Understanding depression and thoughts of self-harm in autism: A potential mechanism involving loneliness.

Background: Individuals with Autism Spectrum Disorder (ASD) are at increased risk of suicidal
ideation and behavior. This study characterized the inter-relationships between loneliness, depression
and thoughts of self-harm in adults with ASD.
Method: Participants were 71 adults with ASD who completed questionnaires that provided information
on loneliness, depression and thoughts of self-harm. Relationships between study
variables were examined with correlations and a regression analysis. Two exploratory mediation
models were then explored. Model 1 tested whether the relationship between depression and
thoughts of self-harm was mediated through loneliness. Model 2 tested whether loneliness acted
on thoughts of self-harm through depression.
Results: Twenty-six percent of participants met the clinical cut-off for depression and 21% reported
thoughts of self-harm. Depressive symptoms, loneliness, and thoughts of self-harm were
significantly correlated. Only Model 2, that identified an indirect pathway from loneliness,
through depression to thoughts of self-harm, was supported. The mediator for this model accounted
for 56.7% of the total effect.
Conclusions: This study examined potential mechanisms underlying depression and thoughts of
self-harm in ASD. These results highlight a possible contribution of loneliness to depression and
thoughts of self-harm, suggesting treatment options that target loneliness may prove beneficial in
improving mental health outcomes in ASD.