Is social camouflaging associated with anxiety and depression in autistic adults?

The study was cross-sectional, so it cannot show whether camouflaging led to mental health problems or mental health problems led to more camouflaging. Participants self-reported autism diagnosis and mental health symptoms, and the researchers could not independently verify diagnoses. The sample was limited to people able to complete English online surveys, was older than many previous samples, had relatively high education and employment, and included people diagnosed later in life, so findings may not apply to autistic children, adolescents, or people diagnosed in early childhood. Only 18 non-binary participants were included, and the transgender and non-binary group of 22 participants was too small to detect small or moderate effects. Mental health measures were screening tools asking about the previous two weeks, so scores above cut-offs were not clinical diagnoses. The study did not measure socioeconomic status, cognitive ability, social motivation, attitudes to camouflaging, or possible confounders such as isolation and victimisation. The association with depression was smaller and the authors advised less confidence in that finding.

The supplied text states that the work was supported by the Medical Research Council, Wellcome Trust, and the Innovative Medicines Initiative 2 Joint Undertaking. It does not include a separate author conflict-of-interest statement.

Do not conclude that camouflaging causes anxiety or depression, or that reducing camouflaging will improve mental health. The study measured camouflaging and symptoms at one time, so it cannot show which came first or whether a treatment aimed at camouflaging would help.