Is social camouflaging associated with anxiety and depression in autistic adults?

Abstract Background There is inconsistent evidence for a clear pattern of association between ‘camouflaging’ (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. Methods This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. Results Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. Limitations These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. Conclusions The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.

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‘People like me don’t get support’: Autistic adults’ experiences of support and treatment for mental health difficulties, self-injury and suicidality

Autism ◽

10.1177/1362361318816053 ◽

2018 ◽

Vol 23 (6) ◽

pp. 1431-1441 ◽

Cited By ~ 30

Author(s):

Louise Camm-Crosbie ◽

Louise Bradley ◽

Rebecca Shaw ◽

Simon Baron-Cohen ◽

Sarah Cassidy

Keyword(s):

Mental Health ◽

Online Survey ◽

Mental Health Problems ◽

Well Being ◽

Health Problems ◽

Treatment Pathways ◽

Self Injury ◽

Autistic People ◽

Mental Health Difficulties ◽

Autistic Adults

Autistic people are at high risk of mental health problems, self-injury and suicidality. However, no studies have explored autistic peoples’ experiences of treatment and support for these difficulties. In partnership with a steering group of autistic adults, an online survey was developed to explore these individuals’ experiences of treatment and support for mental health problems, self-injury and suicidality for the first time. A total of 200 autistic adults (122 females, 77 males and 1 unreported) aged 18–67 (mean = 38.9 years, standard deviation = 11.5), without co-occurring intellectual disability, completed the online survey. Thematic analysis of open-ended questions resulted in an overarching theme that individually tailored treatment and support was both beneficial and desirable, which consisted of three underlying themes: (1) difficulties in accessing treatment and support; (2) lack of understanding and knowledge of autistic people with co-occurring mental health difficulties and (3) appropriate treatment and support, or lack of, impacted autistic people’s well-being and likelihood of seeing suicide as their future. Findings demonstrate an urgent need for autism treatment pathways in mental health services.

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‘Something needs to change’: Mental health experiences of young autistic adults in England

Autism ◽

10.1177/1362361318757048 ◽

2018 ◽

Vol 23 (2) ◽

pp. 477-493 ◽

Cited By ~ 33

Author(s):

Laura Crane ◽

Fern Adams ◽

Georgia Harper ◽

Jack Welch ◽

Elizabeth Pellicano

Keyword(s):

Mental Health ◽

Help Seeking ◽

Online Survey ◽

Mental Health Problems ◽

Health Problems ◽

Autism Spectrum ◽

Health Needs ◽

Mental Health Needs ◽

Autistic People ◽

Autistic Adults

There is a high incidence and prevalence of mental health problems among young people, with several barriers to help-seeking noted in this group. High rates of mental health problems have also been reported in children and adults on the autism spectrum. Taken together, young autistic people may be a particularly vulnerable group when it comes to mental health. Yet, there has been remarkably little work on the mental health needs and experiences of young autistic adults (16–25 years). Adopting a community-based participatory research (CBPR) approach – in which academic researchers and young autistic adults collaborated in an equitable research partnership – we explored young autistic people’s experiences of mental health problems and their perspectives on the support they sought, if any, for these problems. A total of 130 young autistic adults took part in the research: 109 completed an online survey and 21 took part in detailed interviews. The results highlight how young autistic people find it difficult to evaluate their mental health, experience high levels of stigma and often face severe obstacles when trying to access mental health support. The findings also demonstrate how listening to – and learning from – young autistic people is crucial in ensuring that their mental health needs are met.

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Gender differences in self-reported camouflaging in autistic and non-autistic adults

Autism ◽

10.1177/1362361319864804 ◽

2019 ◽

Vol 24 (2) ◽

pp. 352-363 ◽

Cited By ~ 25

Author(s):

Laura Hull ◽

Meng-Chuan Lai ◽

Simon Baron-Cohen ◽

Carrie Allison ◽

Paula Smith ◽

...

Keyword(s):

Gender Differences ◽

Intellectual Disability ◽

Gender Difference ◽

Social Interactions ◽

Online Survey ◽

Autistic Traits ◽

Autistic People ◽

Males And Females ◽

Autistic Adults ◽

First Time

Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic ( n = 306) and non-autistic adults ( n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial η2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial η2 = 0.05) and Assimilation (partial η2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.

