Minority Stress,Camouflaging,and Mental Health Outcomes in Transgender and/or Non-binary Autistic Adults

Abstract

Background:

This study sought to examine the role of autistic and gender minority stress, resilience, and camouflaging in predicting mental health outcomes in transgender and/or non-binary autistic adults in the United Kingdom.

Methods:

In total, 412 transgender and/or non-binary autistic participants completed an online survey. This survey consisted of the Gender Minority Stress and Resilience Scales, Autistic Minority Stress and Resilience Scales, the Camouflaging Autistic Traits Questionnaire, the Depression, Anxiety and Stress Scale, and the Posttraumatic Stress Disorder Checklist.

Results:

The final models in hierarchical regression predicted depression (R² = 0.24), anxiety (R² = 0.26), stress (R² = 0.21), and posttraumatic stress (R² = 0.32). Camouflaging remained a significant unique predictor of anxiety and stress. Internalized anti-autistic prejudice remained a significant unique predictor of each model. Everyday anti-autistic discrimination uniquely predicted anxiety and posttraumatic stress. Gender minority negative expectations uniquely predicted depression and posttraumatic stress.

Conclusion:

These findings suggest that gender and autistic minority stress and camouflaging significantly predict a proportion of variance in depression, anxiety, stress, and posttraumatic stress experienced by transgender and/or non-binary autistic adults.

Community Brief

Why is this an important issue?

Transgender and/or non-binary (TNB) adults and autistic adults may have worse mental health compared with the general population. Little research has looked at the mental health of those who are both TNB and autistic.

What was the purpose of this study?

This study looked at mental health outcomes in TNB autistic adults in the United Kingdom. It investigated factors associated with better or worse mental health, including depression, anxiety, stress, and posttraumatic stress. The factors we looked at were:

• 1.

being physically disabled and/or being non-binary.

2.

minority stress (the extra stress faced by people who belong to a discriminated-against minority group).

3.

resilience (strategies to cope with stress).

4.

camouflaging (minimizing the visibility of autistic traits).

What did the researchers do?

We surveyed 412 TNB autistic adults in the United Kingdom. We asked questions about demographics, autistic minority stress, gender minority stress, resilience, camouflaging, and mental health outcomes. Then we did statistical analyses on the results.

What were the results of the study?

Participants generally scored highly on depression, anxiety, stress, and posttraumatic stress scales. Participants reported frequent experiences of transphobic and anti-autistic discrimination. As experiences of minority stress and camouflaging increased, so did mental health outcome scores. A statistical analysis called a regression was done. This showed that demographics, minority stress, and camouflaging significantly predicted between 21% and 32% of the change in depression, anxiety, stress, and posttraumatic stress.

What do these findings add to what was already known?

This was one of the first studies to show that a sample of TNB autistic adults in the United Kingdom report poor mental health and high rates of discrimination and victimization. Our findings showed, for the first time to our knowledge, that autistic minority stress is associated with anxiety, depression, and posttraumatic stress and that camouflaging is associated with posttraumatic stress and autistic pride with reduced depression. We showed that gender minority negative expectations, autistic internalized prejudice, anti-autistic everyday discrimination, and camouflaging may be particularly important factors in predicting the change in mental health outcomes.

What are potential weaknesses in the study?

Online recruitment may have excluded some autistic adults with higher support needs. Measuring discrimination and distress at the same point in time means that the results cannot prove that past discrimination causes distress later on. There also may have been important variables that we didn’t include that would have influenced the results. The scales we used also probably did not capture the complexity of experiences of TNB autistic adults.

How will these findings help autistic adults now or in the future?

Our findings could help highlight to health care providers and policymakers the urgency of reducing anti-autistic and transphobic discrimination and supporting the mental health of TNB autistic adults.