(PS2-73) Social and behavioral determinants of mental health in gender-diverse and cisgender autistic adults in the NIH All of Us Research Program

Background: One in 45 American adults has an autism diagnosis. Further, recent estimates suggest that >80% of autistic adults have at least one psychiatric diagnosis; yet, little is known about the impact of social and environmental risk factors in adulthood, such as experiences of marginalization, on mental health. Of note, autistic adults are significantly more likely than non-autistic adults to identify as gender diverse (GD); yet, little research has examined whether experiences of reduced social belongingness and mental health challenges compound among autistic adults with an additional marginalized gender identity. Therefore, the goal of this study was to compare experiences of social belongingness (i.e., social connectedness, discrimination) and mental health challenges among cisgender and GD autistic adults.



Methods: Data for this project came from the All of Us (AoU) Research Program, a NIH nation-wide effort that recruits underrepresented individuals in biomedical research. The participant group included individuals who identified as autistic (18+ years), reported their gender identity, and completed “Basics” and “Social Determinants of Health” (SDOH) surveys (N = 1200). Chi-square and t-test analyses were used to compare sociodemographic characteristics, ratings of social connectedness, experiences of discrimination, and mental health outcomes between cisgender and GD autistic adults.

Results: Twenty-three percent of the total autism sample in the AoU database endorsed a GD-identity (e.g., transgender, non-binary, agender). There were no significant racial/ethnic group differences (81% White Non-Hispanic). GD autistic adults were more likely to identify with a sexual minority orientation (e.g, bisexual, lesbian), were less likely to have advanced degrees, and have lower incomes, than cisgender participants. Overall, GD autistic adults reported experiencing greater levels of discrimination (e.g., harassment, experiencing less courtesy and respect) than did cisgender autistic adults (p < .0001). Despite these differences, GD autistic adults reported comparable rates of anxiety, depression, as well as social connectedness, relative to cisgender autistic adults.

Implications: Preliminary findings from this ongoing study reveal that relative to cisgender autistic adults, those with additional GD-identity report comparable levels of social connectedness, but greater experiences of discrimination and mental health challenges, suggesting a potential compounding impact of multiple marginalized identities. Future research should identify ways to improve SDOH for autistic adults with multiple marginalized identities, with the goal of improving access to high quality behavioral health services for these populations.