Fetal Alcohol Spectrum Disorder and Suicidality: What Does the Literature Tell Us?
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| Title: | Fetal Alcohol Spectrum Disorder and Suicidality: What Does the Literature Tell Us? |
|---|---|
| Language: | English |
| Authors: | Flannigan, Katherine (ORCID |
| Source: | Journal of Mental Health Research in Intellectual Disabilities. 2022 15(3):217-252. |
| Availability: | Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals |
| Peer Reviewed: | Y |
| Page Count: | 36 |
| Publication Date: | 2022 |
| Document Type: | Journal Articles Information Analyses |
| Descriptors: | Fetal Alcohol Syndrome, Neurological Impairments, Suicide, Disabilities, Risk |
| DOI: | 10.1080/19315864.2022.2082604 |
| ISSN: | 1931-5864 1931-5872 |
| Abstract: | Introduction Limited research has been conducted on suicidality among individuals with FASD. The purpose of this scoping review was to understand (1) how suicidality has been measured; (2) what proportion of individuals experience suicidality across the lifespan; and (3) what contextual factors are associated with suicidality. Method We conducted a scoping review of the literature on FASD and suicidality. Twenty-eight articles and gray literature sources were included. Results We identified an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. Most studies were Canadian, published within the last 10 years, and focused on adolescents and adults in clinical settings. Only six studies were specifically designed to examine suicidality in FASD. Conclusion This review provides a foundational understanding of suicidality in FASD with important implications for research, policy, and practice. Rates of suicidality across the lifespan are high, underscoring the need for evidence-based approaches to screening, prevention, and treatment. |
| Abstractor: | As Provided |
| Entry Date: | 2022 |
| Accession Number: | EJ1354053 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwFLa67xAqnEJLiaeeUJzkU-AAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDPxgmaqftfbq4EKJhQIBEICBm81PfJCTgNw1UdQjQTwSHQpPsvwV0S33XF2YeW71iYlqyyLN21R22VlOfsSV21MKjNFVzRW8X-fEgA5ThfY-yE9sjwoH6GRiuZRLznWJq2cdZHqAqeVn-JkGqNDS6mHeYt-U31SWVg1jyySEBiemFJIMOaqsFKRj214DTiKmOM9YCBxYgY_XHIohqmjBcjeaFMhQ5s92ZXAGegC6 Text: Availability: 1 Value: <anid>AN0157442546;[5ew6]01jul.22;2022Jun16.06:01;v2.2.500</anid> <title id="AN0157442546-1">Fetal Alcohol Spectrum Disorder and Suicidality: What Does the Literature Tell Us? </title> <p>Limited research has been conducted on suicidality among individuals with FASD. The purpose of this scoping review was to understand (<reflink idref="bib1" id="ref1">1</reflink>) how suicidality has been measured; (<reflink idref="bib2" id="ref2">2</reflink>) what proportion of individuals experience suicidality across the lifespan; and (<reflink idref="bib3" id="ref3">3</reflink>) what contextual factors are associated with suicidality. We conducted a scoping review of the literature on FASD and suicidality. Twenty-eight articles and gray literature sources were included. We identified an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. Most studies were Canadian, published within the last 10 years, and focused on adolescents and adults in clinical settings. Only six studies were specifically designed to examine suicidality in FASD. This review provides a foundational understanding of suicidality in FASD with important implications for research, policy, and practice. Rates of suicidality across the lifespan are high, underscoring the need for evidence-based approaches to screening, prevention, and treatment.</p> <p>Keywords: Fetal alcohol spectrum disorder; suicidal ideation; suicide attempts; suicide; self-harm; mental health; lifespan; scoping review</p> <hd id="AN0157442546-2">INTRODUCTION</hd> <p>Throughout the world, an estimated 700,000 people die by suicide each year (World Health Organization, [<reflink idref="bib82" id="ref4">82</reflink>]). "Suicidality" is broadly defined as <emph>the risk of suicide</emph>, typically including suicidal ideation (i.e., thoughts of harming oneself with the intent to die) and suicidal behaviors (i.e., self-inflicted harm with the intention of death; American Psychology Association, [<reflink idref="bib1" id="ref5">1</reflink>]; Silverman et al., [<reflink idref="bib69" id="ref6">69</reflink>], [<reflink idref="bib70" id="ref7">70</reflink>]). An estimated 9% of the general population are reported to have experienced suicidal ideation and nearly 3% have made an attempt at some point in their lifetime (Nock et al., [<reflink idref="bib53" id="ref8">53</reflink>]). There are many theories about what might lead an individual to experience suicidality, such as the life course theory of suicide risk, the diathesis-stress model, cognitive-behavioral models, the escape from self-theory, and the interpersonal-psychological model, among others (O'Connor &amp; Nock, [<reflink idref="bib55" id="ref9">55</reflink>]); factors that may increase the risk of suicidality vary across the life course, (Chew &amp; McCleary, [<reflink idref="bib15" id="ref10">15</reflink>]; Gunnell &amp; Lewis, [<reflink idref="bib31" id="ref11">31</reflink>]), and many are rooted in an individual's genetics, neurobiology, and early life stressors (Ludwig et al., [<reflink idref="bib44" id="ref12">44</reflink>]). Potential risk factors range from individual and environmental characteristics, such as the presence of psychiatric disorders or exposure to early life abuse and neglect, to sociocultural contexts, such as socioeconomic status and disruption of cultural support (O'Connor &amp; Nock, [<reflink idref="bib55" id="ref13">55</reflink>]; Turecki &amp; Brent, [<reflink idref="bib79" id="ref14">79</reflink>]). Although many of these factors have been explored in isolation, researchers are now calling for more holistic and combined approaches to account for the complex, intersecting, and dynamic processes that influence how, when, and why suicide may occur (Franklin et al., [<reflink idref="bib25" id="ref15">25</reflink>]; Mann &amp; Arango, [<reflink idref="bib45" id="ref16">45</reflink>]; Nock et al., [<reflink idref="bib54" id="ref17">54</reflink>]).</p> <hd id="AN0157442546-3">Suicidality and Disability</hd> <p>Individuals with disabilities experience a heightened risk of suicidality compared to individuals in the general population. For example, physical disabilities associated with pain, mobility, and sensory problems are all linked to increased risk of suicidality (Giannini et al., [<reflink idref="bib29" id="ref18">29</reflink>]; Khazem, [<reflink idref="bib39" id="ref19">39</reflink>]; Khazem &amp; Anestis, [<reflink idref="bib40" id="ref20">40</reflink>]; Moses, [<reflink idref="bib51" id="ref21">51</reflink>]), as are neurodevelopmental disabilities, such as attention deficit hyperactivity disorder (Furczyk &amp; Thome, [<reflink idref="bib28" id="ref22">28</reflink>]; James et al., [<reflink idref="bib38" id="ref23">38</reflink>]; Yoshimasu et al., [<reflink idref="bib83" id="ref24">83</reflink>]), intellectual disabilities (Ludi et al., [<reflink idref="bib43" id="ref25">43</reflink>]), learning disorders (Fuller-Thomson et al., [<reflink idref="bib27" id="ref26">27</reflink>]), and autism (Hedley &amp; Uljarević, [<reflink idref="bib32" id="ref27">32</reflink>]), and having <emph>multiple</emph> disabilities may significantly compound suicide risk (Moses, [<reflink idref="bib51" id="ref28">51</reflink>]). This increased risk of suicidality among individuals with disabilities has been linked to a number of factors including a higher levels of stress, poorer mental and physical health, fewer positive coping skills, minority sexual preference and gender identity, negative family experiences, fewer social supports and greater social victimization, weaker engagement with school and lower academic performance, increased high-risk behaviors (including substance use), involvement in the justice system, as well as lower socio-economic status, and poorer neighborhood connectedness and safety than individuals without disabilities (Moses, [<reflink idref="bib51" id="ref29">51</reflink>]). This evidence aligns with research showing the compounding impacts of disability and adversity, which further elevates the risk of suicidality (Fuller-Thomson et al., [<reflink idref="bib27" id="ref30">27</reflink>]; Moses, [<reflink idref="bib51" id="ref31">51</reflink>]).</p> <p>Despite what is known about the heightened risk of suicide among individuals with disabilities, especially those with co-occurring mental health challenges and adverse life experiences, relatively little research has been conducted on suicidality among individuals with fetal alcohol spectrum disorder (FASD). FASD is one of the most common neurodevelopmental disabilities and is characterized by significant brain- and body-based challenges stemming from in utero exposure to alcohol (Cook et al., [<reflink idref="bib16" id="ref32">16</reflink>]). Prenatal alcohol exposure (PAE) can profoundly impact an individual's neurobiology and behavior, resulting in increased reactivity to stress (Hellemans et al., [<reflink idref="bib33" id="ref33">33</reflink>]) and executive dysfunction, including impulsivity (Rasmussen et al., [<reflink idref="bib66" id="ref34">66</reflink>]), both of which have been associated with an increased risk for suicidality in non-FASD populations (Bredemeier &amp; Miller, [<reflink idref="bib10" id="ref35">10</reflink>]; D. B. O'Connor et al., [<reflink idref="bib56" id="ref36">56</reflink>]). In addition to these brain-based impacts of PAE, individuals with FASD also experience high rates of environmental adversity (McLachlan, Flannigan et al., [<reflink idref="bib48" id="ref37">48</reflink>]; Price et al., [<reflink idref="bib63" id="ref38">63</reflink>]; Streissguth et al., [<reflink idref="bib74" id="ref39">74</reflink>]), as well as co-occurring mental health (Pei et al., [<reflink idref="bib60" id="ref40">60</reflink>]; Weyrauch et al., [<reflink idref="bib81" id="ref41">81</reflink>]) and substance use concerns (Dodge et al., [<reflink idref="bib20" id="ref42">20</reflink>]; Goldschmidt et al., [<reflink idref="bib30" id="ref43">30</reflink>]). Together, these complex biopsychosocial vulnerabilities associated with FASD overlap substantially with the risk factors for suicidality identified in other populations. As early as 1996, researchers reported suicidality to be a major concern for individuals with FASD (Streissguth et al., [<reflink idref="bib73" id="ref44">73</reflink>]), with suicidal threats and attempts reported in more than 40% and 20% (respectively) of adults with FASD aged 21 years and older. Yet, to the authors' knowledge, there have been no comprehensive efforts to date to consolidate the existing evidence on FASD and suicidality. Here, we reviewed this literature, guided by the following research questions:</p> <p></p> <ulist> <item> How has suicidality been measured in PAE/FASD research?</item> <p></p> <item> What proportion of individuals with PAE/FASD experience suicidality across the lifespan?</item> <p></p> <item> What contextual factors are associated with suicidality among individuals with PAE/FASD in the literature to date?</item> </ulist> <p>Understanding the state of the evidence on FASD and suicidality will allow us to better appreciate the scope of the issue, discern factors that may contribute to or reduce the likelihood of suicidality, identify potential targets for treatment and prevention, and reveal gaps to be considered for future research, all of which may support healthier outcomes for individuals with FASD and their families.