results: Suicidal thoughts were reported by 63% of participants, with similar rates across age groups. The final model accounted for nearly 50% of variability in the presence of suicidal thoughts (R²Nagelkerke = 0.48, p < 0.001). Self-harm and depression showed the strongest positive associations with suicidal thoughts (odds ratio (OR) and [95% confidence interval] = 6.41 [3.62, 11.35] and 4.58 [2.51, 8.35], respectively), followed by history of physical abuse (OR = 3.01 [1.20, 7.56]) and a transgender/gender-diverse identity (OR = 2.13 [1.11, 4.10]). Use of the term “neurodiversity”—reflecting a neurodiversity-affirming identity—was associated with lower likelihood of suicidal thoughts (OR = 0.45 [0.24, 0.83]). Conclusion: This study contributes to evidence of high rates of suicidal thoughts among young autistic people and associations with self-harm, depression, a history of abuse, and a gender minority identity. Self-identification with the term neurodiversity emerged as a potential protective factor against suicidal thoughts. These findings highlight the importance of access to autism-adapted mental health care, addressing trauma and identity-related stressors, and fostering belonging and connection through neurodiversity-affirming approaches as part of comprehensive suicide prevention strategies. Longitudinal research is needed to examine whether identity-affirming, connection-building interventions can support autistic youth experiencing suicidality.