Summary: Young autistic women are more likely than young autistic men to receive a co-occurring psychiatric diagnosis — including depression, anxiety, sleep problems and self-harm — and they face a substantially higher risk of psychiatric hospitalization.
Source: Karolinska Institute
Key finding: Autistic young adults are substantially more likely than their non-autistic peers to experience psychiatric disorders and to be hospitalized for mental health problems. Among autistic young people, females show higher rates of psychiatric diagnoses and psychiatric inpatient care than males.
Researchers at Karolinska Institutet report these results in a population-based register study published in JAMA Psychiatry. The study analyzed nationwide Swedish registers to compare mental health outcomes and psychiatric hospitalizations in autistic versus non-autistic young adults, with a focus on sex differences.
The cohort included 1,335,753 individuals born between 1985 and 1997 who were followed between ages 16 and 24 during 2001–2013. Of these, 20,841 people (about 1.6%) had received a clinical autism diagnosis; 7,129 (34.2%) of those diagnosed were female. The mean age at first recorded autism diagnosis was 17.0 years for females and 15.7 years for males.
By age 25, 77 of every 100 autistic females and 62 of every 100 autistic males had been diagnosed with at least one psychiatric disorder. The study evaluated 11 psychiatric outcomes and found elevated risks across many conditions, especially depressive disorders, anxiety disorders, sleep disorders, and self-harm-related diagnoses.
Hospitalization for psychiatric reasons was markedly more common among autistic young adults than among non-autistic peers. Notably, 32 of 100 autistic females had experienced at least one psychiatric inpatient admission by age 25, compared with 19 of 100 autistic males. For non-autistic young people the corresponding figure was fewer than 5 of 100.
Miriam Martini, a doctoral student in psychiatric epidemiology at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet and first author of the study, highlights the vulnerability of autistic young women: “Autistic women in early adulthood appear to experience more psychiatric difficulties across levels of care and are more likely to require hospitalization. We need to strengthen mental health services and follow-up for this group so problems are identified and treated before they escalate.”
The authors emphasize that late adolescence and early adulthood is a critical period for mental health: many psychiatric conditions emerge or worsen during this transition, while access to appropriate care can decline as individuals move from child to adult services. That context helps explain why psychiatric diagnoses and hospitalizations were concentrated in this age window.
Why are autistic women more affected? The study does not establish a single cause, but suggests several contributing factors. Prior research indicates that many autistic women use compensatory or masking strategies to conform to social expectations; those behaviors can delay diagnosis and access to support, allowing co-occurring mental health problems to develop or worsen. Diagnostic criteria and clinical practice may also be less sensitive to how autism presents in females, contributing to under-recognition and later intervention.
The investigators call for improved detection, tailored diagnostic assessment, and expanded mental health services for autistic young adults, with special attention to female-identifying individuals who appear to carry a higher burden of psychiatric illness and hospitalization.
About this autism and mental health research news
Author: Press Office, Karolinska Institute
Source: Karolinska Institute
Contact: Press Office, Karolinska Institute
Image: The image is in the public domain
Original Research: “Sex differences in mental health problems and psychiatric hospitalization in autistic young adults” by Miriam Martini et al., JAMA Psychiatry (closed access).
Abstract (condensed)
Objective: To examine sex differences in psychiatric diagnoses and hospitalizations among autistic compared with non-autistic young adults.
Design and participants: Population-based cohort of all individuals born in Sweden 1985–1997 (n = 1,335,753), including 20,841 clinically diagnosed autistic individuals (7,129 female). Follow-up occurred from ages 16 to 24 during 2001–2013.
Main outcomes: Cumulative incidence of 11 psychiatric diagnoses up to age 25 and incidence of psychiatric inpatient admissions. Analyses used birth year–standardized risk differences and Cox regression to estimate sex-specific hazard ratios adjusted for birth year.
Key results: Autistic young people of both sexes had markedly elevated risk for psychiatric diagnoses compared with same-sex non-autistic peers. Among autistic individuals, females were at higher absolute risk than males for most disorders and for psychiatric hospitalization. Hazard ratio ranges reported in the study include, for psychiatric diagnoses, approximately 3.17 to 20.78 for autistic females and 2.98 to 18.52 for autistic males (95% CIs reported in the original article). For psychiatric hospitalization, risk increases versus non-autistic peers ranged roughly from 5.55 to 26.30 for females and from 3.79 to 29.36 for males (95% CIs reported in the original article).
Conclusions: The findings underline a strong need to expand mental health services and clinical monitoring for autistic young adults, with particular attention to autistic females who experience higher rates of psychiatric disorders and psychiatric inpatient care. Improved detection, earlier support, and tailored interventions could help prevent symptom escalation and reduce hospitalization.