</p> <hd id="AN0157442546-4">MATERIALS AND METHODS</hd> <p>This study was part of a larger research project designed to identify the contextual, risk, and protective factors for suicide among individuals with FASD. Our goals with the current study were two-fold: 1) to summarize and disseminate the current evidence on suicidality and FASD, and 2) to examine the overall state of the literature to identify gaps and potential directions for advancing the field. Our chosen approach was a scoping review. While both scoping and systematic reviews are robust and comprehensive methods for synthesizing large bodies of evidence, systematic reviews are often limited to academic literature and used to address well-defined research questions, confirm current or identify new practices, assess the quality of evidence, identify conflicting research, inform future research, and/or guide decision-making (Arksey &amp; O'Malley, [<reflink idref="bib2" id="ref45">2</reflink>]; Munn et al., [<reflink idref="bib52" id="ref46">52</reflink>]; Peters et al., [<reflink idref="bib62" id="ref47">62</reflink>]). In contrast, scoping reviews are considered more appropriate as an approach to "mapping," clarifying, and providing an overview of evidence; examining common characteristics or factors related to certain constructs; and identifying knowledge gaps, particularly in emerging or broader areas of research (Arksey &amp; O'Malley, [<reflink idref="bib2" id="ref48">2</reflink>]; Munn et al., [<reflink idref="bib52" id="ref49">52</reflink>]; Peters et al., [<reflink idref="bib62" id="ref50">62</reflink>]). Furthermore, whereas systematic reviews are often limited to the scientific literature, there are no restrictions on the types of records that may be included in a scoping review. This broad scope was an important advantage in this study, given the anticipated scarcity of academic research in the area of FASD and suicidality.</p> <p>With these aims in mind, we followed Arksey and O'Malley's ([<reflink idref="bib2" id="ref51">2</reflink>]) five-step process for scoping reviews to guide us in defining our research questions, identifying relevant studies, selecting key articles, charting the data, and collating and reporting the results. During collation and reporting, we organized suicidality-related findings based on a thematic framework derived from our research questions (i.e., measurement of suicidality, rates across the lifespan, and associated contextual factors). Our scoping review protocol was registered with Open Science Framework (Scoping Review Procedures for Review and Analysis, doi:10.17605/OSF.IO/38J2G).</p> <hd id="AN0157442546-5">Eligibility Criteria</hd> <p>We examined literature in peer-reviewed journals, as well as web-based policy and research documents. Records were included if they were publicly available (in English) in the academic or gray literature, and 1) involved human participants with PAE or FASD of any age or gender, and 2) offered new empirical data or evidence-based recommendations (versus review studies or commentary-type papers). Literature published from 1996 to present was reviewed to reflect all evidence on FASD and suicidality generated since Streissguth et al. ([<reflink idref="bib73" id="ref52">73</reflink>]) landmark report.</p> <hd id="AN0157442546-6">Search Strategy and Study Selection</hd> <p>The search strategy for this study was two-pronged, beginning with the collection of peer-reviewed academic materials followed by a targeted search of the gray literature. Between July 30 and August 4, 2020,[<reflink idref="bib1" id="ref53">1</reflink>] the electronic databases Medline (1950-Present), CINAHL, Social Services abstracts, PsycINFO (1827-Present), Web of Science (1975 to Present), and the Cochrane Database of Systematic Reviews were searched. The subject headings and keywords used are outlined in Appendix. They included, but were not limited to, fetal alcohol spectrum disorder, self-injury, self-harm, and suicide. This search strategy was developed in collaboration with the librarian on the team who completed each database search. A second librarian peer-reviewed the search using the Peer Review of Electronic Search Strategies (PRESS) checklist (see acknowledgments).</p> <p>Following review of the academic literature, we conducted a search of relevant gray literature in September 2020 with targeted web-based searches for materials that may not have been captured in the academic literature search. Targeted gray literature sources included government sites, health funders, and other organizations that might include research or evaluation involving individuals with FASD, their families, and their larger communities pertaining to suicidality (e.g., the Canada FASD Research Network, the Canadian Center on Substance Use and Addiction, the Canadian Mental Health Association, the Center for Addiction and Mental Health, etc.). Gray literature documents included conference materials, policy documents, quality improvement reports, and program evaluation reports. Keywords used for the gray literature search were the same as the academic search. We also screened documents or newly published papers that were shared with the research team by other members of the larger project team and/or the FASD community during the preparation of this article (up to November 2021).</p> <p>At each stage of the review and decision-making process, relevant records were independently screened and reviewed by two authors, followed by a review by a third author. Title and abstract screening and review was conducted by two authors (A2, A7) and then checked by a third author (A1). Full texts of articles and gray literature documents were reviewed by three authors (A1, A2, and A7) and data extraction was conducted by two authors (A1, A2). Any discrepancies were resolved through discussions with four additional authors (A3, A4, A5, and A7).</p> <hd id="AN0157442546-7">Data Charting</hd> <p>Data were charted systematically and independently by two authors (A1, A2) for each study included in the review. Study details were first extracted, including author(s), year of publication, country, study design, participant characteristics, and data source/setting (see, Table 1). Information was then extracted specific to suicidality, including the overall research question/purpose, aspect of suicidality measured or reported, and key suicidality-related findings (see, Table 1).</p> <p>Table 1. Study details and key findings</p> <p> <ephtml> &lt;table&gt;&lt;thead&gt;&lt;tr&gt;&lt;td&gt;Author, Year, Country&lt;/td&gt;&lt;td&gt;Research Purpose &amp; Design&lt;/td&gt;&lt;td&gt;Study Sample&lt;/td&gt;&lt;td&gt;Data Source/Setting &amp; Aspect of Suicidality&lt;/td&gt;&lt;td&gt;Key Findings&lt;/td&gt;&lt;/tr&gt;&lt;/thead&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td&gt;Baldwin (&lt;xref ref-type="bibr" rid="bibr6"&gt;2007&lt;/xref&gt;), US&lt;/td&gt;&lt;td&gt;Present a case report and review clinical data on FASD and suicidality; Case report and retrospective record review (academic article)&lt;/td&gt;&lt;td&gt;&lt;italic&gt;Case report&lt;/italic&gt;: One female with PAE (15 years) &lt;italic&gt;Database review&lt;/italic&gt;: 451 children with PAE referred for FASD assessment (3 to 18 years)&lt;/td&gt;&lt;td&gt;Psychiatric consultation in ER; review of FASD referral database &lt;italic&gt;Case report&lt;/italic&gt;: Suicide threats; suicidal ideation; suicide attempts &lt;italic&gt;Database review&lt;/italic&gt;: Consultation for self-harm/suicidal ideation (pooled)&lt;/td&gt;&lt;td&gt;&lt;italic&gt;Case report&lt;/italic&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Admitted in emergency because of suicide threats&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Ideation for five days prior&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Current stressors: parental chronic illness and substance use challenges; familial conflict; consequences of assaulting peer&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;History of sexual abuse&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Familial history of mental health and substance use concerns; suicide attempts&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;No previous attempts but ideation on two prior occasions&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Past diagnoses: ADHD, ODD, MDD, cognitive disorder, developmental dyslexia, LD&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Difficulties with self-regulation (poor anger management, temper outbursts, emotional lability); and adaptive skills&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Assessed for FASD 3 months later, diagnosed with ARND&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;italic&gt;Database review&lt;/italic&gt;: &lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;2.2% of children and adolescents with PAE had received consultation for self-harm/suicidal ideation; of participants 13 to 18 years, 5.8% had received such consultation&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Brackenreed (&lt;xref ref-type="bibr" rid="bibr9"&gt;2013&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Identify key areas of concern and needs of an adult with FASD; Descriptive case study (academic article)&lt;/td&gt;&lt;td&gt;One adult male with PAE and his spouse (age not reported)&lt;/td&gt;&lt;td&gt;Semi-structured interview Suicide attempts&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Two previous suicide attempts&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;History of learning problems and challenges at school; substance use issues; financial and housing instability; difficulty maintaining employment&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Familial history of substance use challenges, severe abuse, and suicide&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Raised in supportive adoptive family&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Described by his wife as a "very smart caring man" and "a wonderful father"&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Brownell et al. (&lt;xref ref-type="bibr" rid="bibr11"&gt;2019&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Examine difference in health, social, education, and justice outcomes for Indigenous children with and without FASD; Retrospective cohort study (academic article)&lt;/td&gt;&lt;td&gt;2972 Indigenous individuals (1 to 25 years), with (n = 743) and without (n = 2229) FASD; 315 non-Indigenous individuals with FASD&lt;/td&gt;&lt;td&gt;Administrative data from health, social services, education, and justice linked with FASD clinical records Suicide/suicide attempts (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;40 cases of suicide attempts or deaths among participants&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Among children 10 and older, suicidality rates were higher among Indigenous children with FASD than Indigenous children without FASD; rates were also higher among males than females in both groups&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;No suicidality was reported among non-Indigenous children with FASD&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Burns et al. (&lt;xref ref-type="bibr" rid="bibr12"&gt;2021&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Compare outcomes of Canadian children and adolescents with FASD living in child welfare settings versus those living with biological or adoptive/other family members; Retrospective record review (academic article)&lt;/td&gt;&lt;td&gt;665 children and youth with FASD (up to 18 years)&lt;/td&gt;&lt;td&gt;National FASD assessment and diagnostic clinical database Suicidal ideation/suicide attempts (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Suicidality rates ranged from 17.8% to 27.3%&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;There were no differences in rates of suicidality between participants living in care versus with biological or adoptive/other family members&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Chatterley-Gonzalez (&lt;xref ref-type="bibr" rid="bibr14"&gt;2010&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Explore the experiences and needs of young people with FASD in care; Cross-sectional qualitative study (master's thesis)&lt;/td&gt;&lt;td&gt;5 adolescents and young adults with PAE who had lived in care (16 to 28 years)&lt;/td&gt;&lt;td&gt;Personal interview Suicidal ideation; suicide attempts&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Two participants reported experiences with suicidality, and both had multiple admissions to crisis units and psychiatric inpatient facilities for suicidal ideation/attempts&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Both individuals described multiple co-occurring mental health challenges, including depression, anxiety, PTSD, ADHD, and ODD&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Denys et al. (&lt;xref ref-type="bibr" rid="bibr17"&gt;2011&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Investigate