Cross-cultural variation in experiences of acceptance, camouflaging and mental health difficulties in autism: A registered report

• Published in: PloS one Vol. 19; no. 3; p. e0299824
• Main Authors: Keating, Connor Tom, Hickman, Lydia, Geelhand, Philippine, Takahashi, Toru, Leung, Joan, Monk, Ruth, Schuster, Bianca, Rybicki, Alicia, Girolamo, Teresa Marie, Clin, Elise, Papastamou, Fanny, Belenger, Marie, Eigsti, Inge-Marie, Cook, Jennifer Louise, Kosaka, Hirotaka, Osu, Rieko, Okamoto, Yuko, Sowden-Carvalho, Sophie
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.03.2024; Public Library of Science (PLoS)
• Subjects: Adult; Autism Spectrum Disorder - psychology; Autistic Disorder - psychology; Biology and Life Sciences; Care and treatment; Cross-Cultural Comparison; Diagnosis; Humans; Medicine and Health Sciences; Mental Health; People and Places; Pervasive developmental disorders; Physical Sciences; Pre-Registration Publication; Research and Analysis Methods; Social Sciences; Surveys and Questionnaires; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0299824

Recent findings suggest that stigma and camouflaging contribute to mental health difficulties for autistic individuals, however, this evidence is largely based on UK samples. While studies have shown cross-cultural differences in levels of autism-related stigma, it is unclear whether camouflaging and mental health difficulties vary across cultures. Hence, the current study had two aims: (1) to determine whether significant relationships between autism acceptance, camouflaging, and mental health difficulties replicate in a cross-cultural sample of autistic adults, and (2) to compare these variables across cultures. To fulfil these aims, 306 autistic adults from eight countries (Australia, Belgium, Canada, Japan, New Zealand, South Africa, the United Kingdom, and the United States) completed a series of online questionnaires. We found that external acceptance and personal acceptance were associated with lower levels of depression but not camouflaging or stress. Higher camouflaging was associated with elevated levels of depression, anxiety, and stress. Significant differences were found across countries in external acceptance, personal acceptance, depression, anxiety, and stress, even after controlling for relevant covariates. Levels of camouflaging also differed across countries however this effect became non-significant after controlling for the covariates. These findings have significant implications, identifying priority regions for anti-stigma interventions, and highlighting countries where greater support for mental health difficulties is needed.