Abstract
There is increased mental-health adversity among individuals with autism spectrum disorder. At the same time, sexual and gender minority groups experience poorer mental-health when compared to heteronormative populations. Recent research suggests that autistic individuals report increased non-heterosexuality and gender-dysphoric traits. The current study aimed to investigate whether as membership of minority grouping becomes increasingly narrowed, mental health worsened. The present study compared the rates of depression, anxiety, and stress using the DASS-21 and Personal Well-Being using the personal well-being index between 261 typically-developing individuals and 309 autistic individuals. As membership to a minority group became more restrictive, mental health symptoms worsened (p < .01), suggesting stressors added. Specialized care is recommended for this vulnerable cohort.
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Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help seeking. American Psychologist, 58(1), 5.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (4th edn.). Washington, DC: American Psychiatric Association.
Barcikowski, R. S., & Robey, R. R. (1984). Decisions in single group repeated measures analysis: Statistical tests and three computer packages. The American Statistician, 38(2), 148–150.
Bijl, R. V., Ravelli, A., & Van Zessen, G. (1998). Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Social Psychiatry & Psychiatric Epidemiology, 33(12), 587–595.
Billstedt, E., Gillberg, I. C., & Gillberg, C. (2010). Aspects of quality of life in adults diagnosed with autism in childhood: A population-based study. Autism. https://doi.org/10.1177/1362361309346066.
Bolton, P. F., Pickles, A., Murphy, M., & Rutter, M. (1998). Autism, affective and other psychiatric disorders: patterns of familial aggregation. Psychological Medicine, 28(02), 385–395.
Brown, S. L. (2000). The effect of union type on psychological well-being: Depression among cohabitors versus marrieds. Journal of Health & Social Behavior, 4, 241–255.
Burns, R. A., Anstey, K. J., & Windsor, T. D. (2011). Subjective well-being mediates the effects of resilience and mastery on depression and anxiety in a large community sample of young and middle-aged adults. Australian & New Zealand Journal of Psychiatry, 45(3), 240–248.
Carroll, L., Gilroy, P. J., & Ryan, J. (2002). Counseling transgendered, transsexual, and gender-variant clients. Journal of Counseling & Development: JCD, 80(2), 131.
Cummins, R. A., Li, N., Wooden, M., & Stokes, M. (2014). A demonstration of set-points for subjective wellbeing. Journal of Happiness Studies, 15(1), 183–206.
Davern, M. T., Cummins, R. A., & Stokes, M. A. (2007). Subjective wellbeing as an affective-cognitive construct. Journal of Happiness Studies, 8(4), 429–449.
Davey, A., Bouman, W. P., Arcelus, J., & Meyer, C. (2014). Social support and psychological well-being in gender dysphoria: A comparison of patients with matched controls. The Journal of Sexual Medicine, 11(12), 2976–2985.
Deogracias, J. J., Johnson, L. L., Meyer-Bahlburg, H. F. L., Kessler, S. J., Schober, J. M., & Zucker, K. J. (2007). The gender identity/gender dysphoria questionnaire for adolescents and adults. Journal of Sex Research, 44, 370–379.
DeVries, A. L. C., Noens, I. L. J., Cohen-Kettenis, P. T., van Berckelaer-Onnes, I. A., & Doreleijers, T. (2010). Autism spectrum disorders in gender dysphoric children and adolescents. Journal of Autism & Developmental Disorders, 40(8), 930–936.
Diener, E. D., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49(1), 71–75.
Frane, A. V. (2015). Power and type I error control for univariate comparisons in multivariate two-group designs. Multivariate Behavioral Research, 50(2), 233–247. https://doi.org/10.1080/00273171.2014.968836.
Gargiulo, R. A., & Stokes, M. A. (2009). Subjective well-being as an indicator for clinical depression. Social Indicators Research, 92(3), 517–527.
George, R. (2016). Sexual Orientation and Gender Identity in High-Functioning Individuals with Autism Spectrum Disorder. (Unpublished doctoral dissertation). Deakin University, Melbourne, Australia.
George, R., & Stokes, M. (2016). “Gender is not on my Agenda!”: Gender dysphoria and autism spectrum disorder. In Psychiatric symptoms and comorbidities in autism spectrum disorder (pp. 139–150). Berlin: Springer International Publishing.
George, R., & Stokes, M. A. (2017). Gender identity and sexual orientation in autism spectrum disorder. Autism. https://doi.org/10.1177/1362361317714587.
Gilmour, L., Schalomon, P. M., & Smith, V. (2012). Sexuality in a community based sample of adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 6, 313–318.
Girden, E. R. (1992). ANOVA: Repeated measures (No. 84). Sage.
Gonsiorek, J. C., Sell, R. L., & Weinrich, J. D. (1995). Definition and measurement of sexual orientation. Suicide and Life-Threatening Behavior, 25(1), 40–51.
Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults. Work, 50, 59.
Hellemans, H., Colson, K., Verbraeken, C., Vermeiren, R., & Deboutte, D. (2007). Sexual behavior in high-functioning male adolescents and young adults with autism spectrum disorder. Journal of Autism & Developmental Disorders, 37(2), 260–269. https://doi.org/10.1007/s10803-006-0159-1.
Hellemans, H., Roeyers, H., Leplae, W., Dewaele, T., & Deboutte, D. (2010). Sexual behavior in male adolescents and young adults with autism spectrum disorder and borderline/mild mental retardation. Sexuality and Disability, 28(2), 93–104.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British journal of clinical psychology, 44(2), 227–239.
Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58(3), 259–261.
Herek, G. M. (2015). Beyond “homophobia”: Thinking more clearly about stigma, prejudice, and sexual orientation. American Journal of Orthopsychiatry, 85(5S), S29.