the effectiveness of the Step-by-Step mentorship program for parents with FASD; Retrospective record review (academic article)&lt;/td&gt;&lt;td&gt;24 parents with suspected or diagnosed FASD (19 to 47 years)&lt;/td&gt;&lt;td&gt;Record review of clients who completed a parenting mentorship program Self-harm/"suicidal" (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;8% of participants were reported to have a history of "self-harm and suicide issues"&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Deren (&lt;xref ref-type="bibr" rid="bibr18"&gt;2019&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Examine criminogenic risk and protective factors among youth who completed a court-ordered psychological assessment; Retrospective record review (master's thesis)&lt;/td&gt;&lt;td&gt;73 justice-involved youth (13 to 18 years), with (n = 37) and without (n = 36) FASD&lt;/td&gt;&lt;td&gt;Historical or retrospectively scored data from the &lt;bold&gt;SAVRY&lt;/bold&gt; Self-harm/suicide attempts (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;21.2% of youth with FASD were rated as having moderate risk (i.e., self-harm not requiring medical assistance, and no intent to die)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;An additional 21.2% of youth with FASD were rated as having high risk (i.e., self-harm requiring medical assistance or suicide attempt)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Dirks et al. (&lt;xref ref-type="bibr" rid="bibr19"&gt;2019&lt;/xref&gt;), Germany&lt;/td&gt;&lt;td&gt;Examine substance use, comorbid psychiatric disorders, and suicide attempts among adults with FASD; Cross-sectional mixed methods study (academic article)&lt;/td&gt;&lt;td&gt;31 adults with FASD (17 to 53 years)&lt;/td&gt;&lt;td&gt;Structured interview (&lt;bold&gt;MINI&lt;/bold&gt;; EUROP-ASI-R) as part of a specialized in-hospital FASD diagnostic service Suicide attempts&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;25.8% of participants reported at least one suicide attempt&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Farasi (&lt;xref ref-type="bibr" rid="bibr21"&gt;2010&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Explore the effectiveness of FASD programs and services for Indigenous children and youth with FASD in British Columbia; Cross-sectional qualitative study (master's thesis)&lt;/td&gt;&lt;td&gt;27 "key informants" including FASD researchers, service providers, government representatives, caregivers/parents, and elders&lt;/td&gt;&lt;td&gt;Semi-structured interviews and one focus group Suicide attempts; suicide&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;A parent of an adult with FASD who died by "accidental" suicide reported that FASD was recorded as a "secondary cause" of suicide in her son's death; this was a "first in Canada"&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;She noted that her son had multiple previous attempts (which she described as "fake"), and that community housing would have saved him&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Flannigan, McMorris (&lt;xref ref-type="bibr" rid="bibr24"&gt;2022&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Investigate the rates of suicidality and associated demographic and biopsychosocial factors in individuals with PAE; Retrospective record review (academic article)&lt;/td&gt;&lt;td&gt;796 individuals with PAE (6 to 59 years)&lt;/td&gt;&lt;td&gt;National FASD assessment and diagnostic clinical database Suicidal ideation/suicide attempts (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Across the whole sample, 25.9% of participants were reported to experience suicidality&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;By demographic group, rates of suicidality were highest among adolescents and transition-aged youth, individuals who resided in Western/Northern Canada, and those in group care&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Neurodevelopmental impairment (especially affect regulation and adaptive function), sleep problems, co-occurring mental health diagnoses (especially anxiety, depression, and PTSD), substance use challenges, history of trauma/abuse, and socio-environmental difficulties (especially legal problems and independent living needs) were significantly associated with suicidality&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Findings from regression analysis indicated that the odds of suicidality increased nearly 7-fold for those with substance use issues, 3-fold for those with history of trauma/abuse, and 2-fold for those impaired affect regulation&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Himmelreich et al. (&lt;xref ref-type="bibr" rid="bibr34"&gt;2020&lt;/xref&gt;), Canada/US&lt;/td&gt;&lt;td&gt;Broadly explore health issues in individuals with FASD; Cross-sectional survey (book chapter)&lt;/td&gt;&lt;td&gt;541 adolescents and adults with FASD (&amp;#60;16 to &amp;#62;60 years)&lt;/td&gt;&lt;td&gt;Community-based online health survey Suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;29.7% of participants in the survey were reported to have had attempted suicide&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Huggins et al. (&lt;xref ref-type="bibr" rid="bibr37"&gt;2008&lt;/xref&gt;), US&lt;/td&gt;&lt;td&gt;Explore suicide risk factors in the context of FASD, and compare clinical profiles of individuals with FASD who had attempted suicide with those who had not; Pilot study with case vignettes (academic article)&lt;/td&gt;&lt;td&gt;11 young adults with FASD (18 to 29 years)&lt;/td&gt;&lt;td&gt;Clinical research interview (&lt;bold&gt;LPS&lt;/bold&gt;*, YASR, &lt;bold&gt;SCID&lt;/bold&gt;) Self-harm ("parasuicidal behavior"); suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;6/11 (55%) participants reported past suicide attempt(s)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Age of first attempt ranged from 8 to 19 years; most attempts were in response to interpersonal or family distress and conflict; methods, lethality, and intent were varied; none received medical or psychological attention after their first attempt; 5/6 had a subsequent attempt, 3 of which led to an ER visit, and 2 resulted in psychiatric hospitalization&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;All 11 participants had elevated psychosocial and behavior problems compared to same-age norms&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;A greater proportion of participants who attempted suicide had current or past mental health and substance use disorders, a history of abuse or domestic violence, and unreliable or inconsistent financial and family support&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;No group differences were statistically significant&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Landgren et al. (&lt;xref ref-type="bibr" rid="bibr42"&gt;2019&lt;/xref&gt;), Sweden&lt;/td&gt;&lt;td&gt;Characterize outcomes among young adults with FASD reared in a socially favorable rearing environment, and evaluate the diagnostic stability of FASD into adulthood; Population-based cohort study (academic article)&lt;/td&gt;&lt;td&gt;36 young adults (18 to 28 years), diagnosed with FASD in childhood and followed up 13 to 17 years later&lt;/td&gt;&lt;td&gt;Multidisciplinary clinical evaluation (social, medical, psychiatric, ophthalmological, psychological) Suicide attempt; self-injurious behavior; self-harm&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;21% of participants had made a past suicide attempt&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;24% had a history of self-injurious behavior&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Additional information in a supplementary appendix was provided for three individuals with history of suicidality: two had attempted suicide in the past (one as a child, one as a teenager) but presented with no psychopathology at the time of the study; one had a history of depression, self-harm, suicide attempts, and sexual assault, and presented with persistent mental health concerns and pain problems at the time of the study&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;McLachlan (&lt;xref ref-type="bibr" rid="bibr46"&gt;2012&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Examine the psycholegal abilities, experiences with the justice system, and risks associated with offending among youth with FASD; Cross-sectional mixed methods study (doctoral dissertation)&lt;/td&gt;&lt;td&gt;100 justice-involved youth (12 to 23 years), with (n = 50) and without (n = 50) FASD&lt;/td&gt;&lt;td&gt;Semi-structured interviews; clinical forensic assessment (including the &lt;bold&gt;SAVRY&lt;/bold&gt;); intellectual and academic tests Self-harm/suicide attempt (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Youth with FASD had much higher scores on a measure of historical self-harm/suicide attempts than youth without FASD (mean 1.36 vs 0.60 on the SAVRY, where 0 = low risk, 1 = moderate risk; 3 = high risk)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;McLachlan et al. (&lt;xref ref-type="bibr" rid="bibr47"&gt;2019&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Estimate the prevalence of FASD in a Canadian correctional population; Active case ascertainment study (academic article)&lt;/td&gt;&lt;td&gt;80 justice-involved adults (18 to 40 years), 20 (25.0%) of whom had confirmed PAE, and 14 (17.5%) of whom were diagnosed with FASD&lt;/td&gt;&lt;td&gt;Interdisciplinary medical and neurobehavioral assessments (medical and psychological evaluations) Suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;41.2% of participants were reported to have attempted suicide in the past&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Rates of past suicide attempt were comparable across groups: 43% of participants diagnosed with FASD, 46% of those deferred, and 40% of those not diagnosed&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;McLachlan, Amlung et al. (&lt;xref ref-type="bibr" rid="bibr49"&gt;2020&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Explore the feasibility and utility of FASD screening tools in a Canadian forensic mental health program; Quasi-cohort, cross-sectional mixed methods study (academic article)&lt;/td&gt;&lt;td&gt;41 adults in a forensic mental health setting (mean age 39 years; range not reported), and an additional 110 patient charts&lt;/td&gt;&lt;td&gt;Retrospective chart review and interview (including the LHS) Suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Individuals identified as being at high risk for FASD (i.e., previous diagnosis or evidence of PAE) had higher rates of a previous suicide attempt (100%) than those in the lower risk group (27%)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;M. J. O'Connor et al. (&lt;xref ref-type="bibr" rid="bibr57"&gt;2019&lt;/xref&gt;), US&lt;/td&gt;&lt;td&gt;Examine the prevalence of suicidal ideation and serious suicide attempts in a group of adolescents with FASD; Subset of intervention study (academic article)&lt;/td&gt;&lt;td&gt;54 adolescents with PAE (13 to 18 years)&lt;/td&gt;&lt;td&gt;Physical examination, neurocognitive testing, behavioral questionnaires as part of an FASD assessment; structured psychiatric interview (&lt;bold&gt;ChIPS&lt;/bold&gt;) Suicidal ideation; "serious" suicide attempt (i.e., requiring medical care)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;35.2% of participants endorsed past-year suicidal ideation in the past year&lt;/p&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;No sex differences in suicidal ideation (41.7% males vs 31.0% females)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;13% of participants had made at least one serious suicide attempt (i.e., that involved a wish to die and required medical assistance) in the past year&lt;/p&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Sex differences were found, with males reporting a significantly higher rate of serious suicide attempts (29.2%) than females (0%)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Among males, those who attempted suicide had significantly lower IQ scores than those who had not attempted&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Participants with a higher number of home placements were more likely to report suicidal ideation