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Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality

Published online by Cambridge University Press:  21 February 2020

Katie N. Sampson*
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Rachel Upthegrove
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK Institute for Mental Health, University of Birmingham, Birmingham, UK School of Psychology, University of Birmingham, Birmingham, UK
Ahmad Abu-Akel
Institute of Psychology, University of Lausanne, Lausanne, Switzerland
Sayeed Haque
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
Stephen J. Wood
School of Psychology, University of Birmingham, Birmingham, UK Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
Renate Reniers
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK Institute for Mental Health, University of Birmingham, Birmingham, UK
Author for correspondence: Katie N. Sampson, E-mail:



There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.


Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.


A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.


This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.

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Copyright © The Author(s) 2020. Published by Cambridge University Press

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Abu-Akel, A., Baxendale, L., Mohr, C., & Sullivan, S. (2018). The association between schizotypal traits and social functioning in adolescents from the general population. Psychiatry Research, 270, 895900. doi:10.1016/j.psychres.2018.11.007CrossRefGoogle ScholarPubMed
Abu-Akel, A., Clark, J., Perry, A., Wood, S. J., Forty, L., Craddock, N., … Jones, L. (2017). Autistic and schizotypal traits and global functioning in bipolar I disorder. Journal of Affective Disorders, 207, 268275. doi:10.1016/j.jad.2016.09.059CrossRefGoogle ScholarPubMed
Abu-Akel, A., Testa, R. R., Jones, H. P., Ross, N., Skafidas, E., Tonge, B., & Pantelis, C. (2018). Attentional set-shifting and social abilities in children with schizotypal and comorbid autism spectrum disorders. Australian and New Zealand Journal of Psychiatry, 52(1), 6877. doi:10.1177/0004867417708610CrossRefGoogle ScholarPubMed
Abu-Akel, A., Wood, S. J., Hansen, P. C., & Apperly, I. A. (2015). Perspective-taking abilities in the balance between autism tendencies and psychosis proneness. Proceedings. Biological sciences/The Royal Society, 282(1808), 20150563. doi:10.1098/rspb.2015.0563CrossRefGoogle ScholarPubMed
Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The Autism-Spectrum Quotient (AQ): Evidence from asperger syndrome/high-functioning autism, malesand females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 517. doi:10.1023/a:1005653411471CrossRefGoogle Scholar
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, 57(1), 289300.Google Scholar
Bevan Jones, R., Thapar, A., Lewis, G., & & Zammit, S. (2012). The association between early autistic traits and psychotic experiences in adolescence. Schizophrenia Research, 135(1), 164169. doi: ScholarPubMed
Borschmann, R., Hogg, J., Phillips, R., & Moran, P. (2012). Measuring self-harm in adults: A systematic review. European Psychiatry, 27(3), 176180. doi: ScholarPubMed
Buckley, P. F., Miller, B. J., Lehrer, D. S., & Castle, D. J. (2009). Psychiatric comorbidities and schizophrenia. Schizophrenia Bulletin, 35(2), 383402. doi:10.1093/schbul/sbn135CrossRefGoogle Scholar
Carter-Harris, L. (2016). Facebook targeted advertisement for research recruitment: A primer for nurse researchers. Applied Nursing Research, 32, 144147. doi: ScholarPubMed
Chisholm, K., Lin, A., Abu-Akel, A., & Wood, S. J. (2015). The association between autism and schizophrenia spectrum disorders: A review of eight alternate models of co-occurrence. Neuroscience & Biobehavioral Reviews, 55, 173183. doi: ScholarPubMed
Davidson, C. A., Hoffman, L., & Spaulding, W. D. (2016). Schizotypal personality questionnaire – brief revised (updated): An update of norms, factor structure, and item content in a large non-clinical young adult sample. Psychiatry Research, 238, 345355. doi: Scholar
De Crescenzo, F., Postorino, V., Siracusano, M., Riccioni, A., Armando, M., Curatolo, P., & Mazzone, L. (2019). Autistic symptoms in schizophrenia spectrum disorders: A systematic review and meta-analysis. Frontiers in Psychiatry, 10, 78. doi:10.3389/fpsyt.2019.00078CrossRefGoogle ScholarPubMed
