Loneliness Mediates the Association between Friendship, Autism Symptoms, and Mental Health in Young Adults with Autism

Background: Mental health concerns are often tied to social experiences; psychological health can be supported by friendship and deteriorated by loneliness. Core challenges of Autism Spectrum Disorder (ASD) may hinder the development and maintenance of friendships, and, in turn, elicit loneliness and poor mental health. Few studies, however, have explored these associations. In adults with ASD, one study found that loneliness and friendship each explained unique variance in anxiety and depression (Mazurek, 2014). Another study identified a mediating role of social connectedness and loneliness in the association between the Broader Autism Phenotype (BAP) and internalizing symptoms among typically developing young adults (Stice & Lavner, 2018).

Objectives: The current study sought to replicate and extend these findings in a sample of young adults with ASD, and more specifically, test the mediating role of loneliness in the associations between 1) friendship and mental health and 2) ASD symptoms and mental health (Figure 1).

Methods: Fifty-two young adults with ASD completed a battery of questionnaires assessing social and emotional functioning as part of a larger study of the PEERS^® intervention; pre-intervention data was used in the present analyses. ASD was confirmed using the ADOS-G (Lord et al., 2000). Measures included in the current study were the Friendship Questionnaire (FQ), the Social Phobia Inventory (SPIN), the Autism Quotient (AQ), the Beck Depression Inventory (BDI), and the Social and Emotional Loneliness Scale for Adults (SELSA). Analyses in MPlus Version 7.4 involved composite scores on the SPIN, AQ, and BDI, an item on the FQ on number of get-togethers, and the social loneliness subscale of the SELSA.

Results: A series of path analyses were used to test the hypothesized model for each anxiety and depression (Figure 1). Friendship (b=-0.47, p=0.01) and autism symptoms (b=0.27, p=0.03) explained unique variance in social loneliness. Loneliness was a significant predictor of anxiety (b=0.53, p=0.00) and depression (b=0.50, p=0.00), controlling for the effect of friendship and autism symptoms (both ns). Results also indicated that there were indirect effects of friendship (anxiety: b=-0.25, p=0.01; depression: b=-0.23, p=0.02) and autism symptoms (anxiety: b=0.14, p=0.05; depression b=0.14, p=0.07) on mental health through loneliness. All direct and indirect effects were significant, except the marginally significant indirect effect of friendship on depression through loneliness.

Conclusions: Findings of the present study suggest that loneliness may be a vulnerability factor for mental health concerns among young adults with ASD. Based on the current analyses, loneliness may stem from a combination of core autism symptoms as well as secondary effects of autism, namely, less social contact. While these effects are likely related, they appear to contribute independently to loneliness. Moreover, in contrast to previous results in ASD and in parallel with findings on the BAP, the current study did not identify friendship and loneliness as independent predictors of mental health concerns, but instead found a mediational pathway. Thus, the current study highlights that loneliness is a core contributor of mental health concerns in ASD, which may be ameliorated by improving social challenges and facilitating the development of meaningful friendships.