and attempts&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;The presence of a depressive disorder was also related to suicidality: 36.8% of youth who met criteria experienced suicidal ideation, and 42.9% of males who met criteria experienced a serious attempt&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Number of home placements and presence of a depressive disorder predicted both suicidal ideation and serious suicide attempts in regression models&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;O'Malley and Huggins (&lt;xref ref-type="bibr" rid="bibr58"&gt;2005&lt;/xref&gt;), US&lt;/td&gt;&lt;td&gt;Illustrate the risk of suicide in adolescents and adults with FASD and its clinical manifestation; Pilot study report and two case vignettes (letter to the editor)&lt;/td&gt;&lt;td&gt;2 adult males with FASD (19 and 21 years) (&lt;italic&gt;subset of&lt;/italic&gt; Huggins et al., &lt;xref ref-type="bibr" rid="bibr37"&gt;2008&lt;/xref&gt;)&lt;/td&gt;&lt;td&gt;Convenience sample from a larger clinical study to describe the life course of individuals with FASD Suicide attempt&lt;/td&gt;&lt;td&gt;Pilot study data &lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;6/11 (55%) participants reported at least one lifetime suicide attempt; 2 were classified as severe, 3 were classified as moderate, and 1 was classified as low risk&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Only one participant was receiving mental health treatment at the time of the study, in the form of medication management&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt; Case studies &lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;One participant attempted suicide because he was "enraged" at his parents, who he felt were "smothering him" but being unable to express himself verbally, he attempted suicide; he later described his "overwhelming suicidal urges" as being a result of feeling "trapped"&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;The second participant felt socially isolated but lacked the resources to live away from home; he starved himself without the intention to die and was later diagnosed with "severe persistent melancholic depression" and responded to medication&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Based on this data, the authors proposed that lethality of a suicide attempt or self-harm does not correlate with the intent&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Peled et al. (&lt;xref ref-type="bibr" rid="bibr61"&gt;2014&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Improve our understanding of the needs of youth with FASD, including those who are justice-involved, and of promising practices to reduce substance use; Cross-sectional study with retrospective record review (community-based project)&lt;/td&gt;&lt;td&gt;&lt;italic&gt;Interviews&lt;/italic&gt;: 50 youth with FASD (14 to 24 years), 55 caregivers and service providers; &lt;italic&gt;Survey data&lt;/italic&gt;: 260 youth with FASD&lt;/td&gt;&lt;td&gt;Interviews and retrospective analysis of data pooled from three community-based surveys (adolescent health survey, youth in custody survey, alternative-to-custody program survey) Self-harm; suicidal ideation; suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Youth with FASD were more likely than youth without FASD to experience past-year self-harm (33% vs 15%), serious suicidal ideation (28% vs 12%), and to have attempted suicide (25% vs 6%)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Females with FASD had higher rates of past-year self-harm (43%), serious suicidal ideation (41%), and suicide attempts (36%) than males with FASD (24%, 16%, and 16%, respectively)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Youth with FASD were more likely than "mainstream peers" to have a family relative attempt suicide, both past-year (16% vs 4%) and lifetime (30% vs 13%)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Past-year self-harm and suicide attempt was less common among youth with FASD who felt they had an adult (outside of their family and school) who cared about them (24% vs 45% for self-harm, 16% vs 36% for attempt)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td /&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Among Indigenous youth, those who engaged in weekly cultural activities were less likely than those who never participated to have past-year serious suicidal ideation or attempt (specific rates not reported)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Among youth with FASD in alternative-to-custody programs, those who had a supportive peer at discharge were more likely to have reduced suicidal ideation 6 months later than youth without a supportive peer (specific rates not reported)&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Youth with FASD who reached out to more than one person for support and had three or more close friends were less likely to self-harm or attempt suicide in the past year than those with less social support (specific rates not reported)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Rangmar et al. (&lt;xref ref-type="bibr" rid="bibr64"&gt;2015&lt;/xref&gt;), Sweden&lt;/td&gt;&lt;td&gt;Investigate educational, employment, health, and criminal outcomes among adults with FASD; Prospective observational cohort study (academic article)&lt;/td&gt;&lt;td&gt;79 adults (18 to 47 years) diagnosed with FASD as infants or children, and 3,160 individuals matched on age, gender, and birthplace (of which a subset of 122 individuals who had been placed in state care were pulled out for further comparisons)&lt;/td&gt;&lt;td&gt;Record linkage of national health, child welfare, and criminal registers Suicide attempt (defined as self-inflicted injury resulting in hospitalization)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;6.3% of participants with FASD had received hospital care for self-inflicted injury/poisoning, which was significantly higher than the rate found in the comparison group as a whole (2.0%), but not the subset of comparison individuals placed in state care (9.8%)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Rangmar et al. (&lt;xref ref-type="bibr" rid="bibr65"&gt;2017&lt;/xref&gt;), Sweden&lt;/td&gt;&lt;td&gt;Investigate self-reported health, substance use, and criminality among adults with FASD; Cross-sectional mixed methods study (academic article)&lt;/td&gt;&lt;td&gt;20 adults with FASD (18 to 41 years) and 20 age- and gender-matched comparison individuals&lt;/td&gt;&lt;td&gt;Structured interviews using measures of substance use (ASI) and mental health (&lt;bold&gt;BDI&lt;/bold&gt;, BAI) Suicidal ideation; suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Lifetime suicidal ideation and suicide attempts were both more common among participants with FASD (47.4% and 15.8%) than those without FASD (10.0% and 5.0%), though not statistically significant&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Age of first suicidal ideation was significantly lower for participants with FASD (21 years) than those without (33 years)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Salmon and Buetow (&lt;xref ref-type="bibr" rid="bibr67"&gt;2012&lt;/xref&gt;), New Zealand&lt;/td&gt;&lt;td&gt;Explore the daily challenges of individuals with FASD; Cross-sectional qualitative study (academic article)&lt;/td&gt;&lt;td&gt;14 adolescents and adults with FASD (14 to 37 years)&lt;/td&gt;&lt;td&gt;Unstructured interviews Suicidal ideation/suicide attempt (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;In discussing his experience with mental health issues, one participant noted that, in the past, he would cut his wrists when he could no longer "handle life"&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Schecke et al. (&lt;xref ref-type="bibr" rid="bibr68"&gt;2019&lt;/xref&gt;), Germany&lt;/td&gt;&lt;td&gt;Describe patterns of substance use and psychiatric comorbidities among adults with FASD; Cross-sectional mixed methods study (conference poster)&lt;/td&gt;&lt;td&gt;68 adults with FASD (18 to 53 years)&lt;/td&gt;&lt;td&gt;Structured interviews, record review, mental health and substance use measures (LHS, &lt;bold&gt;Mini DIPS OA&lt;/bold&gt;, EUROP-ASI-R), various neuropsychological tests Suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;30.9% of participants were reported to have had at least one suicide attempt&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Streissguth et al. (&lt;xref ref-type="bibr" rid="bibr73"&gt;1996&lt;/xref&gt;), US&lt;/td&gt;&lt;td&gt;Examine secondary disabilities associated with FASD and assess risk and protective factors; Cross-sectional mixed methods study (report)&lt;/td&gt;&lt;td&gt;415 individuals with FASD (6 to 51 years)&lt;/td&gt;&lt;td&gt;Psychological testing battery (intellectual, academic, adaptive behavior) and structured interview (LHI) with caregivers/informants Suicide threats; suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Across age groups, suicide threat(s) was the third most common mental health concern (following ADHD and depression) and the most common reason for inpatient mental health treatment&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Rates of suicide threat(s) were approximately 19% for children 6 to 11 years, 39% for youth 12 to 20 years, and 43% for adults 21 to 51 years&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Rates of suicide attempt(s) were approximately 2% for children 6 to 11 years, 13% for youth 12 to 20 years, and 23% for adults 21 to 51 years&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Tait et al. (&lt;xref ref-type="bibr" rid="bibr75"&gt;2017&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Present the life history and post-incarceration experiences of two adults with FASD and co-occurring mental illness; Case study (academic article)&lt;/td&gt;&lt;td&gt;2 adult males with FASD (61 and 66 years old) with previous justice-involvement and co-occurring psychiatric disorders&lt;/td&gt;&lt;td&gt;Multiple interviews over a year, including a PhotoVoice approach Suicide attempt&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;One participant was described as having attempted suicide several times, first after leaving foster care, then several years later because of unemployment and depression&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Both participants were reported to have made multiple suicide attempts while incarcerated because of feelings of guilt and shame about their crimes; they reported positive impacts of counseling in reducing feelings of suicidality&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Both men reported that they would commit suicide if they were faced with re-incarceration&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Temple et al. (&lt;xref ref-type="bibr" rid="bibr76"&gt;2019&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Examine the relationship between affect regulation impairment and mental health problems/diagnoses among children and adults with FASD; Retrospective record review (academic article)&lt;/td&gt;&lt;td&gt;335 individuals with PAE (5 to 55 years)&lt;/td&gt;&lt;td&gt;National FASD assessment and diagnostic clinical database Suicidal ideation/suicide attempt (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Participants with impaired affect regulation were 8.6 times more likely to have a history of suicide attempt(s)/ideation than participants without impaired affect regulation&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Thanh and Jonsson (&lt;xref ref-type="bibr" rid="bibr77"&gt;2016&lt;/xref&gt;), Canada&lt;/td&gt;&lt;td&gt;Estimate the life expectancy and examine causes of death among individuals with FASD; Retrospective cohort study (academic article)&lt;/td&gt;&lt;td&gt;6052 individuals with FASD (0 to 60+ years)&lt;/td&gt;&lt;td&gt;Data from inpatient, outpatient, claims, and vital statistics from administrative health databases Suicide&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Average life expectancy was reported to be 34 years old; average age of death was 28 years&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Of the 98 deaths reported during the study period with documented cause, 44% were by "external causes," the most common of which were suicide (15%) and accidents (14%), followed by poisoning