DeVylder, J. E., Burnette, D., & Yang, L. H. (2014). Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples. Psychological Medicine, 44(16), 35033513. doi:10.1017/S0033291714000944CrossRefGoogle ScholarPubMed
Dinsdale, N. L., Hurd, P. L., Wakabayashi, A., Elliot, M., & Crespi, B. J. (2013). How are autism and schizotypy related? evidence from a non-clinical population. PLOS ONE, 8(5), e63316. doi:10.1371/journal.pone.0063316CrossRefGoogle ScholarPubMed
Fonseca Pedrero, E., & Debbane, M. (2017). Schizotypal traits and psychotic-like experiences during adolescence: An update. Psicothema, 29(1), 517. doi:10.7334/psicothema2016.209Google ScholarPubMed
Fonseca-Pedrero, E., Paino, M., Lemos-Giraldez, S., Sierra-Baigrie, S., Ordonez-Camblor, N., & Muniz, J. (2011). Early psychopathological features in Spanish adolescents. Psicothema, 23(1), 8793. Retrieved from ScholarPubMed
Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 32(4), 299306. Retrieved from ScholarPubMed
Gratz, K. L. (2001). Measurement of deliberate self-harm: Preliminary data on the deliberate self-harm inventory. Journal of Psychopathology and Behavioral Assessment, 23(4), 253263. doi:10.1023/a:1012779403943CrossRefGoogle Scholar
Hamlyn, J., Duhig, M., McGrath, J., & Scott, J. (2013). Modifiable risk factors for schizophrenia and autism – shared risk factors impacting on brain development. Neurobiology of Disease, 53, 39. doi: ScholarPubMed
Hankin, B. L., Gibb, B. E., Abela, J. R., & Flory, K. (2010). Selective attention to affective stimuli and clinical depression among youths: Role of anxiety and specificity of emotion. Journal of Abnormal Psychology, 119(3), 491501. doi:10.1037/a0019609CrossRefGoogle ScholarPubMed
Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O., … Leboyer, M. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1), 35. doi:10.1186/1471-244x-9-35CrossRefGoogle ScholarPubMed
Hommer, R. E., & Swedo, S. E. (2015). Schizophrenia and autism – related disorders. Schizophrenia Bulletin, 41(2), 313314. doi:10.1093/schbul/sbu188CrossRefGoogle ScholarPubMed
Hurst, R. M., Nelson-Gray, R. O., Mitchell, J. T., & Kwapil, T. R. (2007). The relationship of asperger's characteristics and schizotypal personality traits in a non-clinical adult sample. Journal of Autism and Developmental Disorders, 37(9), 17111720. doi:10.1007/s10803-006-0302-zCrossRefGoogle Scholar
Jones, H. P., Testa, R. R., Ross, N., Seal, M. L., Pantelis, C., & Tonge, B. (2015). The Melbourne assessment of schizotypy in kids: A useful measure of childhood schizotypal personality disorder. Biomed Research International, 2015, 635732. doi:10.1155/2015/635732CrossRefGoogle ScholarPubMed
Kanne, S. M., Christ, S. E., & Reiersen, A. M. (2009). Psychiatric symptoms and psychosocial difficulties in young adults with autistic traits. Journal of Autism and Developmental Disorders, 39(6), 827833. doi:10.1007/s10803-008-0688-xCrossRefGoogle ScholarPubMed
Kaymaz, N., Drukker, M., Lieb, R., Wittchen, H. U., Werbeloff, N., Weiser, M., … van Os, J. (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine, 42(11), 22392253. doi:10.1017/S0033291711002911CrossRefGoogle ScholarPubMed
Kayrouz, R., Dear, B. F., Karin, E., & Titov, N. (2016). Facebook as an effective recruitment strategy for mental health research of hard to reach populations. Internet Interventions, 4, 110. doi: ScholarPubMed
Kincaid, D. L., Doris, M., Shannon, C., & Mulholland, C. (2017). What is the prevalence of autism spectrum disorder and ASD traits in psychosis? A systematic review. Psychiatry Research, 250, 99105. doi: ScholarPubMed
Kushima, I., Aleksic, B., Nakatochi, M., Shimamura, T., Okada, T., Uno, Y., … Ozaki, N. (2018). Comparative analyses of copy-number variation in autism spectrum disorder and schizophrenia reveal etiological overlap and biological insights. Cell Reports, 24(11), 28382856. doi:10.1016/j.celrep.2018.08.022CrossRefGoogle ScholarPubMed
Larson, F. V., Wagner, A. P., Jones, P. B., Tantam, D., Lai, M.-C., Baron-Cohen, S., & Holland, A. J. (2017). Psychosis in autism: Comparison of the features of both conditions in a dually affected cohort. British Journal of Psychiatry, 210(4), 269275. doi:10.1192/bjp.bp.116.187682CrossRefGoogle Scholar
