Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland.
JAMA Psychiatry. 2022 Dec 1;79(12):1188-1198. doi: 10.1001/jamapsychiatry.2022.3475.
Psychiatric disorders are common among autistic children and adults. Little is known about sex differences in psychiatric disorders and hospitalization in early adulthood.
To examine sex differences in psychiatric diagnoses and hospitalizations in autistic compared with nonautistic young adults.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study assessed all individuals born in Sweden between 1985 and 1997. A total of 1 335 753 individuals, including 20 841 autistic individuals (7129 [34.2%] female individuals), were followed up from age 16 through 24 years between 2001 and 2013. Analysis took place between June 2021 and August 2022.
Autism was defined as having received at least 1 clinical diagnosis of autism based on the International Classification of Diseases.
The cumulative incidence of 11 psychiatric diagnoses up until age 25 years was estimated, and birth year-standardized risk difference was used to compare autistic female and male individuals directly. Sex-specific birth year-adjusted hazard ratios (HRs) with 95% CIs were calculated using Cox regression. Analyses were repeated for inpatient diagnoses to assess psychiatric hospitalization.
Of 1 335 753 individuals included in this study, 650 314 (48.7%) were assigned female at birth. Autism was clinically diagnosed in 20 841 individuals (1.6%; 7129 [34.2%] female) with a mean (SD) age of 16.1 (5.1) years (17.0 [4.8] years in female individuals and 15.7 [5.2] years in male individuals) for the first recorded autism diagnosis. For most disorders, autistic female individuals were at higher risk for psychiatric diagnoses and hospitalizations. By age 25 years, 77 of 100 autistic female individuals and 62 of 100 autistic male individuals received at least 1 psychiatric diagnosis. Statistically significant standardized risk differences were observed between autistic female and male individuals for any psychiatric disorder (-0.18; 95% CI, -0.26 to -0.10) and specifically for anxiety, depressive, and sleep disorders. Risk differences were larger among autistic than nonautistic individuals. Compared with nonautistic same-sex individuals, autistic female individuals (HR range [95% CI], 3.17 [2.50-4.04.]-20.78 [18.48-23.37]) and male individuals (HR range [95% CI], 2.98 [2.75-3.23]-18.52 [17.07-20.08]) were both at increased risk for all psychiatric diagnoses. Any psychiatric hospitalization was statistically significantly more common in autistic female individuals (32 of 100) compared with autistic male individuals (19 of 100). However, both autistic female and male individuals had a higher relative risk for psychiatric hospitalization compared with nonautistic female and male individuals for all disorders (female individuals: HR range [95% CI], 5.55 [4.63-6.66]-26.30 [21.50-32.16]; male individuals: HR range [95% CI], 3.79 [3.22-4.45]-29.36 [24.04-35.87]).
These findings highlight the need for profound mental health services among autistic young adults. Autistic female individuals, who experience more psychiatric difficulties at different levels of care, require increased clinical surveillance and support.
自闭症儿童和成人中常见精神障碍。关于自闭症儿童和成人在成年早期的精神障碍和住院方面的性别差异，知之甚少。
研究自闭症与非自闭症年轻成年人相比，在精神疾病诊断和住院方面的性别差异。
设计、地点和参与者：本基于人群的队列研究评估了瑞典 1985 年至 1997 年期间出生的所有人群。共有 1335753 人，包括 20841 名自闭症患者（7129 [34.2%] 名女性），从 2001 年至 2013 年期间进行了 16 岁至 24 岁的随访。分析于 2021 年 6 月至 2022 年 8 月之间进行。
自闭症是根据国际疾病分类标准，至少有一次临床诊断为自闭症的定义。
估计了 11 种精神疾病在 25 岁之前的累积发病率，并使用出生年份标准化风险差异直接比较自闭症女性和男性个体。使用 Cox 回归计算了特定性别出生年份调整后的危险比（HR）及其 95%置信区间。重复分析住院诊断以评估精神病住院情况。
在本研究中包括的 1335753 名个体中，有 650314 名（48.7%）为女性。自闭症的临床诊断见于 20841 名患者（1.6%；7129 [34.2%] 名女性），平均年龄（标准差）为 16.1（5.1）岁（女性为 17.0 [4.8] 岁，男性为 15.7 [5.2] 岁），第一次记录自闭症诊断的年龄。对于大多数疾病，自闭症女性患者患精神疾病和住院的风险更高。到 25 岁时，100 名自闭症女性中有 77 名和 100 名自闭症男性中有 62 名至少接受了一次精神科诊断。自闭症女性和男性之间存在统计学显著的标准化风险差异，用于任何精神障碍（-0.18；95%CI，-0.26 至 -0.10）和特定的焦虑、抑郁和睡眠障碍。自闭症患者之间的风险差异大于非自闭症患者。与非自闭症同性个体相比，自闭症女性（HR 范围[95%CI]，3.17 [2.50-4.04] - 20.78 [18.48-23.37]）和男性（HR 范围[95%CI]，2.98 [2.75-3.23] - 18.52 [17.07-20.08]）患所有精神疾病的风险均增加。自闭症女性患者（32 名/100 名）的任何精神科住院治疗均明显高于自闭症男性患者（19 名/100 名）。然而，与非自闭症女性和男性相比，自闭症女性和男性患者的所有疾病的精神病住院治疗的相对风险均较高（女性：HR 范围[95%CI]，5.55 [4.63-6.66] - 26.30 [21.50-32.16]；男性：HR 范围[95%CI]，3.79 [3.22-4.45] - 29.36 [24.04-35.87]）。
这些发现强调了自闭症年轻成年人需要深入的心理健康服务。自闭症女性患者在不同级别的护理中经历更多的精神障碍，需要增加临床监测和支持。
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