Cognitive Emotion Regulation, Peer Victimisation, and Stress Reactivity as Multidimensional Pathways to Suicidality and Self-Harm in Autistic Individuals Without Intellectual Disability

Autistic individuals without intellectual disabilities show high rates of suicidal thoughts and behaviours (STBs); however, the processes underlying this vulnerability remain still unclear and understudied. This study examined STBs within a multidimensional framework integrating intrapersonal, interpersonal, and environmental factors. Eighty-four autistic adolescents and young adults (aged 12–32 years) were included. Overall, 36.9% of participants reported suicidal ideation, 27.4% reported self-harm, and 42.9% endorsed at least one indicator of STBs. Regression analyses reported that peer victimisation was associated with both suicidal ideation and self-harm, while self-harm also showed a specific association with cognitive emotion regulation strategy. Two canonical correlation analyses were performed, including maladaptive and adaptive cognitive emotion regulation strategies. A positive canonical correlation emerged between maladaptive strategies and the STBs domain, whereas a negative canonical correlation was observed between adaptive strategies and the same outcome. Finally, as a sensitivity analysis, a moderation model examined whether perceived stress reactivity influenced the association between emotion regulation and self-harm, showing that this association varied as a function of stress reactivity. Overall, these findings indicate that STBs in autism reflect a dynamic psychopathological process involving interpersonal, intrapersonal, and stress-related domains, with important implications for clinical assessment and the development of targeted prevention strategies.