by drugs or alcohol (7%), and other external causes (7%)&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;tr&gt;&lt;td&gt;Tsang et al. (&lt;xref ref-type="bibr" rid="bibr78"&gt;2017&lt;/xref&gt;), Australia&lt;/td&gt;&lt;td&gt;Examine parent/caregiver-rated and teacher-rated behavior in primary school-aged children; Population-based cohort study (academic article)&lt;/td&gt;&lt;td&gt;108 children (7 to 9 years), of which 60 (58.3%) had confirmed PAE and 21 (19.4%) were diagnosed with FASD&lt;/td&gt;&lt;td&gt;Behavior assessment via parent-/caregiver- (&lt;bold&gt;CBCL&lt;/bold&gt;) and teacher-report (&lt;bold&gt;TRF&lt;/bold&gt;) Suicidal ideation ("talk about killing self"); self-harm/suicide attempt (pooled)&lt;/td&gt;&lt;td&gt;&lt;list list-type="Bullet"&gt;&lt;list-item&gt;&lt;p&gt;Parent/caregiver-reported self-harm/suicide attempt(s) was endorsed in one (6%) participant with FASD and no (0%) participants without FASD&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;Teacher-reported self-harm/suicide attempt(s) was endorsed in no (0%) participants with FASD and one (1%) participant without FASD&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;"Talks about killing self" was endorsed by two (11%) parents/caregivers of participants with FASD and one (1%) parent/caregiver of a participant without FASD&lt;/p&gt;&lt;/list-item&gt;&lt;list-item&gt;&lt;p&gt;"Talks about killing self" was endorsed by three (14%) teachers of participants with FASD and one (1%) teacher of a participant without FASD; this group difference was statistically significant&lt;/p&gt;&lt;/list-item&gt;&lt;/list&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt; </ephtml> </p> <p>1 ADHD = attention deficit hyperactivity disorder; ARND = alcohol-related neurodevelopmental disorder; ASI = Addiction Severity Index; BAI = Beck Anxiety Inventory; BDI = Beck Depression Inventory; CBCL = Child Behavior Checklist; ChIPS = Children's Interview for Psychiatric Syndromes; ER = emergency room; EUROP-ASI-R = European Addiction Severity Index (German version); FASD = fetal alcohol spectrum disorder; IQ = intelligence quotient; LD = learning disorder; LHI = Life History Interview; LHS = Life History Screen; LPS = Lifetime Parasuicide/Suicide Attempt Count; MDD = major depressive disorder; MINI = Mini International Neuropsychiatric Interview; Mini DIPS OA = Mini-DIPS-Open Access; ODD = opposition defiant disorder; PAE = prenatal alcohol exposure; PTSD = post-traumatic stress disorder; SAVRY = Structured Assessment of Violence Risk in Youth; SCID = Structured Clinical Interview for DSM; TRF = Teacher Report Form; US = Unites States; YASR = Young Adult Self-Report.</p> <ulist> <item>2 Bold denotes broadband measures with embedded items related to suicidality.</item> <item>3 * Validated tool specifically designed to measure suicidality.</item> </ulist> <hd id="AN0157442546-8">RESULTS</hd> <p></p> <hd id="AN0157442546-9">Study Selection and Characteristics</hd> <p>Our search yielded 995 academic references and 26 gray literature resources. After duplicates were removed, 758 records remained, of which 54 were reviewed in full (28 academic, 26 gray). Upon our initial review of identified gray literature resources, it was determined that title screening, keyword searching, and abstract or executive summary screening was insufficient to determine if the resources had pertinent material regarding FASD and suicidality. Therefore, the decision was made as a team to include all gray literature resources for full review to ensure that no oversights were made for included content. An additional five academic references were identified (three of which were ultimately included) during the preparation of this article, for a total of 59 full records reviewed. After excluding articles that were not relevant to PAE/FASD (n = 1) or suicidality (n = 15) and those that did not provide new empirical data (n = 15), 28 references were included in the review (see, Figure 1 for a PRISMA flowchart).</p> <p>PHOTO (COLOR): Figure 1. PRISMA flowchart of study selection.</p> <p>Academic studies varied in design, including retrospective or prospective cohort studies (n = 6), case studies/reports (n = 4), record reviews (n = 4), and cross-sectional studies (n = 3), as well as one active case ascertainment study, and one data subset from an intervention study (see, Table 1). The gray literature included seven cross-sectional studies, one retrospective record review, and one letter-to-the-editor with case vignettes.</p> <p>Most studies originated in Canada (n = 16, with one supplementing data from the United States; see, Brackenreed, [<reflink idref="bib9" id="ref54">9</reflink>]; Brownell et al., [<reflink idref="bib11" id="ref55">11</reflink>]; Burns et al., [<reflink idref="bib12" id="ref56">12</reflink>]; Chatterley-Gonzalez, [<reflink idref="bib14" id="ref57">14</reflink>]; Denys et al., [<reflink idref="bib17" id="ref58">17</reflink>]; Deren, [<reflink idref="bib18" id="ref59">18</reflink>]; Farasi, [<reflink idref="bib21" id="ref60">21</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref61">24</reflink>]; Himmelreich et al., [<reflink idref="bib34" id="ref62">34</reflink>]; McLachlan, [<reflink idref="bib46" id="ref63">46</reflink>]; McLachlan, Amlung et al., [<reflink idref="bib49" id="ref64">49</reflink>]; McLachlan et al., [<reflink idref="bib47" id="ref65">47</reflink>]; Peled et al., [<reflink idref="bib61" id="ref66">61</reflink>]; Tait et al., [<reflink idref="bib75" id="ref67">75</reflink>]; Temple et al., [<reflink idref="bib76" id="ref68">76</reflink>]; Thanh &amp; Jonsson, [<reflink idref="bib77" id="ref69">77</reflink>]), five were conducted in the United States (see, Baldwin, [<reflink idref="bib6" id="ref70">6</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref71">37</reflink>]; M. J. O'Connor et al., [<reflink idref="bib57" id="ref72">57</reflink>]; O'Malley &amp; Huggins, [<reflink idref="bib58" id="ref73">58</reflink>]; Streissguth et al., [<reflink idref="bib73" id="ref74">73</reflink>]), three in Sweden (see, Landgren et al., [<reflink idref="bib42" id="ref75">42</reflink>]; Rangmar et al., [<reflink idref="bib65" id="ref76">65</reflink>], [<reflink idref="bib64" id="ref77">64</reflink>]), two in Germany (see, Dirks et al., [<reflink idref="bib19" id="ref78">19</reflink>]; Schecke et al., [<reflink idref="bib68" id="ref79">68</reflink>]), one in Australia (see, Tsang et al., [<reflink idref="bib78" id="ref80">78</reflink>]), and one in New Zealand (see, Salmon &amp; Buetow, [<reflink idref="bib67" id="ref81">67</reflink>]).</p> <p>The largest number of studies (n = 13) were focused on adults with PAE/FASD (18 years and older). Two studies involved adolescents (12 to 18 years old), and one involved children (7 to 9 years old). The remaining 12 studies included participants across multiple age groups. Sample sizes ranged widely, from a case study to a large retrospective cohort study with 6,052 participants. Studies were conducted in a variety of settings, most often clinical[<reflink idref="bib2" id="ref82">2</reflink>] (n = 13), community-based (n = 7), and justice (n = 5), or a combination of settings (n = 3).</p> <hd id="AN0157442546-10">How Is Suicidality Measured in FASD Research?</hd> <p>We identified evidence on the full spectrum of suicidality, including suicidal ideation (n = 11), suicide attempts (n = 26), and death by suicide (n = 3); findings related to self-harm were also commonly reported (n = 8).[<reflink idref="bib3" id="ref83">3</reflink>] Researchers most often reported on lifetime (versus current) suicidality (n = 20). Two studies included data on past-year suicidality and in the remaining six studies, it was unclear whether suicidality was lifetime or current.</p> <p>Notably, only six studies had the explicit and targeted purpose of exploring suicidality in the context of PAE/FASD. More commonly, studies were conducted to investigate broad social, health, and other outcomes (n = 7); clinical or justice-related profiles (n = 6); needs and lived experiences of those with FASD (n = 5); impacts of intervention (n = 2); or FASD screening and prevalence (n = 2). Suicidality data was most often (n = 8) derived from screening tools or broader measures with embedded items related to suicidality (e.g., the Structured Assessment of Violence Risk in Youth; Mini International Neuropsychiatric Interview; Structured Clinical Interview for DSM; Children's Interview for Psychiatric Syndromes; Beck Depression Inventory; Mini-DIPS-OA; and Child Behavior Checklist and Teacher Report Form). Other methods for measuring suicidality were interviews (n = 5), clinical or legal record review (n = 5), health and other database review (n = 3), surveys or questionnaires (n = 2), or a combination of sources (n = 5). Only one study included a validated tool specifically designed to measure suicidality (the Lifetime Parasuicide/Suicide Attempt Count).</p> <hd id="AN0157442546-11">What Proportion of Individuals with PAE/FASD Experience Suicidality across the Lifespan?</hd> <p>Rates of suicidality were reported in 18 studies and varied widely depending on participants' ages, study settings, aspects of suicidality reported, and how suicidality was measured (see supplemental information for more details). Most of the evidence in this area was on suicide attempts or suicidal ideation/attempts pooled. Among children with PAE/FASD 12 years and younger, reported rates of suicidality ranged from 0% (parent-reported self-harm in Tsang et al., [<reflink idref="bib78" id="ref84">78</reflink>]) to 19% ("suicide threats" in Streissguth et al., [<reflink idref="bib73" id="ref85">73</reflink>]). In studies with adolescents, rates spanned from 6% (self-harm/suicidal ideation pooled in Baldwin, [<reflink idref="bib6" id="ref86">6</reflink>]) to 39% ("suicide threats" in Streissguth et al., [<reflink idref="bib73" id="ref87">73</reflink>]). Findings also varied widely in studies with adults, ranging from 6.3% (self-inflicted injury/poisoning in Rangmar et al., [<reflink idref="bib65" id="ref88">65</reflink>]) to 100% (previous suicide attempt in McLachlan, Amlung et al., [<reflink idref="bib49" id="ref89">49</reflink>]), though most were between 15% (suicide attempts in Rangmar et al., [<reflink idref="bib65" id="ref90">65</reflink>]) and 55% (suicide attempts in Huggins et al., [<reflink idref="bib37" id="ref91">37</reflink>]). In one of the few studies of death by suicide among individuals with fetal alcohol syndrome, Thanh and Jonsson ([<reflink idref="bib77" id="ref92">77</reflink>]) found that 15% of all deaths investigated were caused by suicide, making it the leading cause of mortality recorded in provincial databases.[<reflink idref="bib4" id="ref93">4</reflink>]</p> <hd id="AN0157442546-12">What Contextual Factors are Associated with Suicidality in PAE/FASD?</hd> <p>Only three studies were identified where researchers statistically examined factors contributing to suicidality in the context of PAE/FASD (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref94">24</reflink>]; M. J. O'Connor et al., [<reflink idref="bib57" id="ref95">57</reflink>]; Temple et al., [<reflink idref="bib76" id="ref96">76</reflink>]). However, most studies included descriptive accounts of characteristics and needs of individuals with PAE/FASD who experienced suicidality (see, Table 1 for key findings). Here, we synthesized these commonly reported characteristics and experiences, combined with data on direct associations, and organized them in terms of individual, relational, and environmental factors, based on the categories used by the Centers for Disease Control and Prevention ([<reflink idref="bib13" id="ref97">13</reflink>]).