Liew, S. M., Thevaraja, N., Hong, R. Y., & Magiati, I. (2015). The relationship between autistic traits and social anxiety, worry, obsessive–compulsive, and depressive symptoms: Specific and non-specific mediators in a student sample. Journal of Autism and Developmental Disorders, 45(3), 858872. doi:10.1007/s10803-014-2238-zCrossRefGoogle Scholar
Linscott, R. J., & van Os, J. (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine, 43(6), 11331149. doi:10.1017/S0033291712001626CrossRefGoogle ScholarPubMed
Lundström, S., Chang, Z., Kerekes, N., Gumpert, C. H., Råstam, M., Gillberg, C., … Anckarsäter, H. (2011). Autistic-like traits and their association with mental health problems in two nationwide twin cohorts of children and adults. Psychological Medicine, 41(11), 24232433. doi:10.1017/S0033291711000377CrossRefGoogle ScholarPubMed
Maddox, B. B., Trubanova, A., & White, S. W. (2017). Untended wounds: Non-suicidal self-injury in adults with autism spectrum disorder. Autism, 21(4), 412422. doi:10.1177/1362361316644731CrossRefGoogle ScholarPubMed
Mark, W., & Toulopoulou, T. (2016). Psychometric properties of ‘Community Assessment of Psychic Experiences’: Review and meta-analyses. Schizophrenia Bulletin, 42(1), 3444. doi:10.1093/schbul/sbv088Google Scholar
Matsuo, J., Kamio, Y., Takahashi, H., Ota, M., Teraishi, T., Hori, H., … Kunugi, H. (2015). Autistic-like traits in adult patients with mood disorders and schizophrenia. PLOS ONE, 10(4), e0122711. doi:10.1371/journal.pone.0122711CrossRefGoogle Scholar
McGinty, J., Sayeed Haque, M., & Upthegrove, R. (2017). Depression during first episode psychosis and subsequent suicide risk: A systematic review and meta-analysis of longitudinal studies. Schizophrenia Research, 195, 5866. doi: ScholarPubMed
Mealey, A., Abbott, G., Byrne, L. K., & McGillivray, J. (2014). Overlap between autistic and schizotypal personality traits is not accounted for by anxiety and depression. Psychiatry Research, 219(2), 380385. doi: Scholar
Meltzer, H. L. D., Corbin, T., Singleton, N., Jenkins, R., & Brugha, T. (2002). Non fatal suicidal behaviour among adults aged 16-74 in Great Britain. Survey of psychiatric morbidity carried out in 2000. London: The Stationery Office.Google Scholar
Michael, F. (2013). Overlap between autism and schizophrenia: History and current status. Advances in Mental Health and Intellectual Disabilities, 8(1), 1523. doi:10.1108/AMHID-09-2013-0058Google Scholar
Mirowsky, J., & Ross, C. E. (1992). Age and depression. Journal of Health and Social Behavior, 33(3), 187205. doi:10.2307/2137349CrossRefGoogle ScholarPubMed
Moseley, R. L., Gregory, N. J., Smith, P., Allison, C., & Baron-Cohen, S. J. M. A. (2019). A ‘choice’, an ‘addiction’, a way ‘out of the lost’: Exploring self-injury in autistic people without intellectual disability. Molecular Autism, 10(1), 18. doi:10.1186/s13229-019-0267-3.CrossRefGoogle ScholarPubMed
Mouridsen, S. E., Rich, B., & Isager, T. (2008). Psychiatric disorders in adults diagnosed as children with atypical autism. A case control study. Journal of Neural Transmission, 115(1), 135138. doi:10.1007/s00702-007-0798-1CrossRefGoogle ScholarPubMed
Nishida, A., Sasaki, T., Nishimura, Y., Tanii, H., Hara, N., Inoue, K., … Okazaki, Y. (2010). Psychotic-like experiences are associated with suicidal feelings and deliberate self-harm behaviors in adolescents aged 12–15 years. Acta Psychiatrica Scandinavica, 121(4), 301307. doi:10.1111/j.1600-0447.2009.01439.xCrossRefGoogle ScholarPubMed
Office for National Statistics; National Records of Scotland; Northern Ireland Statistics and Research Agency (2017). 2011 Census aggregate data. UK Data Service. doi: Scholar
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001). The Suicidal Behaviors Questionnaire-Revised (SBQ-R): Validation with clinical and nonclinical samples. Assessment, 8(4), 443454. doi:10.1177/107319110100800409CrossRefGoogle ScholarPubMed
Pelton, M. K., & Cassidy, S. A. (2017). Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample. Autism Research, 10(11), 18911904. doi:10.1002/aur.1828CrossRefGoogle Scholar
Piccinelli, M., & Wilkinson, G. (2000). Gender differences in depression: Critical review. British Journal of Psychiatry, 177(6), 486492. doi:10.1192/bjp.177.6.486CrossRefGoogle ScholarPubMed
