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. 2024 Mar 20;19(3):e0299824.
doi: 10.1371/journal.pone.0299824. eCollection 2024.

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

Connor Tom Keating  1 , Lydia Hickman  1 , Philippine Geelhand  2 , Toru Takahashi  3 , Joan Leung  4 , Ruth Monk  5 , Bianca Schuster  1   6 , Alicia Rybicki  1 , Teresa Marie Girolamo  7 , Elise Clin  2 , Fanny Papastamou  2 , Marie Belenger  2 , Inge-Marie Eigsti  8 , Jennifer Louise Cook  1 , Hirotaka Kosaka  9 , Rieko Osu  3 , Yuko Okamoto  10 , Sophie Sowden-Carvalho  1
Affiliations

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

Connor Tom Keating et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. A visual representation of the relationships that were tested in the current study.
Black arrows indicate positive relationships. Red arrows indicate negative relationships.
Fig 2
Fig 2. Responses to the question “do you feel that society generally accepts you as an autistic person” across country groups.
Fig 3
Fig 3. Responses to the question “over the past week I have felt accepted by society as an autistic person” across country groups.
Fig 4
Fig 4
Levels of external acceptance (left) and personal acceptance (right) experienced by autistic individuals across Australia (Aus), Belgium (Bel), Canada (Can), Japan (Jap), New Zealand (NZ), South Africa (SA), the United Kingdom (UK), and the United States of America (USA).
Fig 5
Fig 5. Levels of camouflaging across Australia (Aus), Belgium (Bel), Canada (Can), Japan (Jap), New Zealand (NZ), South Africa (SA), the United Kingdom (UK), and the United States of America (USA).
Fig 6
Fig 6
Levels of depression (top left), anxiety (bottom left), and stress (right) across Australia (Aus), Belgium (Bel), Canada (Can), Japan (Jap), New Zealand (NZ), South Africa (SA), the United Kingdom (UK), and the United States of America (USA).
See this image and copyright information in PMC

Update of

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