</p> <hd id="AN0157442546-13">Individual Factors</hd> <p>Most of the contextual evidence highlighted co-occurring mental health and substance use challenges as being associated with suicidality in FASD. Individuals with FASD who experienced suicidality were also often reported to have co-occurring depression, anxiety, and post-traumatic stress disorder (Baldwin, [<reflink idref="bib6" id="ref98">6</reflink>]; Chatterley-Gonzalez, [<reflink idref="bib14" id="ref99">14</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref100">24</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref101">37</reflink>]; Landgren et al., [<reflink idref="bib42" id="ref102">42</reflink>]; M. J. O'Connor et al., [<reflink idref="bib57" id="ref103">57</reflink>]; O'Malley &amp; Huggins, [<reflink idref="bib58" id="ref104">58</reflink>]; Tait et al., [<reflink idref="bib75" id="ref105">75</reflink>]; Temple et al., [<reflink idref="bib76" id="ref106">76</reflink>]). In three studies, statistical modeling revealed that the presence of a depressive disorder (M. J. O'Connor et al., [<reflink idref="bib57" id="ref107">57</reflink>]) or depression/anxiety (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref108">24</reflink>]; Temple et al., [<reflink idref="bib76" id="ref109">76</reflink>]) significantly increased the likelihood of suicidality. Similarly, problems with substance use were frequently reported among individuals with FASD who experienced suicidality (Baldwin, [<reflink idref="bib6" id="ref110">6</reflink>]; Brackenreed, [<reflink idref="bib9" id="ref111">9</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref112">24</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref113">37</reflink>]), and in one study was the most significant contributor to suicidal ideation/attempts among all factors examined (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref114">24</reflink>]).</p> <p>Other co-occurring neurocognitive and behavioral challenges that are often reported in the wider FASD population were also discussed in the context of suicidality, though the evidence was somewhat mixed. In several studies, self-regulation difficulties, adaptive behavior challenges, and learning difficulties/disorders were reported among individuals with PAE/FASD who experience suicidality (Baldwin, [<reflink idref="bib6" id="ref115">6</reflink>]; Brackenreed, [<reflink idref="bib9" id="ref116">9</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref117">24</reflink>]). With respect to intellectual ability, study findings were inconsistent. In one study, males with FASD who attempted suicide had a lower IQ compared to males who did not attempt suicide (M. J. O'Connor et al., [<reflink idref="bib57" id="ref118">57</reflink>]), whereas IQ was not significantly related to suicidality in other research (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref119">24</reflink>]). Similarly, although both Baldwin ([<reflink idref="bib6" id="ref120">6</reflink>]) and Chatterley-Gonzalez ([<reflink idref="bib14" id="ref121">14</reflink>]) reported co-occurring ADHD among individuals with FASD who experienced suicidality, ADHD was not significantly associated with suicidality in Flannigan et al. ([<reflink idref="bib24" id="ref122">24</reflink>]). We also identified emerging evidence that difficulties with persistent pain (Landgren et al., [<reflink idref="bib42" id="ref123">42</reflink>]) and sleep problems (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref124">24</reflink>]) may potentially contribute to suicidality in FASD, though given that data in these areas is preliminary, robust conclusions cannot be drawn.</p> <p>In studies involving adults with FASD, challenges with independence and stability were commonly noted among those who experienced suicidality. Flannigan et al. ([<reflink idref="bib24" id="ref125">24</reflink>]) reported that difficulty with independence was one of the most significant socioenvironmental challenges associated with suicidality in their sample. Relatedly, in several studies, individuals with FASD who experienced suicidality were reported to have co-occurring problems with employment, financial security, and housing (Brackenreed, [<reflink idref="bib9" id="ref126">9</reflink>]; Farasi, [<reflink idref="bib21" id="ref127">21</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref128">24</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref129">37</reflink>]; Tait et al., [<reflink idref="bib75" id="ref130">75</reflink>]). In one study, the mother of an adult with FASD attributed her son's death by "accidental" suicide to a lack of community housing (Farasi, [<reflink idref="bib21" id="ref131">21</reflink>]). Although there have been no explicit investigations of the links between justice-involvement and suicidality in FASD, several studies were conducted in justice contexts (Deren, [<reflink idref="bib18" id="ref132">18</reflink>]; McLachlan, [<reflink idref="bib46" id="ref133">46</reflink>]; McLachlan, Amlung et al., [<reflink idref="bib49" id="ref134">49</reflink>]; McLachlan et al., [<reflink idref="bib47" id="ref135">47</reflink>]; Peled et al., [<reflink idref="bib61" id="ref136">61</reflink>]; Tait et al., [<reflink idref="bib75" id="ref137">75</reflink>]) and there is some preliminary evidence that legal problems with offending (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref138">24</reflink>]) and associated guilt and shame (Tait et al., [<reflink idref="bib75" id="ref139">75</reflink>]) may relate to suicidality in this population.</p> <hd id="AN0157442546-14">Relational Factors</hd> <p>The most common relational factors that were associated with suicidality in FASD were family history, interpersonal stressors, and experiences of trauma. In several studies, researchers reported that individuals with FASD who experience suicidality had family histories of mental health concerns, substance use challenges, and suicidality (Baldwin, [<reflink idref="bib6" id="ref140">6</reflink>]; Brackenreed, [<reflink idref="bib9" id="ref141">9</reflink>]; Peled et al., [<reflink idref="bib61" id="ref142">61</reflink>]). Interpersonal conflict and distress (often within the family system), social isolation (O'Malley &amp; Huggins, [<reflink idref="bib58" id="ref143">58</reflink>]), and disconnection from supportive adults and peers (Peled et al., [<reflink idref="bib61" id="ref144">61</reflink>]) were also common for individuals with FASD who experienced suicidality (Baldwin, [<reflink idref="bib6" id="ref145">6</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref146">37</reflink>]; O'Malley &amp; Huggins, [<reflink idref="bib58" id="ref147">58</reflink>]). Finally, there is some evidence that experiences of trauma/abuse, especially early in life, may relate to suicidality in FASD (Baldwin, [<reflink idref="bib6" id="ref148">6</reflink>]; Huggins et al., [<reflink idref="bib37" id="ref149">37</reflink>]; Landgren et al., [<reflink idref="bib42" id="ref150">42</reflink>]). In one recent study, history of trauma/abuse was associated with a three-fold increase in the likelihood of experiencing suicidality (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref151">24</reflink>]).</p> <hd id="AN0157442546-15">Environmental Factors</hd> <p>In addition to the individual and relational factors associated with suicidality in FASD, there was also evidence that living situation may play a role. In a study focused on adolescents with FASD, M. J. O'Connor et al. ([<reflink idref="bib57" id="ref152">57</reflink>]) found that having a higher number of home placements significantly increased the likelihood of experiencing suicidality. In terms of how the <emph>type</emph> of living situation may relate to suicidality in FASD, evidence in this area was mixed. In one Swedish study, suicidality was more common among adults with FASD than those without; however, when participants with FASD were compared to adults without FASD who had lived in state care (i.e., foster and residential placements), there were no statistical differences in rates of suicidality (Rangmar et al., [<reflink idref="bib65" id="ref153">65</reflink>]). Similarly, Canadian researchers compared rates of suicidality between children and youth with PAE/FASD living in foster or group care with those living with biological and adoptive parents and found no significant differences (Burns et al., [<reflink idref="bib12" id="ref154">12</reflink>]). In contrast, Flannigan et al. ([<reflink idref="bib24" id="ref155">24</reflink>]) examined rates of suicidality among individuals with PAE across placement types and found significantly higher rates among individuals who lived in group homes and institutional settings (i.e., in custody or in-patient treatment) than those in other living circumstances.</p> <hd id="AN0157442546-16">DISCUSSION</hd> <p>Individuals with PAE and FASD experience complex neurobiological, cognitive, and behavioral challenges compounded by mental health difficulties and socioenvironmental adversity across the lifespan. There is a growing body of evidence to suggest an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. However, to date, the literature on suicidality and FASD has not been consolidated. Consolidation of the current evidence on suicidality in FASD provides us with a clearer picture of the state of the literature, the scope of the issue and potentially related factors, and possible directions for advancing research, practice, and policy. The purpose of the current study was to review and summarize the existing evidence on PAE/FASD and suicidality. We identified 28 studies, the majority of which were Canadian and published in the past 10 years. Most research was focused on adolescents and adults with PAE/FASD and conducted in clinical settings. Only six studies were specifically designed to examine suicidality in the context of FASD. Instead, most data on suicidality were gathered as part of larger projects focused more broadly on clinical profiles, experiences, needs, and outcomes of individuals with PAE/FASD. Although limited, this literature provides a foundational understanding of suicidality in PAE/FASD with important implications for practice and policy.</p> <p>The ways in which suicidality has been measured in FASD research is varied. Many studies lacked clear distinctions regarding the specific aspect or timeframe of suicidality under investigation. For example, few researchers specified whether individuals experienced <emph>active</emph> versus <emph>passive</emph> ideation, <emph>ideation</emph> versus <emph>attempt</emph>, or <emph>lifetime</emph> or <emph>current</emph> suicidality. Different aspects of suicidality have unique implications for risk assessment, intervention responses, and trajectories (Batterham et al., [<reflink idref="bib7" id="ref156">7</reflink>]; Horváth et al., [<reflink idref="bib35" id="ref157">35</reflink>]; Turner et al., [<reflink idref="bib80" id="ref158">80</reflink>]), and therefore a more nuanced understanding of the spectrum of suicidality among individuals with FASD is needed.</p> <p>Data on suicidality were often collected tangentially, and although several evidence-based approaches were used to measure suicidality, almost all of these were screening-like questions embedded in interviews or broad psychiatric or psychological measures rather than thorough and detailed assessments. Moreover, none of the measures used to assess suicidality have been formally validated for use with individuals with PAE/FASD. Studies that involved direct and intentional investigation of suicidality were often small (i.e., pilot or case studies) or limited to a specific age group (i.e., adolescents) or population (i.e., individuals with justice-involvement). Although the current literature provides important foundational evidence, it lacks generalizability and a nuanced understanding of the nature, severity, chronicity, and acuteness of suicidality among individuals with FASD. As such, more intentional, systematic, and rigorous research on suicidality in those with FASD is warranted, using validated measurement approaches. This approach will allow for clearer interpretation of findings, synthesis of the evidence base, and guidance for practice and policy in suicide screening, prevention, and treatment in this population.