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Camouflaging in non-autistic adults is associated with poorer mental health

10.31234/osf.io/myp4g ◽

2019 ◽

Author(s):

Mark Somerville ◽

Sarah E. MacPherson ◽

Sue Fletcher-Watson

Keyword(s):

Mental Health ◽

Executive Function ◽

Autistic Traits ◽

Self Report ◽

Linear Regression Models ◽

Mental Health Symptoms ◽

Health Symptoms ◽

Autistic People ◽

Autistic Adults ◽

The Relationship

Camouflaging is a frequently reported behaviour in autistic people, which entails the use of strategies to compensate for and mask autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a non-autistic sample, examining the relationship between autistic traits, camouflaging, and mental health. In addition, the role of executive functions as a mechanism underpinning camouflaging was explored. Sixty-three non-autistic adults completed standardised self-report questionnaires which measured: autistic traits, mental health symptoms, and camouflaging behaviours. In addition, a subset (n=51) completed three tests of executive function measuring inhibition, working memory, and set-shifting. Multiple linear regression models were used to analyse data. Results indicated that autistic traits are not associated with mental health symptoms when controlling for camouflaging, and camouflaging predicted increased mental health symptoms. Camouflaging did not correlate with any measure of executive function. These findings have implications for understanding the relationship between autistic traits and mental health in non-autistic people and add to the growing development of theory and knowledge about the mechanism and effects of camouflaging.

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Met and unmet needs among adults with mild to moderate intellectual disability with and without mental health problems

10.31234/osf.io/ztrjg ◽

2020 ◽

Author(s):

Matthias Schützwohl

Keyword(s):

Mental Health ◽

Intellectual Disability ◽

Unmet Needs ◽

Mental Health Problems ◽

Psychiatric Symptoms ◽

Health Problems ◽

Service Planning ◽

Support Needs ◽

Behaviour Problem ◽

Prevalence Rates

Background: People with an intellectual disability (ID) show a great number and complex constellation of support needs. With respect to the planning of services, it is important to assess needs at the population level. ID services need to know to what extent support needs of clients with mental health problems differ from support needs of clients without any mental health problem.Aims: The aim of this study was to compare the prevalence rates of needs in relevant study groups. Methods: Data was generated from the MEMENTA-Study (“Mental health care for adults with intellectual disability and a mental disorder”). The Camberwell Assessment of Need for Adults with Intellectual Disabilities (CANDID) was used to assess met und unmet support needs. Data was available for n=248 adults with mild to moderate ID.Results: Mean total number of needs and unmet needs was associated with mental health status. However, in most particular areas under study, individuals without significant psychiatric symptoms or any behaviour problem needed as much as often help as individuals with such mental health problems. A higher rate of need for care among study participants with significant psychiatric symptoms or any behaviour problem was mainly found with regard to these specific areas (“minor mental health problems”, “major mental health problems”, “inappropriate behaviour”) or with regard to closely related areas (“safety of others”).Conclusions: Differences in prevalence rates mainly occurred in such areas of need that rather fall under the responsibility of mental health services than under the responsibility of ID services. This has implications for service planning.

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Demographic and psychological predictors of alcohol use and misuse in autistic adults

Autism ◽

10.1177/1362361321992668 ◽

2021 ◽

Vol 25 (5) ◽

pp. 1469-1480

Author(s):

Maya Bowri ◽

Laura Hull ◽

Carrie Allison ◽

Paula Smith ◽

Simon Baron-Cohen ◽

...

Keyword(s):