Rhebergen, D., Batelaan, N. M., Graaf, R. D., Nolen, W. A., Spijker, J., Beekman, A. T. F., & Penninx, B. W. J. H. (2011). The 7-year course of depression and anxiety in the general population. Acta Psychiatrica Scandinavica, 123(4), 297306. doi:10.1111/j.1600-0447.2011.01677.xCrossRefGoogle ScholarPubMed
Rosbrook, A., & Whittingham, K. (2010). Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology? Research in Autism Spectrum Disorders, 4(3), 415424. doi: Scholar
Rousseeuw, P. J., & Leroy, A. M. (2005). Robust regression and outlier detection. New York, USA: John Wiley & Sons, Inc.Google Scholar
Russell-Smith, S. N., Maybery, M. T., & Bayliss, D. M. (2011). Relationships between autistic-like and schizotypy traits: An analysis using the autism spectrum quotient and Oxford-Liverpool inventory of feelings and experiences. Personality and Individual Differences, 51(2), 128132. doi: Scholar
Ruzich, E., Allison, C., Smith, P., Watson, P., Auyeung, B., Ring, H., & Baron-Cohen, S. (2015). Measuring autistic traits in the general population: A systematic review of the Autism-Spectrum Quotient (AQ) in a nonclinical population sample of 6900 typical adult males and females. Molecular Autism, 6(1), 2. doi:10.1186/2040-2392-6-2CrossRefGoogle Scholar
Saha, S., Scott, J. G., Johnston, A. K., Slade, T. N., Varghese, D., Carter, G. L., & McGrath, J. J. (2011). The association between delusional-like experiences and suicidal thoughts and behaviour. Schizophrenia Research, 132(2), 197202. doi: ScholarPubMed
Schlier, B., Jaya, E. S., Moritz, S., & Lincoln, T. M. (2015). The community assessment of psychic experiences measures nine clusters of psychosis-like experiences: A validation of the German version of the CAPE. Schizophrenia Research, 169(1), 274279. doi: ScholarPubMed
Shi, L.-J., Liu, W.-H., Shi, H.-S., Yan, C., Wang, Y., Wang, Y., … Chan, R. C. K. (2017). Co-occurrence of autistic and schizotypal traits and its association with emotional and psychosocial function in Chinese college students. Psychiatry Research, 248, 6470. doi: ScholarPubMed
Sierro, G., Rossier, J., & Mohr, C. (2016). Validation of the French autism spectrum quotient scale and its relationships with schizotypy and Eysenckian personality traits. Comprehensive Psychiatry, 68, 147155. doi: ScholarPubMed
Spek, A. A., & Wouters, S. G. M. (2010). Autism and schizophrenia in high functioning adults: Behavioral differences and overlap. Research in Autism Spectrum Disorders, 4(4), 709717. doi:10.1016/j.rasd.2010.01.009CrossRefGoogle Scholar
Stewart, C. S., McEwan, F., Konstantellou, A., Eisler, I., & Simic, M. (2017). Impact of ASD traits on treatment outcomes of eating disorders in girls. European Eating Disorders Review, 25(2), 123128. doi:10.1002/erv.2497.CrossRefGoogle ScholarPubMed
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics: Pearson New international edition. Harlow, UK: Pearson Education UK.Google Scholar
Upthegrove, R., Abu-Akel, A., Chisholm, K., Lin, A., Zahid, S., Pelton, M., … Wood, S. J. (2018). Autism and psychosis: Clinical implications for depression and suicide. Schizophrenia Research, 195, 8085. doi: ScholarPubMed
Van Dam, N. T., & Earleywine, M. (2011). Validation of the Center for Epidemiologic Studies Depression Scale – Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186(1), 128132. doi: Scholar
Wainer, A. L., Ingersoll, B. R., & Hopwood, C. J. (2011). The structure and nature of the broader autism phenotype in a non-clinical sample. Journal of Psychopathology and Behavioral Assessment, 33(4), 459. doi:10.1007/s10862-011-9259-0CrossRefGoogle Scholar
Wakabayashi, A., Baron-Cohen, S., & Ashwin, C. (2012). Do the traits of autism-spectrum overlap with those of schizophrenia or obsessive-compulsive disorder in the general population? Research in Autism Spectrum Disorders, 6(2), 717725. doi: Scholar
World Health Organisation (2018). Depression. Retrieved from Scholar
Zahid, S., & Upthegrove, R. (2017). Suicidality in autistic spectrum disorders. Crisis, 38(4), 237246. doi:10.1027/0227-5910/a000458CrossRefGoogle ScholarPubMed
Zerbo, O., Massolo, M. L., Qian, Y., & Croen, L. A. (2015). A study of physician knowledge and experience with autism in adults in a large integrated healthcare system. Journal of Autism and Developmental Disorders, 45(12), 40024014. doi:10.1007/s10803-015-2579-2CrossRefGoogle Scholar
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