Depression & Suicide Risk – A Conversation with Dr. Jessica Schwartzman

Dr. Jessica Schwartzman’s research goes above and beyond when it comes to helping improve the quality of life of the neurodiverse community. She has researched critical real-world problems, such as COVID and suicide, as they have affected adolescents with autism and studied them to find solutions to such serious current issues. She is a professional in the diagnosis and treatment of anxiety disorders and autism and has utilized cognitive behavioral approaches in a positive, unique way to target the needs of autistic youth and adults.

The Real Spectrum: How did you become interested in autism research?

Dr. Schwartzman: I first became interested in autism research in the early 2000s. I have a younger brother who is diagnosed with autism and an intellectual disability. I’ve had both a personal and professional interest in this research over the past 27 years. In terms of research, I really fell in love with working with autistic people at UCLA and then at Stanford, and now here at Vanderbilt.

I’ve never considered the suicidality aspect of ASD. Why do you think autistic youth are prone to suicidal thoughts and behaviors?

Dr. Jessica Schwartzman

In the United States, adolescent suicide is the second leading cause of death. It’s a huge issue. Some of the work that has come out in the past decade has told us that autistic youth are over 7 times more likely to die prematurely by suicide. So, this population of adolescents and children are at substantial risk. It’s been encouraging to see that the National Institute of Health and other agencies are really trying to support clinical research and services targeting this challenge. I think suicide in non-autistic populations is a really dynamic process; there’s not only one reason for suicidal thoughts. In autism as well as in neurotypical children, suicidal thoughts are mainly apparent in kids with gender-diverse identities. We also know that trauma is a huge risk factor. This could look like bullying, which we know is more common in autism, or abuse and neglect. Loneliness is a third really critical factor in many adverse outcomes, whether it’s physical illness, suicidal thoughts, or depression. I don’t think there is only one reason why individuals with autism are at elevated risk for suicidal thoughts and behaviors. However, now that we know some of the risk factors, we can plan out ways to intervene from a more sensitive perspective.

How do you think kindness can be practiced in cognitive behavioral approaches and techniques?

I think in terms of cognitive behavioral approaches for non-autistic people, if they’re interested in engaging neurodiverse people, I think it’d be really important to think about kindness. In order to be kind, I think one aspect of that is to really understand and learn from people’s actual experiences through getting involved in a neurodiverse community group or spending time with people who are neurodiverse. Kindness could do a lot for the stigmatization challenges that many autistic people face in a negative way. In terms of cognitive behavioral approaches for autistic people, I would flip it on its head a little bit and I would say that self kindness would be something that I would really want to focus on. I think much of the stigma creates a lot of negative beliefs about autistic people. I encounter that a lot in the work that I do. We could cultivate this idea that autistic identity is something that can be celebrated and encouraged for both the strengths that it brings, and maybe adaptations or difficulties that may occur. A lot of that could happen through self kindness and recognition.

How have you brought your own knowledge and expertise to the Frist Center for Autism and Innovation?

I would say that I don’t work directly at the Frist Center; I’m a member which means that I contribute in various ways to the research projects. The Frist Center gave me and my mentor, Blythe Corbett, some funding to look at the intersection of depression and unemployment in ASD, both being more prevalent problems in autistic people. That research is actually just about to come out. We basically found that depression has some significantly negative effects in autistic people when trying to obtain and remain in a job. We don’t actually see the opposite to be true. We don’t see that employment has protective factors in the way we think it does. It’s possible that employment provides financial security and gives people a sense of independence. However, when it comes to mitigating depression or suicide risk, we don’t really see a benefit. The Frist Center is becoming increasingly interested in mental health outcomes as a result of employment.

What do you think will be the long-term effects of COVID-19 quarantine on individuals with ASD or other neurodevelopmental disorders?

My mentor at Vanderbilt, Blythe Corbett, did a study early in the pandemic. We basically followed a set of adolescents and parents throughout the pandemic. We followed a set of adolescents with ASD and their parents. The parents of autistic youth had stress that was substantially higher, which can then affect the autistic child and their family system. We saw then that autistic youth had higher anxiety. We know that autistic youth are more likely to experience anxiety than non-autistic youth. But COVID may have exacerbated that anxiety. Moving forward, it’s important to work with teens and parents about how to reintegrate into the world, whether it’s going back to school in person, or going out to the community activities that they loved. It’s helping families think about how to do that safely from a physically safe perspective, but also thinking about mental safety too.

Are there often defects in treatment techniques, inventories, and diagnostic questionnaires when using them to diagnose and treat various ethnic or racial groups?

Yes and I think this is a huge challenge to autism research and clinical research across the board. Oftentimes, the majority of our treatments and research is built from caucasian populations. To take steps forward, we need to enhance community engagement and participatory research. We should meet with families from other countries, like Ecuador or Guatemala. We should be engaging these cultural communities from the start when offering new treatments or developing new screening measures. Having community engagement from start to finish and even sharing the research is really critical. This is a very complex issue but a second area needing work is the amount of funding. If funding is increased, we can create new specific culture-based techniques to target everyone’s needs.

What can you say to young women interested in STEM?

I want to encourage women interested in STEM to get connected or to build a “women in STEM” network. There are really great established organizations across the US that they can reach out to as well. Even if they are in high school, college, or in fields like marketing or business, it is so important to form connections with people. I think there’s a lot of benefits that come from forming a network and having a collective effort. There’s a lot of systemic challenges that have really hindered women from achieving certain benchmarks and we need to think about how we can advocate for changes in the systems that we work in so that people have equivalent and achievable benchmarks. I’m hopeful that this generation, your generation, will continue to advocate and create conversation. It’s super important.

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