</p> <p>The reviewed evidence suggests that individuals with PAE/FASD experience higher rates of suicidality across the lifespan compared to the general population and in line with the high rates of suicidality reported among individuals with other intellectual and neurodevelopmental disabilities (e.g., Balazs &amp; Kereszteny, [<reflink idref="bib5" id="ref159">5</reflink>]; Howe et al., [<reflink idref="bib36" id="ref160">36</reflink>]; Kõlves et al., [<reflink idref="bib41" id="ref161">41</reflink>]; Ludi et al., [<reflink idref="bib43" id="ref162">43</reflink>]; Oliphant et al., [<reflink idref="bib59" id="ref163">59</reflink>]; South et al., [<reflink idref="bib71" id="ref164">71</reflink>]). Depending on the setting and specific aspect of suicidality investigated, reported rates ranged from 0% to 19% in children, 6% to 39% in adolescents, and 6% to 100% in adults (though most were between 15% and 55%). In comparison to prevalence estimates of lifetime suicidal ideation (9%) and attempts (3%) in the general adult population (Nock et al., [<reflink idref="bib53" id="ref165">53</reflink>]), the rates of suicidality in FASD appear to be elevated. Moreover, in one Canadian study of mortality among individuals with FASD (Thanh &amp; Jonsson, [<reflink idref="bib77" id="ref166">77</reflink>]), suicide was the leading cause of death, reported in 15% of the study sample. Compared to the approximately 1.5% of deaths caused by suicide in the general Canadian population (Statistics Canada, [<reflink idref="bib72" id="ref167">72</reflink>]), this data highlights the increased vulnerability of individuals with FASD. Although the current evidence suggests disproportionately high rates of suicidality among individuals with FASD, the variability with which suicidality is measured and the diversity of populations studied precludes any robust conclusions about prevalence. More work is needed to establish stronger prevalence estimates, including identification of subpopulations who may be at higher risk. Establishing more accurate estimates would help to inform suicide prevention, identification, screening efforts, and allocation of resources, to support healthier outcomes.</p> <p>Furthermore, few researchers statistically examined factors that may contribute to suicidality in FASD, though certain individual characteristics and relational factors were commonly reported among individuals with FASD who experienced suicidality. Based on the available evidence, the presence of co-occurring mental health (anxiety and depression in particular) and substance use challenges appear to be most frequently associated with suicidality among individuals with FASD. Given that most individuals with FASD experience difficulties with their mental health (Weyrauch et al., [<reflink idref="bib81" id="ref168">81</reflink>]), that many report substance use challenges (Goldschmidt et al., [<reflink idref="bib30" id="ref169">30</reflink>]), and that co-occurring mental health and substance use concerns greatly increase suicide risk in the general population (Bornheimer et al., [<reflink idref="bib8" id="ref170">8</reflink>]), targeted FASD-informed suicide interventions that incorporate these complex needs are required. In addition, family history and experiences of interpersonal stress, trauma, and abuse were also commonly reported among individuals with FASD who experience suicidality. In non-FASD populations, relational stressors, and interpersonal trauma have also been associated with suicidality, with important implications for suicide risk and treatment responses (Ásgeirsdóttir et al., [<reflink idref="bib3" id="ref171">3</reflink>]; Bahk et al., [<reflink idref="bib4" id="ref172">4</reflink>]; Horváth et al., [<reflink idref="bib35" id="ref173">35</reflink>]). More research is needed to explore how or whether suicide prevention and treatment approaches should be tailored for individuals with FASD to address the intersecting impacts of mental health, substance use, interpersonal stressors, and trauma on suicide risk.</p> <p>Although the evidence was mixed, residential stability, including number of living placements (M. J. O'Connor et al., [<reflink idref="bib57" id="ref174">57</reflink>]), placement type (Flannigan, McMorris et al., [<reflink idref="bib24" id="ref175">24</reflink>]), and housing problems (Brackenreed, [<reflink idref="bib9" id="ref176">9</reflink>]; Farasi, [<reflink idref="bib21" id="ref177">21</reflink>]; Flannigan, McMorris et al., [<reflink idref="bib24" id="ref178">24</reflink>]) may be relevant to suicidality among people with FASD. Past research indicates that caregiver disruption, child welfare involvement, multiple living placements, and housing instability are all experienced at high rates in the wider FASD population (Flannigan, Kapasi et al., [<reflink idref="bib23" id="ref179">23</reflink>]; Fuchs et al., [<reflink idref="bib26" id="ref180">26</reflink>]; McLachlan, Flannigan et al., [<reflink idref="bib48" id="ref181">48</reflink>]), but also that stable and nurturing home environments may be protective factors against adverse outcomes (Streissguth et al., [<reflink idref="bib74" id="ref182">74</reflink>]). Findings from the current review indicate that more studies are needed to understand how or whether increased quality and stability of the home environment may also protect against suicidality-related outcomes for individuals with FASD. Similarly, we also found emerging evidence that individuals with FASD who experience suicidality also often face problems with independence, unemployment, and financial insecurity. The associations between disability, unemployment, mental health, and suicidality are complex (Milner et al., [<reflink idref="bib50" id="ref183">50</reflink>]), and more research is needed to tease apart whether and how these factors influence the risk of suicidality among people with FASD. Further inquiry is also needed to explore whether targeted interventions that increase financial security, employment opportunities, and supported independence may reduce suicide risk for individuals with FASD.</p> <hd id="AN0157442546-17">Future Directions</hd> <p>Acknowledging that the current literature on suicidality in FASD is critical but limited, more rigorous and intentional research is needed to replicate and expand upon the evidence presented in this review. Importantly, relatively little is known about the lived experiences of suicidality for individuals with FASD and their families. More information about the circumstances that surround suicidality is needed to better understand the unique needs of individuals with FASD, identify service gaps, and equip health and social service providers with the knowledge necessary to support individuals, families, and communities affected by FASD. Future research on FASD and suicidality should also explore whether and how rates and contributing factors change across the lifespan or differentially for certain groups of people with FASD. Enhanced evidence and increased knowledge translation are also needed to inform policy decision-making around prevention initiatives, screening efforts, and resource allocation, for the development of stronger infrastructure to support healthier outcomes. Importantly, researchers should prioritize the investigation of strengths, coping strategies, and protective factors that can be leveraged to promote health, happiness, and wellbeing for people with FASD (Flannigan, Wrath et al., [<reflink idref="bib22" id="ref184">22</reflink>]).</p> <hd id="AN0157442546-18">CONCLUSION</hd> <p>The literature on suicidal ideation, attempts, and death by suicide among individuals with PAE/FASD is limited but growing. Across the lifespan, rates of suicidality among individuals with PAE/FASD are high, and emerging evidence reveals potentially associated factors. This review underscores the need for more intentional and rigorous research to expand the evidence base. There is also a need for more evidence-based FASD suicide screening, prevention, and treatment approaches that incorporate the needs of the individual and their broader family system. Greater awareness of the mental health concerns associated with FASD, particularly for front-line service providers, will help to increase capacity for supporting safety and healthier outcomes in this population. The compounding impacts of PAE on the brain and body, as well as exposure to environmental adversity, create multiple layers of vulnerability for people with FASD, and multiple opportunities for intervention and support. With a better understanding of what is currently known about suicidality in FASD, and where the gaps in our knowledge may be, researchers, practitioners, and policymakers will be better able to advance the field and more effectively support the safety, health, and wellbeing of individuals with FASD and their families.</p> <hd id="AN0157442546-19">Disclosure Statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0157442546-20">Supplementary Material</hd> <p>Supplemental data for this article can be accessed on the https://doi.org/10.1080/19315864.2022.2082604</p> <hd id="AN0157442546-21">Appendix</hd> <hd1 id="AN0157442546-22">Search Histories</hd1> <p> <emph>CINAHL</emph> </p> <p>S1 (MH "Suicide+")</p> <p>S2 (MH "Self-Injurious Behavior")</p> <p>S3 (MH "Injuries, Self-Inflicted")</p> <p>S4 ((suicid*) or (self N3 injur*) or (self N3 harm*) or (self N3 destruct*) or (self N3 mutilat*))</p> <p>S5 S1 OR S2 OR S3 OR S4</p> <p>S6 Fetal Alcohol Spectrum Disorders/</p> <p>S7 (fetal N3 alcohol N3 spectrum N3 disorder*) OR (FASD*) OR (fetal N3 alcohol N3 syndrome*) OR (FAS) OR (alcohol N3 related N3 neuro*) OR (ARND*) OR (prenatal N3 alcohol N3 expos*) OR (PAE) OR (growth N3 retard* N3 facial abnormalit* N3 central N3 nervous N3 system N3 dysfunction*) OR (alcohol N3 related N3 birth N3 defect*) OR (alcohol N3 related N3 neurodevelopmental N3 disorder*) OR (FAES OR FAE) OR (fetal N3 alcohol N3 exposure*)</p> <p>S8 S6 OR S7</p> <p>S9 S5 AND S8</p> <p> <emph>Cochrane</emph> </p> <p>1 suicid*.mp.</p> <ulist> <item>2 ((self adj3 injur*) or (self adj3 harm*) or (self adj3 destruct*) or (self adj3 mutilat*)).mp.</item> <item>3 (fetal adj3 alcohol adj3 spectrum adj3 disorder*).mp.</item> <item>4 FASD*.mp.</item> <item>5 (fetal adj3 alcohol adj3 syndrome*).mp.</item> <item>6 FAS.mp.</item> <item>7 (alcohol adj3 related adj3 neuro*).mp.</item> <item>8 ARND*.mp.</item> <item>9 (prenatal adj3 alcohol adj3 expos*).mp.</item> <item>10 PAE.mp.</item> <item>11 (growth adj3 retard* adj3 facial abnormalit* adj3 central adj3 nervous adj3 system adj3 dysfunction*).mp.</item> <item>12 (alcohol adj3 related adj3 birth adj3 defect*).mp.</item> <item>13 (alcohol adj3 related adj3 neurodevelopmental adj3 disorder*).mp.</item> <item>14 FAES.mp.</item> <item>15 FAE.mp.</item> <item>16 (fetal adj3 alcohol adj3 exposure*).mp.</item> <item>17 1 or 2</item> <item>18 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16</item> <item>19 17 and 18</item> </ulist> <p> <emph>MEDLINE</emph> </p> <p>1 exp Suicide/</p> <ulist> <item>2 suicid*.mp.</item> <item>3 exp Self-Injurious Behavior/</item> <item>4 ((self adj3 injur*) or (self adj3 harm*) or (self adj3 destruct*) or (self adj3 mutilat*)).mp.</item> <item>5 Fetal Alcohol Spectrum Disorders/</item> <item>6 (fetal adj3 alcohol adj3 spectrum adj3 disorder*).mp.</item> <item>7 FASD*.mp.</item> <item>8 (fetal adj3 alcohol adj3 syndrome*).mp.</item> <item>9 FAS.mp.</item> <item>10 (alcohol adj3 related adj3 neuro*).mp.</item> <item>11 ARND*.mp.</item> <item>12 (prenatal adj3 alcohol adj3 expos*).mp.</item> <item>13 PAE.mp.</item> <item>14 (growth adj3 retard* adj3 facial abnormalit* adj3 central adj3 nervous adj3 system adj3</item> </ulist> <p>dysfunction*).mp.</p> <ulist> <item>15 (alcohol adj3 related adj3 birth adj3 defect*).mp.</item> <item>16 (alcohol adj3 related adj3 neurodevelopmental adj3 disorder*).mp.</item> <item>17 FAES.mp.</item> <item>18 FAE.mp.</item> <item>19 (fetal adj3 alcohol adj3 exposure*).mp.