Social Vulnerability and Mental Health in Adults with Autism Spectrum Conditions

Background: Individuals with autism are at greater risk of developing co-morbid mental health conditions such as anxiety and depression. Social vulnerability may contribute to environmental risk for mental health conditions, by increasing the incidence of experiences such as bullying, domestic abuse, financial hardship, unemployment and difficulties accessing services. It is important to have measures of social vulnerability in order to look at whether this is a contributing factor in the high rates of mental health comorbidities in autism.

Objectives: To create a checklist to measure lifetime social vulnerability and compare responses in a large sample of adults with and without autism.

Methods: A new ‘autism vulnerability checklist’ was designed using a participatory research method. Items were developed from focus groups with stakeholders. Participants report whether they have experienced any of 60 events in 10 different domains (education, employment, finances, social service contact, criminal justice system contact, childhood victimisation, adulthood victimisation, domestic abuse, mental illness and social support). Adults with and without autism completed the checklist in an online survey. Participants also completed a demographics questionnaire, screening measures for anxiety and depression and a life-satisfaction scale. For each domain, participants’ responses were coded according to whether they reported at least one experience, or no experiences. The number of different domains (0-10) endorsed as having at least one experience was calculated. Chi-squared tests for each domain were applied to compare the proportions of participants in each group who had experienced at least one event. T-test were used to compare average number of domains and scores on anxiety, depression and a life-satisfaction measures.

Results: Complete responses were collected from 435 autistic adults (58% female, age M = 43 years sd = 14.60) and 286 controls (73% female, age M = 51 years, sd = 15.47). Across all domains, significantly more autistic adults had experienced at least one event (X²s > 18.78, ps < .001). The largest difference was for vulnerability in work (X²(1) = 111.28, OR= 10.01 95% CI = 6.21-16.15). Participants with autism had experienced events across a larger number of domains than controls (autism M = 7, control M = 5, t(463.81) = 14.44, p < .001). They also reported higher rates of anxiety (autism M = 9.45, control M = 6.65, t(680.59) = 11.40, p < .001) and depression symptoms (autism M = 11.52, control M = 6.00, t(688.93) = 11.38, p < .001) and lower levels of life satisfaction (autism M = 13.56, control M = 19.02, t(633.17)= 11.43, p < .001) than controls.

Conclusions: Adults with autism are vulnerable to experiencing negative life events across a variety of domains including; education, employment, financial difficulties, social service contact, criminal justice system contact, childhood victimisation, adulthood victimisation, domestic abuse, mental illness and poor social support. These data also confirmed previous findings that adults with autism have high rates of symptoms of anxiety and depression and lower levels of life satisfaction. Future analysis will determine if social vulnerability is associated with mental health symptoms and life satisfaction in this population.