McQuaid Goldie A, Sadowski Lauren Y, Lee Nancy Raitano, Wallace Gregory L
Department of Psychology, George Mason University, Fairfax, Virginia, USA.
Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, District of Columbia, USA.
Autism Adulthood. 2024 Sep 16;6(3):345-361. doi: 10.1089/aut.2022.0121. eCollection 2024 Sep.
Camouflaging involves the masking of autism traits, potentially creating an outer impression of "non-autisticness." Although associations of camouflaging with anxiety and depression in autistic adults are widely reported, factors that mediate these associations are unclear. We examined two potential mediators of the association between camouflaging and anxiety/depression: perceived stress and emotion regulation (ER) challenges.
Seven hundred eighty-seven autistic adults (18.2-78.2 years) recruited through Simons Powering Autism Research (SPARK) Research Match completed questionnaires, including the Camouflaging Autistic Traits Questionnaire (CAT-Q), and measures of autistic traits, depressive and anxious symptomatology, perceived stress, and ER challenges. Four moderated mediation models were tested. In all models the independent variable was CAT-Q total score, and the moderator variable was sex designated at birth. The dependent variable was depressive or anxious symptomatology, and the mediator variable was perceived stress or ER challenges.
We found that more camouflaging, increased ER challenges, and higher levels of perceived stress were associated with greater depressive and anxious symptomatology. We also found that perceived stress and ER challenges significantly mediated the associations between camouflaging and both depression and anxiety. In the model with perceived stress and anxiety, sex moderated the mediation, with females showing a stronger mediation. There was no significant moderation in any of the other models.
We contextualize the findings within the broader literature on camouflaging as a response to stigma and other facets of minority stress. We discuss how the results of this study support the idea that the day-to-day stress of living in a neurotypical world, the cognitively demanding nature of camouflaging, and the constraints that camouflaging place on autistic people's behaviors in social contexts (e.g., contributing to suppressing ER strategies such as stimming), create a cycle that contributes to elevated rates of anxiety and depression in autistic people.
伪装涉及对自闭症特征的掩盖，可能营造出“非自闭症”的外在印象。尽管自闭症成年人中伪装与焦虑和抑郁之间的关联已被广泛报道，但介导这些关联的因素尚不清楚。我们研究了伪装与焦虑/抑郁之间关联的两个潜在中介因素：感知压力和情绪调节（ER）挑战。
通过西蒙斯推动自闭症研究（SPARK）研究匹配招募的787名自闭症成年人（年龄在18.2至78.2岁之间）完成了问卷调查，包括伪装自闭症特征问卷（CAT-Q），以及自闭症特征、抑郁和焦虑症状、感知压力和ER挑战的测量。测试了四个调节中介模型。在所有模型中，自变量是CAT-Q总分，调节变量是出生时指定的性别。因变量是抑郁或焦虑症状，中介变量是感知压力或ER挑战。
我们发现，更多的伪装、增加的ER挑战和更高水平的感知压力与更严重的抑郁和焦虑症状相关。我们还发现，感知压力和ER挑战显著介导了伪装与抑郁和焦虑之间的关联。在感知压力与焦虑的模型中，性别调节了中介作用，女性的中介作用更强。在其他任何模型中均未发现显著的调节作用。
我们将研究结果置于关于伪装作为对污名和其他少数群体压力方面的反应的更广泛文献背景中。我们讨论了本研究结果如何支持这样一种观点，即生活在一个神经典型世界中的日常压力、伪装的认知需求性质以及伪装对自闭症患者在社交情境中行为的限制（例如，导致抑制诸如自我刺激等ER策略），形成了一个导致自闭症患者焦虑和抑郁发生率升高的循环。
