ABSTRACT
Background: Although disparities in mental health and subjective quality of life (QoL) have been reported for autistic adults, reasons for these disparities are poorly understood. A potential factor in these disparities is exposure to social stressors related to minority status (i.e., minority stress), including stigma and discrimination. Autistic individuals are more likely than nonautistic individuals to be from groups with other minority identities, including sexual minorities (i.e., sexual orientations such as asexual, bisexual, gay). However, to date, few studies have examined whether sexual minority autistic adults experience diminished mental health relative to heterosexual autistic adults, and no research has examined subjective QoL for sexual minority compared with heterosexual autistic adults. Methods: Participants were 651 autistic adults aged 18.5 to 83.3 years recruited through Simons Powering Autism Research's Research Match. All participants resided in the United States. Participants completed surveys online, including measures of anxious and depressive symptomatology, perceived stress, and subjective QoL. Participants reported their sexual orientation and other sociodemographic variables. Results: A large proportion of autistic adults reported a sexual minority identity (41.2%), and a diversity of sexual identities was reported. Sexual minority autistic adults reported poorer mental health and lower subjective QoL across all assessed domains relative to heterosexual autistic adults. Conclusion: Understanding factors that may be associated with poorer mental health and decreased subjective QoL in autistic adults is critical and has been identified as a research priority by autistic stakeholders. The findings reported here underscore the need to examine mental health and subjective QoL disparities among autistic individuals within a societal context, taking into consideration the potential of intersecting minority identities and increased social stressors, as these added stressors may increase risks for poorer outcomes.
Why is this an important issue?: Autistic people are at risk for mental health problems, such as depression and anxiety, and report lower quality of life. Autistic people are more likely than nonautistic people to identify as a sexual minority. Sexual minority identities are sexual orientations other than heterosexual, such as asexual, bisexual, or gay. Sexual minority persons are also at risk for mental health problems and lower quality of life. Autistic people who are sexual minorities may have even higher risk of mental health problems and lower quality of life. What was the purpose of this study?: There is little research on mental health and quality of life in persons who are both autistic and identify as a sexual minority. Sexual minority autistic adults may be exposed to more minority-related stress than heterosexual autistic adults. People who belong to minority groups face added stress created by society. This added stress is referred to as minority stress, which includes things such as discrimination, rejection, or violence. Minority stress could increase risk for poor outcomes. We compared heterosexual and sexual minority autistic adults to see if having more than one minority identity (an autistic identity and a sexual minority identity) was associated with mental health or subjective quality of life. Subjective quality of life refers to how a person feels about parts of their life, such as their physical and psychological health or their living arrangements. What did the researchers do?: We asked 651 autistic adults living in the United States to complete surveys online. Participants rated their anxiety, depression, and everyday stress; answered questions about their subjective quality of life; and reported their sexual orientation, sex assigned at birth, and gender identity. We compared sexual minority with heterosexual autistic adults to see if they differed for mental health or subjective quality-of-life ratings. What were the results of the study?: A total of 41.2% of autistic adults reported a sexual minority identity. Autistic adults reported a diversity of sexual orientations, including asexual, bisexual, gay, and pansexual. Sexual minority autistic adults reported more depression, anxiety, and stress compared with heterosexual autistic adults. Sexual minority autistic adults reported poorer subjective quality of life across different areas of their lives compared with heterosexual autistic adults. Sexual minority autistic adults reported having less energy and more physical pain than heterosexual autistic adults. Sexual minority autistic adults also reported feeling more negative emotions and having problems with thinking/concentration. Sexual minority autistic adults reported more concerns about things such as having health care and transportation and greater worries about feeling safe in their homes and neighborhoods. Finally, sexual minority autistic adults were more likely to report that they faced barriers in their everyday lives (such as sensory sensitivities making it hard to grocery shop). What are the potential weaknesses in the study?: Although we found significant differences between sexual minority and heterosexual autistic groups, other factors likely play a role in these results. For example, we know that not having enough social support can contribute to worse mental health and quality of life. Measuring other such factors is needed in future studies. How will these findings help autistic adults now or in the future?: These findings highlight the need for more awareness of sexual minority identities in autistic adults. Understanding factors that may contribute to worse mental health and quality of life for autistic adults can help us improve well-being for all autistic people.