Social Anxiety ◽

Alcohol Use ◽

Online Survey ◽

Autistic Traits ◽

Well Being ◽

Psychological Predictors ◽

Autistic Adults ◽

Mental Well Being ◽

Shaped Pattern ◽

Significant Factors

This study explored demographic and psychological predictors of alcohol use and misuse in a high-functioning, community sample of 237 autistic adults aged 18–75 (mean = 41.92 and standard deviation = 13.3) recruited in the United Kingdom. An online survey measured demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use with the Alcohol Use Disorders Identification Test. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) and multinomial logistic regression models were used to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring significantly higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. In multivariate analysis, autistic non-drinkers were less likely to be male (odds ratio = 0.44; 95% confidence interval = 0.22–0.87) and had more autistic traits (odds ratio = 2.50; 95% confidence interval = 1.19–5.28). Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community. Lay abstract Alcohol use and misuse are associated with a variety of negative physical, psychological and social consequences. The limited existing research on substance use including alcohol use in autistic adults has yielded mixed findings, with some studies concluding that autism reduces the likelihood of substance use and others suggesting that autism may increase an individual’s risk for substance misuse. This study investigated demographic and psychological predictors of alcohol use and misuse in a sample of 237 autistic adults. An online survey was used to obtain data on demographic information, autistic traits, depression, generalised anxiety, social anxiety, mental well-being, social camouflaging and alcohol use. The sample was divided into three groups (non-drinkers, non-hazardous drinkers and hazardous drinkers) in order to investigate associations between alcohol use and demographic factors, autistic traits, mental health variables and social camouflaging. Our results demonstrated a U-shaped pattern among autistic adults, with non-drinkers and hazardous drinkers scoring higher than non-hazardous drinkers on levels of autistic traits, depression, generalised anxiety and social anxiety. Autistic non-drinkers were less likely to be male and had more autistic traits. Gender and level of autistic traits may be the most significant factors in predicting alcohol use in the autistic community.

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Embitterment as a Specific Mental Health Reaction during the Coronavirus Pandemic

Psychopathology ◽

10.1159/000517447 ◽

2021 ◽

pp. 1-10

Author(s):

Beate Muschalla ◽

Clio Vollborn ◽

Anke Sondhof

Keyword(s):

Mental Health ◽

Mental Illness ◽

Online Survey ◽

Mental Health Problems ◽

Affective State ◽

Well Being ◽

Health Problems ◽

Social Consequences ◽

High Rate ◽

Perceived Injustice

Introduction: Embitterment can occur as a reaction to perceived injustice. During the pandemic and restrictions in daily living due to infection risk management, a range of many smaller or severe injustices have occurred. Objective: The aim of this study is to investigate what characterizes persons with high embitterment, mental illness, embitterment and mental illness, and those without embitterment or mental health problems. Methods: We conducted an online survey including persons from the general population in November 2020 and December 2020, the phase during which a second lockdown took place, with closed shops, restaurants, cultural and activity sites. 3,208 participants (mean age 47 years) gave self-ratings on their present well-being, burdens experienced during the pandemic, embitterment, wisdom, and resilience. Results: Embitterment occurred among 16% of the sample, which is a high rate in comparison with 4% during pre-pandemic times. Embitterment was weakly correlated with unspecific mental well-being. There were more persons with embitterment than those with embitterment and a mental health problem. Persons with embitterment reported less coronavirus-related anxiety than persons without embitterment. However, embittered persons reported more social and economic burdens and more frequent experiences of losses (job loss and canceling of medical treatments). Embittered persons perceive their own wisdom competencies on a similar level as persons with mental health problems or persons without mental health problems. Conclusion: Embitterment is a specific potentially alone-standing affective state, which is distinguishable from general mental health and coping capacities (here: wisdom). The economic and social consequences of pandemic management should be carefully recognized and prevented by policy.

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Online screening and feedback to increase help-seeking for mental health problems: population-based randomised controlled trial

BJPsych Open ◽

10.1192/bjpo.bp.115.001552 ◽

2016 ◽

Vol 2 (1) ◽

pp. 67-73 ◽

Cited By ~ 20

Author(s):

Philip J. Batterham ◽

Alison L. Calear ◽

Matthew Sunderland ◽

Natacha Carragher ◽

Jacqueline L. Brewer

Keyword(s):

Mental Health ◽

Social Anxiety ◽

Help Seeking ◽

Service Use ◽

Mental Health Problems ◽

Controlled Trial ◽

Population Based ◽

Health Problems ◽

Professional Service ◽

Negative Effect

BackgroundCommunity-based screening for mental health problems may increase service use through feedback to individuals about their severity of symptoms and provision of contacts for appropriate services.AimsThe effect of symptom feedback on service use was assessed. Secondary outcomes included symptom change and study attrition.MethodUsing online recruitment, 2773 participants completed a comprehensive survey including screening for depression (n=1366) or social anxiety (n=1407). Across these two versions, approximately half (n=1342) of the participants were then randomly allocated to receive tailored feedback. Participants were reassessed after 3 months (Australian New Zealand Clinical Trials Registry ANZCTR12614000324617).ResultsA negative effect of providing social anxiety feedback to individuals was observed, with significant reductions in professional service use. Greater attrition and lower intentions to seek help were also observed after feedback.ConclusionsOnline mental health screening with feedback is not effective for promoting professional service use. Alternative models of online screening require further investigation.

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