A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people

IF 2.2 4区医学 Q1 EDUCATION, SPECIAL Research in Autism Spectrum Disorders Pub Date : 2024-10-01 DOI:10.1016/j.rasd.2024.102492

Valeria Khudiakova, Emmeline Russell, Sophie Sowden-Carvalho, Andrew D.R. Surtees

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Abstract

Background

This systematic review and meta-analysis aimed to assess the strength and quality of the evidence for the relationship between camouflaging and its potential outcomes in autistic people. With the worryingly high proportions of autistic people experiencing mental illness and suicidality, it is important to understand whether camouflaging is a risk factor in that population.

Methods

Searches of five databases (Web of Science, MEDLINE, PsycINFO, Embase, ProQuest Dissertations & Theses) yielded 16 studies eligible for a meta-analysis using correlations and six additional studies eligible for a narrative review, with 5897 autistic participants in total. Risk of bias was assessed for all studies using a bespoke tool. Based on the 16 studies eligible for the meta-analysis, we computed meta-correlations between camouflaging and anxiety, depression, social anxiety, and psychological wellbeing, using a random-effects model. Meta-regressions examined if study effect sizes were moderated by study quality, participants’ mean age, and proportions of female and clinically diagnosed participants. Results:

We found significant moderate positive relationships between camouflaging and anxiety/generalised anxiety, depression, and social anxiety and a significant small negative relationship between camouflaging and mental wellbeing. There was no significant moderating effect of the aforementioned variables on study effect sizes.

Discussion

All of the studies were underpowered to detect small effects, and many used insufficiently validated measures. The established link between camouflaging and mental health difficulties is discussed with reference to future research and clinical practice. Longitudinal studies should also aim to establish causality.

Other

There was no funding associated with this review. The researchers have no conflicts of interest to disclose. The review was preregistered on PROSPERO (REDACTED FOR ANONYMISED PEER REVIEW).

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与自闭症患者伪装相关的心理健康结果的系统回顾和荟萃分析

背景本系统综述和荟萃分析旨在评估伪装与自闭症患者潜在后果之间关系的证据强度和质量。方法通过对五个数据库（Web of Science、MEDLINE、PsycINFO、Embase、ProQuest Dissertations & Theses）的检索，发现有16项研究符合利用相关性进行荟萃分析的条件，另有6项研究符合进行叙述性综述的条件，共有5897名自闭症患者参与了这些研究。使用定制工具对所有研究的偏倚风险进行了评估。根据符合荟萃分析条件的 16 项研究，我们使用随机效应模型计算了伪装与焦虑、抑郁、社交焦虑和心理健康之间的荟萃相关性。元回归分析了研究效应大小是否受研究质量、参与者平均年龄、女性参与者比例和临床诊断参与者比例的影响。结果：我们发现伪装与焦虑/广泛性焦虑、抑郁和社交焦虑之间存在明显的中度正相关关系，而伪装与心理健康之间存在明显的小幅负相关关系。讨论：所有研究的研究力量都不足，无法检测到微小的影响，而且许多研究使用的测量方法未经充分验证。本文讨论了伪装与心理健康困难之间的既定联系，并对未来的研究和临床实践提供了参考。纵向研究也应以确定因果关系为目标。研究人员没有需要披露的利益冲突。本综述已在 PROSPERO（匿名同行评议）上预先注册。

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来源期刊

Research in Autism Spectrum Disorders Multiple-

CiteScore

4.20

自引率

8.00%

发文量

108

期刊介绍： Research in Autism Spectrum Disorders (RASD) publishes high quality empirical articles and reviews that contribute to a better understanding of Autism Spectrum Disorders (ASD) at all levels of description; genetic, neurobiological, cognitive, and behavioral. The primary focus of the journal is to bridge the gap between basic research at these levels, and the practical questions and difficulties that are faced by individuals with ASD and their families, as well as carers, educators and clinicians. In addition, the journal encourages submissions on topics that remain under-researched in the field. We know shamefully little about the causes and consequences of the significant language and general intellectual impairments that characterize half of all individuals with ASD. We know even less about the challenges that women with ASD face and less still about the needs of individuals with ASD as they grow older. Medical and psychological co-morbidities and the complications they bring with them for the diagnosis and treatment of ASD represents another area of relatively little research. At RASD we are committed to promoting high-quality and rigorous research on all of these issues, and we look forward to receiving many excellent submissions.