Mapping the link between socio-economic factors, autistic traits and mental health across different settings.

Lay Abstract: Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings - in Europe and South Africa - to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people.
Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: J.T. has acted as a paid consultant and is a current employee of F. Hoffmann-La Roche AG. T.C. has acted as a paid consultant of F. Hoffmann-La Roche Ltd and Servier and receives royalties for the publication of textbooks for Guilford Press and Sage Publications. J.B. has been in the past 3 years a consultant to/member of advisory boards of/and/or speaker for Janssen Cilag BV, Eli Lilly, Lundbeck, Shire, Roche, Novartis, Medice, and Servier. S.B. receives royalties for the German and Swedish KONTAKT manuals and adaptations of the ADI-R, ADOS, and S.R.S. from Hogrefe Publishers, and has in the past 3 years acted as an author, consultant or lecturer for Medice and Roche. T.B. has served in an advisory or consultancy role for eye level, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche and Takeda. He received conference support or speaker’s fee by Janssen, Medice and Takeda. He received royalties from Hogrefe, Kohlhammer, CIP Medien and Oxford University Press; the present work is unrelated to these relationships. A.S.J.C. has acted as a paid consultant for F. Hoffman-La Roche and Servier, and has been actively involved in clinical trials managed by both companies. All other authors report no biomedical financial interests or potential conflicts of interest.