Herek, G. M., & Capitanio, J. P. (1996). " Some of my best friends”: Intergroup contact, concealable stigma, and heterosexuals’ attitudes toward gay men and lesbians. Personality & Social Psychology Bulletin, 22, 412–424.
Hofvander, B., Delorme, R., Chaste, P., Nydén, A., Wentz, E., Ståhlberg, O. et al. (2009). Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry, 9(1), 35.
Holtmann, M., Bölte, S., & Poustka, F. (2007). Autism spectrum disorders: Sex differences in autistic behaviour domains and coexisting psychopathology. Developmental Medicine & Child Neurology, 49(5), 361–366.
Huynh, H., & Feldt, L. S. (1976). Estimation of the Box correction for degrees of freedom from sample data in randomized block and split-plot designs. Journal of Educational and Behavioral Statistics, 1(1), 69–82.
Izuma, K., Matsumoto, K., Camerer, C. F., & Adolphs, R. (2011). Insensitivity to social reputation in autism. Proceedings of the National Academy of Sciences, 108(42), 17302–17307.
Jacobi, F., Wittchen, H. U., Hölting, C., Höfler, M., Pfister, H., Müller, N., & Lieb, R. (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine, 34(04), 597–611.
Jones, R. M., Wheelwright, S., Farrell, K., Martin, E., Green, R., Di Ceglie, D., & Baron-Cohen, S. (2012). Brief report: Female-to-male transsexual people and autistic traits. Journal of Autism & Developmental Disorders, 42(2), 301–306.
Keppel, G. (1991). Design and analysis: A researcher’s handbook (3rd edn.). Upper Saddle River, NJ: Prentice-Hall, Inc.
Kirk, R. E. (1991). Experimental design: Procedures for the behavioral sciences (3rd edn.). Pacific Grove, CA: Brooks/Cole Publishing Company.
Kite, M. E., & Whitley Jr, B. E. (1996). Sex differences in attitudes toward homosexual persons, behaviors, and civil rights a meta-analysis. Personality and Social Psychology Bulletin, 22(4), 336–353.
Kuyper, L., Iedema, J., & Keuzenkamp, S. (2013). Towards tolerance. Exploring changes and explaining differences in attitudes towards homosexuality in Europe. Sociaal en Cultureel Planbureau.
Lau, A. L., Cummins, R. A., & McPherson, W. (2005). An investigation into the cross-cultural equivalence of the Personal Wellbeing Index. Social Indicators Research, 72(3), 403–430.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research & Therapy, 33(3), 335–343.
Lugnegård, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32(5), 1910–1917.
Mannion, A., & Leader, G. (2013). Comorbidity in autism spectrum disorder: A literature review. Research in Autism Spectrum Disorders, 7(12), 1595–1616.
Meyer, I. H. (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674.
Pasterski, V., Gilligan, L., & Curtis, R. (2013). Traits of autism spectrum disorders in adults with gender dysphoria. Archives of Sexual Behaviour, 43(2), 387–393. https://doi.org/10.1007/s10508-013-0154-5.
Piven, J., & Palmer, P. (1999). Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. American Journal of Psychiatry, 156(4), 557–563.
Powdthavee, N., & Wooden, M. (2015). Life satisfaction and sexual minorities: Evidence from Australia and the United Kingdom. Journal of Economic Behavior & Organization, 116, 107–126.
Sandfort, T. G., de Graaf, R., Bijl, R. V., & Schnabel, P. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58(1), 85–91.
Sandfort, T. G., Melendez, R. M., & Diaz, R. M. (2007). Gender nonconformity, homophobia, and mental distress in Latino gay and bisexual men. Journal of Sex Research, 44(2), 181–189.
Santor, D. A., Poulin, C., LeBLANC, J. C., & Kusumakar, V. (2007). Online health promotion, early identification of difficulties, and help seeking in young people. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), 50–59.
Settipani, C. A., Puleo, C. M., Conner, B. T., & Kendall, P. C. (2012). Characteristics and anxiety symptom presentation associated with autism spectrum traits in youth with anxiety disorders. Journal of Anxiety Disorders, 26(3), 459–467.
Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., & Wallace, G. L. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6(1), 406–412.
Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate analysis. New York: Boston University: Harper Collins College Publishers.
Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2010). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: school victimization and young adult psychosocial adjustment. Developmental Psychology, 46(6), 1580.
van Heijst, B. F., & Geurts, H. M. (2014). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19(2), 158–167.
Zimmermann, A. C., & Easterlin, R. A. (2006). Happily ever after? Cohabitation, marriage, divorce, and happiness in Germany. Population & Development Review, 32(3), 511–528.
Zucker, K. J. (2005). Gender identity disorder in children and adolescents. Annual Review of Clinical Psychology, 1, 467–492.
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No funding was received for this research. This work is original research and forms part of the doctoral dissertation of the author.
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Both authors contributed to the analytic methods and written work presented in this paper. RG and MAS conceived, and participated in the design of the study. RG conducted all systematic search and meta-analysis procedures, and drafted the original manuscript. MAS provided expertise regarding the study, critically evaluated all key sections of the review, and assisted in drafting the manuscript. MAS oversaw all analyses, participated in the interpretation of data, reviewed, and was involved in the write up of all drafts. Both authors were involved in the final revisions and approval of the published manuscript.
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George, R., Stokes, M.A. A Quantitative Analysis of Mental Health Among Sexual and Gender Minority Groups in ASD. J Autism Dev Disord 48, 2052–2063 (2018). https://doi.org/10.1007/s10803-018-3469-1
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DOI: https://doi.org/10.1007/s10803-018-3469-1