“For me, it is like a tide: it is always there...”: a qualitative exploration of dynamic suicidal thoughts in autistic adolescents
Abstract
Background Autistic young people are twice as likely to die by suicide than their non-autistic peers, but mechanisms driving this remain undefined. This study explored factors contributing to suicidal thoughts in adolescence (aged 11-15), alongside processes of coping and recovery.
Methods We conducted reflexive thematic analysis of semi-structured interviews with nine autistic young people (mean age=21.1) to produce conceptual models of: (i) suicide risk; and (ii) recovery.
Findings An over-arching theme described adolescent suicidal thoughts as omnipresent, fluctuating, and unpredictably building to crisis. Self-exploration uncovered multiple meanings and functions of suicidal thoughts. Nested sub-theme 1 described the development of autistic identity. Early experiences of rejection and de-humanisation resulted in existential questioning; self-discovery, neuroaffirming resources, and neurodivergent communities enabled agency and a protective autistic identity. Nested sub-theme 2 described marginalisation and social identity. Harmful school environments, pressure to mask autistic traits and invalidation in health services resulted in suicidal distress and crisis. Critical consciousness and leaving education enabled autonomy, purposeful coping and pursuit of life goals. Living well as an autistic person offered greatest protection, but recurrent setbacks and others’ lack of understanding hindered progress.
Interpretation Suicidal thoughts and feelings were shaped by interactions between autistic young people and their environment and marked by epistemic injustice. Findings resonate with the Integrated Motivational-Volitional model’s emphasis on defeat and entrapment; however, defeat was experienced early, and was pervasive and entrenched, while fluctuations in risk were shaped by harmful environments and neuronormative pressures. Findings further support the COURAGE model of suicide recovery, particularly domains for optimising identity, self-understanding, and meaning in life; however, domains dependent on social acceptance and empowerment were less well-supported, suggesting that opportunities were constrained by broader social and structural barriers. Across both models’ structural factors increased risk and constrained the conditions necessary for autistic people to live meaningful and sustainable lives. Clinicians should prioritise neuroaffirming approaches and resources, but lasting reductions in suicide risk in autistic young people will require structural change, including greater equality of opportunity and an urgent action to reduce the distress of educational environments.
Related
- Suicidal ideation, depressive experiences, and resilience among adolescents living with HIV in rural Ghana: a qualitative exploration of psychological experiences and coping
- Discrimination and school belonging independently but not interactively associated with suicidal thoughts among adolescents: a brief report
- Lived experiences, barriers, and facilitators of voluntary non-suicidal self-injury disclosure among adolescents who have disclosed: a qualitative systematic review protocol
- The lived experiences of primary caregivers supporting adolescents with non-suicidal self-injury: a qualitative systematic review and meta-aggregation
- A qualitative exploration of the psychosocial burden and coping among adolescents and young adults with hematologic malignancies
BibTeX
@misc{pelton2026like,
title = {{“For me, it is like a tide: it is always there...”: a qualitative exploration of dynamic suicidal thoughts in autistic adolescents}},
author = {Mirabel Pelton and Lilian Clark and Xinxin Zhu and Ed Flexney and Martha Enticott and Rachael Adams and Olivia King and Maria Gardani and Rachel L Moseley-Braund and Tanya Procyshyn},
howpublished = {PsyArXiv},
year = {2026},
month = sep,
doi = {10.31234/osf.io/n6cts_v2},
url = {https://osf.io/preprints/psyarxiv/n6cts_v2/},
note = {CC BY 4.0},
}
RIS
TY - UNPB
TI - “For me, it is like a tide: it is always there...”: a qualitative exploration of dynamic suicidal thoughts in autistic adolescents
AU - Mirabel Pelton
AU - Lilian Clark
AU - Xinxin Zhu
AU - Ed Flexney
AU - Martha Enticott
AU - Rachael Adams
AU - Olivia King
AU - Maria Gardani
AU - Rachel L Moseley-Braund
AU - Tanya Procyshyn
PY - 2026
DA - 2026/09/24
PB - PsyArXiv
DO - 10.31234/osf.io/n6cts_v2
UR - https://osf.io/preprints/psyarxiv/n6cts_v2/
AB - Background Autistic young people are twice as likely to die by suicide than their non-autistic peers, but mechanisms driving this remain undefined. This study explored factors contributing to suicidal thoughts in adolescence (aged 11-15), alongside processes of coping and recovery. Methods We conducted reflexive thematic analysis of semi-structured interviews with nine autistic young people (mean age=21.1) to produce conceptual models of: (i) suicide risk; and (ii) recovery. Findings An over-arching theme described adolescent suicidal thoughts as omnipresent, fluctuating, and unpredictably building to crisis. Self-exploration uncovered multiple meanings and functions of suicidal thoughts. Nested sub-theme 1 described the development of autistic identity. Early experiences of rejection and de-humanisation resulted in existential questioning; self-discovery, neuroaffirming resources, and neurodivergent communities enabled agency and a protective autistic identity. Nested sub-theme 2 described marginalisation and social identity. Harmful school environments, pressure to mask autistic traits and invalidation in health services resulted in suicidal distress and crisis. Critical consciousness and leaving education enabled autonomy, purposeful coping and pursuit of life goals. Living well as an autistic person offered greatest protection, but recurrent setbacks and others’ lack of understanding hindered progress. Interpretation Suicidal thoughts and feelings were shaped by interactions between autistic young people and their environment and marked by epistemic injustice. Findings resonate with the Integrated Motivational-Volitional model’s emphasis on defeat and entrapment; however, defeat was experienced early, and was pervasive and entrenched, while fluctuations in risk were shaped by harmful environments and neuronormative pressures. Findings further support the COURAGE model of suicide recovery, particularly domains for optimising identity, self-understanding, and meaning in life; however, domains dependent on social acceptance and empowerment were less well-supported, suggesting that opportunities were constrained by broader social and structural barriers. Across both models’ structural factors increased risk and constrained the conditions necessary for autistic people to live meaningful and sustainable lives. Clinicians should prioritise neuroaffirming approaches and resources, but lasting reductions in suicide risk in autistic young people will require structural change, including greater equality of opportunity and an urgent action to reduce the distress of educational environments.
ER -