Sexual Minority Identities in Autistic Adults: Diversity and Associations with Mental Health Symptoms and Subjective Quality of Life

Abstract

Background: Although disparities in mental health and subjective quality of life (QoL) have been reported for autistic adults, reasons for these disparities are poorly understood. A potential factor in these disparities is exposure to social stressors related to minority status (i.e., minority stress), including stigma and discrimination. Autistic individuals are more likely than nonautistic individuals to be from groups with other minority identities, including sexual minorities (i.e., sexual orientations such as asexual, bisexual, gay). However, to date, few studies have examined whether sexual minority autistic adults experience diminished mental health relative to heterosexual autistic adults, and no research has examined subjective QoL for sexual minority compared with heterosexual autistic adults.

Methods: Participants were 651 autistic adults aged 18.5 to 83.3 years recruited through Simons Powering Autism Research's Research Match. All participants resided in the United States. Participants completed surveys online, including measures of anxious and depressive symptomatology, perceived stress, and subjective QoL. Participants reported their sexual orientation and other sociodemographic variables.

Results: A large proportion of autistic adults reported a sexual minority identity (41.2%), and a diversity of sexual identities was reported. Sexual minority autistic adults reported poorer mental health and lower subjective QoL across all assessed domains relative to heterosexual autistic adults.

Conclusion: Understanding factors that may be associated with poorer mental health and decreased subjective QoL in autistic adults is critical and has been identified as a research priority by autistic stakeholders. The findings reported here underscore the need to examine mental health and subjective QoL disparities among autistic individuals within a societal context, taking into consideration the potential of intersecting minority identities and increased social stressors, as these added stressors may increase risks for poorer outcomes.

Keywords: anxiety; autism; depression; quality of life; sexual minority; stress.

FIG. 1.

Relative frequencies of autistic adults with sexual minority and heterosexual identities (A) and within the sexual minority group (B) by sex assigned at birth.

FIG. 2.

Mean item scores for WHOQOL-BREF domains (Physical Health, Psychological Health, Social Relationships and Environment) and ASQoL for heterosexual and sexual minority groups (A); and for heterosexual, gay, asexual, pansexual, and bisexual sexual minority identities (B). Error bars represent standard error of the mean. ASQoL, Autism Spectrum Quality of Life; WHOQOL-BREF, abbreviated World Health Organization Quality of Life Questionnaire.