</item> <item>20 1 or 2 or 3 or 4</item> <item>21 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19</item> <item>22 20 and 21</item> <item>23 Animals/not (Animals/and Humans/)</item> <item>24 22 not 23</item> <item>25 limit 24 to English language</item> </ulist> <p> <emph>PsycINFO</emph> </p> <p>((MAINSUBJECT.EXACT("Fetal Alcohol Syndrome") OR (fetal NEAR/3 alcohol NEAR/3 spectrum NEAR/3 disorder*) OR (FASD*) OR (fetal NEAR/3 alcohol NEAR/3 syndrome*) OR (FAS) OR (alcohol NEAR/3 related NEAR/3 neuro*) OR (ARND*) OR (prenatal NEAR/3 alcohol NEAR/3 expos*) OR (PAE) OR (growth NEAR/3 retard* NEAR/3 facial abnormalit* NEAR/3 central NEAR/3 nervous NEAR/3 system NEAR/3 dysfunction*) OR (alcohol NEAR/3 related NEAR/3 birth NEAR/3 defect*) OR (alcohol NEAR/3 related NEAR/3 neurodevelopmental NEAR/3 disorder*) OR (FAES OR FAE) OR (fetal NEAR/3 alcohol NEAR/3 exposure*)) AND (MAINSUBJECT.EXACT.EXPLODE("Self-Destructive Behavior") OR ((suicid*) OR (self NEAR/3 injur*) OR (self NEAR/3 harm*) OR (self NEAR/3 destruct*) OR (self NEAR/3 mutilat*)))) AND (la.exact("ENG") AND PEER(yes))</p> <p> <emph>Social Services Abstracts</emph> </p> <p>(((fetal NEAR/3 alcohol NEAR/3 spectrum NEAR/3 disorder*) OR (FASD*) OR (fetal NEAR/3 alcohol NEAR/3 syndrome*) OR (FAS) OR (alcohol NEAR/3 related NEAR/3 neuro*) OR (ARND*) OR (prenatal NEAR/3 alcohol NEAR/3 expos*) OR (PAE) OR (growth NEAR/3 retard* NEAR/3 facial abnormalit* NEAR/3 central NEAR/3 nervous NEAR/3 system NEAR/3 dysfunction*) OR (alcohol NEAR/3 related NEAR/3 birth NEAR/3 defect*) OR (alcohol NEAR/3 related NEAR/3 neurodevelopmental NEAR/3 disorder*) OR (FAES OR FAE) OR (fetal NEAR/3 alcohol NEAR/3 exposure*)) AND (MAINSUBJECT.EXACT.EXPLODE("Self Destructive Behavior") OR ((suicid*) OR (self NEAR/3 injur*) OR (self NEAR/3 harm*) OR (self NEAR/3 destruct*) OR (self NEAR/3 mutilat*)))) AND (la.exact("ENG") AND PEER(yes))</p> <p> <emph>Web of Science</emph> </p> <p>#1 TS=(fetal NEAR3 alcohol NEAR3 spectrum NEAR3 disorder*) OR TS=FASD* OR TS=(fetal NEAR3 alcohol NEAR3 syndrome*) OR TS=FAS OR TS=(alcohol NEAR3 related NEAR3 neuro*) OR TS=ARND* OR TS=(prenatal NEAR3 alcohol NEAR3 expos*) OR TS=PAE OR TS=(growth NEAR3 retard* NEAR3 facial abnormalit* NEAR3 central NEAR3 nervous NEAR3 system NEAR3 dysfunction*) OR TS=(alcohol NEAR3 related NEAR3 birth NEAR3 defect*) OR TS=(alcohol NEAR3 related NEAR3 neurodevelopmental NEAR3 disorder*) OR TS=FAES OR TS=FAE OR TS=(fetal NEAR3 alcohol NEAR3 exposure*)</p> <p>#2 TS=((suicid*) OR TS=(self NEAR3 injur*) OR TS=(self NEAR3 harm*) OR TS=(self NEAR3 destruct*) OR TS=(self NEAR3 mutilat*))</p> <p>#3 (#1 AND #2) <emph>AND</emph> LANGUAGE: (English)</p> <ref id="AN0157442546-23"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Psychology Association. 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Journal of Attention Disorders, 23 (8), 777 – 786. https://doi.org/10.1177/1087054717718264</bibtext> </blist> </ref> <ref id="AN0157442546-24"> <title> Footnotes </title> <blist> <bibtext> A cursory search of the academic literature was conducted in November 2021 to capture any additional articles published during the preparation of this article, and no new records were identified.</bibtext> </blist> <blist> <bibtext> In the contexts of FASD assessment/diagnosis and intervention, or psychiatric/mental health settings.</bibtext> </blist> <blist> <bibtext> These <emph>n</emph>'s add to more than 28 because most studies included data on multiple aspects of suicidality (see, Table 1).</bibtext> </blist> <blist> <bibtext> It is important to note that this statistic does not reflect the prevalence of death by suicide among individuals with FASD, but rather the proportion of deaths that were caused by suicide in one Canadian sample of adults with FASD.</bibtext> </blist> </ref> <aug> <p>By Katherine Flannigan; Andrew J. Wrath; Dorothy E. Badry; Carly A. McMorris; Amanda Ewasiuk; Alanna Campbell and Kelly D. Harding</p> <p>Reported by Author; Author; Author; Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib82" firstref="ref4"></nolink> <nolink nlid="nl2" bibid="bib69" firstref="ref6"></nolink> <nolink nlid="nl3" bibid="bib70" firstref="ref7"></nolink> <nolink nlid="nl4" bibid="bib53" firstref="ref8"></nolink> <nolink nlid="nl5" bibid="bib55" firstref="ref9"></nolink> <nolink nlid="nl6" bibid="bib15" firstref="ref10"></nolink> <nolink nlid="nl7" bibid="bib31" firstref="ref11"></nolink> <nolink nlid="nl8" bibid="bib44" firstref="ref12"></nolink> <nolink nlid="nl9" bibid="bib79" firstref="ref14"></nolink> <nolink nlid="nl10" bibid="bib25" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib45" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib54" firstref="ref17"></nolink> <nolink nlid="nl13" bibid="bib29" firstref="ref18"></nolink> <nolink nlid="nl14" bibid="bib39" firstref="ref19"></nolink> <nolink nlid="nl15" bibid="bib40" firstref="ref20"></nolink> <nolink nlid="nl16" bibid="bib51" firstref="ref21"></nolink> <nolink nlid="nl17" bibid="bib28" firstref="ref22"></nolink> <nolink nlid="nl18" bibid="bib38" firstref="ref23"></nolink> <nolink nlid="nl19" bibid="bib83" firstref="ref24"></nolink> <nolink nlid="nl20" bibid="bib43" firstref="ref25"></nolink> <nolink nlid="nl21" bibid="bib27" firstref="ref26"></nolink> <nolink nlid="nl22" bibid="bib32" firstref="ref27"></nolink> <nolink nlid="nl23" bibid="bib16" firstref="ref32"></nolink> <nolink nlid="nl24" bibid="bib33" firstref="ref33"></nolink> <nolink nlid="nl25" bibid="bib66" firstref="ref34"></nolink> <nolink nlid="nl26" bibid="bib10" firstref="ref35"></nolink> <nolink nlid="nl27" bibid="bib56" firstref="ref36"></nolink> <nolink nlid="nl28" bibid="bib48" firstref="ref37"></nolink> <nolink nlid="nl29" bibid="bib63" firstref="ref38"></nolink> <nolink nlid="nl30" bibid="bib74" firstref="ref39"></nolink> <nolink nlid="nl31" bibid="bib60" firstref="ref40"></nolink> <nolink nlid="nl32" bibid="bib81" firstref="ref41"></nolink> <nolink nlid="nl33" bibid="bib20" firstref="ref42"></nolink> <nolink nlid="nl34" bibid="bib30" firstref="ref43"></nolink> <nolink nlid="nl35" bibid="bib73" firstref="ref44"></nolink> <nolink nlid="nl36" bibid="bib52" firstref="ref46"></nolink> <nolink nlid="nl37" bibid="bib62" firstref="ref47"></nolink> <nolink nlid="nl38" bibid="bib11" firstref="ref55"></nolink> <nolink nlid="nl39" bibid="bib12" firstref="ref56"></nolink> <nolink nlid="nl40" bibid="bib14" firstref="ref57"></nolink> <nolink nlid="nl41" bibid="bib17" firstref="ref58"></nolink> <nolink nlid="nl42" bibid="bib18" firstref="ref59"></nolink> <nolink nlid="nl43" bibid="bib21" firstref="ref60"></nolink> <nolink nlid="nl44" bibid="bib24" firstref="ref61"></nolink> <nolink nlid="nl45" bibid="bib34" firstref="ref62"></nolink> <nolink nlid="nl46" bibid="bib46" firstref="ref63"></nolink> <nolink nlid="nl47" bibid="bib49" firstref="ref64"></nolink> <nolink nlid="nl48" bibid="bib47" firstref="ref65"></nolink> <nolink nlid="nl49" bibid="bib61" firstref="ref66"></nolink> <nolink nlid="nl50" bibid="bib75" firstref="ref67"></nolink> <nolink nlid="nl51" bibid="bib76" firstref="ref68"></nolink> <nolink nlid="nl52" bibid="bib77" firstref="ref69"></nolink> <nolink nlid="nl53" bibid="bib37" firstref="ref71"></nolink> <nolink nlid="nl54" bibid="bib57" firstref="ref72"></nolink> <nolink nlid="nl55" bibid="bib58" firstref="ref73"></nolink> <nolink nlid="nl56" bibid="bib42" firstref="ref75"></nolink> <nolink nlid="nl57" bibid="bib65" firstref="ref76"></nolink> <nolink nlid="nl58" bibid="bib64" firstref="ref77"></nolink> <nolink nlid="nl59" bibid="bib19" firstref="ref78"></nolink> <nolink nlid="nl60" bibid="bib68" firstref="ref79"></nolink> <nolink nlid="nl61" bibid="bib78" firstref="ref80"></nolink> <nolink nlid="nl62" bibid="bib67" firstref="ref81"></nolink> <nolink nlid="nl63" bibid="bib13" firstref="ref97"></nolink> <nolink nlid="nl64" bibid="bib35" firstref="ref157"></nolink> <nolink nlid="nl65" bibid="bib80" firstref="ref158"></nolink> <nolink nlid="nl66" bibid="bib36" firstref="ref160"></nolink> <nolink nlid="nl67" bibid="bib41" firstref="ref161"></nolink> <nolink nlid="nl68" bibid="bib59" firstref="ref163"></nolink> <nolink nlid="nl69" bibid="bib71" firstref="ref164"></nolink> <nolink nlid="nl70" bibid="bib72" firstref="ref167"></nolink> <nolink nlid="nl71" bibid="bib23" firstref="ref179"></nolink> <nolink nlid="nl72" bibid="bib26" firstref="ref180"></nolink> <nolink nlid="nl73" bibid="bib50" firstref="ref183"></nolink> <nolink nlid="nl74" bibid="bib22" firstref="ref184"></nolink> |
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| Items | – Name: Title Label: Title Group: Ti Data: Fetal Alcohol Spectrum Disorder and Suicidality: What Does the Literature Tell Us? – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Flannigan%2C+Katherine%22">Flannigan, Katherine</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-7230-2532">0000-0001-7230-2532</externalLink>)<br /><searchLink fieldCode="AR" term="%22Wrath%2C+Andrew+J%2E%22">Wrath, Andrew J.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-4043-0633">0000-0002-4043-0633</externalLink>)<br /><searchLink fieldCode="AR" term="%22Badry%2C+Dorothy+E%2E%22">Badry, Dorothy E.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-6829-5894">0000-0001-6829-5894</externalLink>)<br /><searchLink fieldCode="AR" term="%22McMorris%2C+Carly+A%2E%22">McMorris, Carly A.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-5164-6210">0000-0002-5164-6210</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ewasiuk%2C+Amanda%22">Ewasiuk, Amanda</searchLink><br /><searchLink fieldCode="AR" term="%22Campbell%2C+Alanna%22">Campbell, Alanna</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-1420-2570">0000-0003-1420-2570</externalLink>)<br /><searchLink fieldCode="AR" term="%22Harding%2C+Kelly+D%2E%22">Harding, Kelly D.</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0001-8996-8058">0000-0001-8996-8058</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Mental+Health+Research+in+Intellectual+Disabilities%22"><i>Journal of Mental Health Research in Intellectual Disabilities</i></searchLink>. 2022 15(3):217-252. – Name: Avail Label: Availability Group: Avail Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 36 – Name: DatePubCY Label: Publication Date Group: Date Data: 2022 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Information Analyses – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Fetal+Alcohol+Syndrome%22">Fetal Alcohol Syndrome</searchLink><br /><searchLink fieldCode="DE" term="%22Neurological+Impairments%22">Neurological Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Suicide%22">Suicide</searchLink><br /><searchLink fieldCode="DE" term="%22Disabilities%22">Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Risk%22">Risk</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1080/19315864.2022.2082604 – Name: ISSN Label: ISSN Group: ISSN Data: 1931-5864<br />1931-5872 – Name: Abstract Label: Abstract Group: Ab Data: Introduction Limited research has been conducted on suicidality among individuals with FASD. The purpose of this scoping review was to understand (1) how suicidality has been measured; (2) what proportion of individuals experience suicidality across the lifespan; and (3) what contextual factors are associated with suicidality. Method We conducted a scoping review of the literature on FASD and suicidality. Twenty-eight articles and gray literature sources were included. Results We identified an elevated risk of suicidal ideation, attempts, and death among individuals with FASD. Most studies were Canadian, published within the last 10 years, and focused on adolescents and adults in clinical settings. Only six studies were specifically designed to examine suicidality in FASD. Conclusion This review provides a foundational understanding of suicidality in FASD with important implications for research, policy, and practice. Rates of suicidality across the lifespan are high, underscoring the need for evidence-based approaches to screening, prevention, and treatment. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2022 – Name: AN Label: Accession Number Group: ID Data: EJ1354053 |
| PLink | https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1354053 |
| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1080/19315864.2022.2082604 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 36 StartPage: 217 Subjects: – SubjectFull: Fetal Alcohol Syndrome Type: general – SubjectFull: Neurological Impairments Type: general – SubjectFull: Suicide Type: general – SubjectFull: Disabilities Type: general – SubjectFull: Risk Type: general Titles: – TitleFull: Fetal Alcohol Spectrum Disorder and Suicidality: What Does the Literature Tell Us? Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Flannigan, Katherine – PersonEntity: Name: NameFull: Wrath, Andrew J. – PersonEntity: Name: NameFull: Badry, Dorothy E. – PersonEntity: Name: NameFull: McMorris, Carly A. – PersonEntity: Name: NameFull: Ewasiuk, Amanda – PersonEntity: Name: NameFull: Campbell, Alanna – PersonEntity: Name: NameFull: Harding, Kelly D. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 1931-5864 – Type: issn-electronic Value: 1931-5872 Numbering: – Type: volume Value: 15 – Type: issue Value: 3 Titles: – TitleFull: Journal of Mental Health Research in Intellectual Disabilities Type: main |
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