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Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults

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Title: Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults
Language: English
Authors: Karson T. F. Kung (ORCID 0000-0002-1598-1513)
Source: Journal of Autism and Developmental Disorders. 2024 54(4):1389-1397.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 9
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Symptoms (Individual Disorders), Stress Variables, LGBTQ People, Mental Health, Adults, Predictor Variables, Correlation, Social Bias, Anxiety
DOI: 10.1007/s10803-022-05875-7
ISSN: 0162-3257
1573-3432
Abstract: The present study investigated the relation between autistic traits and gender minority stress and the relative importance of autistic traits and gender minority stress in predicting mental health outcomes in gender minority adults. An online survey was completed by 90 transgender women, 72 transgender men, 48 non-binary individuals assigned male at birth (AMAB), and 98 non-binary individuals assigned female at birth (AFAB). Autistic traits positively correlated with internalised transphobia in the non-binary groups. In general, higher autistic traits and gender minority stress correlated with poorer mental health outcomes. After controlling for gender minority stress, autistic traits accounted for additional variance of suicidality across gender minority groups, anxiety symptoms in the non-binary groups, and all mental health outcomes in non-binary AFAB.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1418449
Database: ERIC
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  Value: <anid>AN0177351477;aut01apr.24;2024May22.05:52;v2.2.500</anid> <title id="AN0177351477-1">Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults </title> <p>The present study investigated the relation between autistic traits and gender minority stress and the relative importance of autistic traits and gender minority stress in predicting mental health outcomes in gender minority adults. An online survey was completed by 90 transgender women, 72 transgender men, 48 non-binary individuals assigned male at birth (AMAB), and 98 non-binary individuals assigned female at birth (AFAB). Autistic traits positively correlated with internalised transphobia in the non-binary groups. In general, higher autistic traits and gender minority stress correlated with poorer mental health outcomes. After controlling for gender minority stress, autistic traits accounted for additional variance of suicidality across gender minority groups, anxiety symptoms in the non-binary groups, and all mental health outcomes in non-binary AFAB.</p> <p>Keywords: Autism; Mental health; Minority stress model; Non-binary; Transgender</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <hd id="AN0177351477-2">Introduction</hd> <p>Individuals whose gender identity does not match their sex assigned at birth, such as transgender men, transgender women, and non-binary individuals, may be referred to as gender minority individuals. A recent large-scale population study including over 600,000 individuals has shown that autistic traits are elevated in gender minority adults (Warrier et al., [<reflink idref="bib40" id="ref1">40</reflink>]). Similarly, a recent meta-analysis including over 10 studies consisting of mostly adult participants has reported elevated autistic traits in gender minority individuals (Kallitsounaki & Williams, [<reflink idref="bib14" id="ref2">14</reflink>]). Almost all prior studies found increased autistic traits in gender minority adults assigned female at birth compared with control females (Hendriks et al., [<reflink idref="bib10" id="ref3">10</reflink>]; Heylens et al., [<reflink idref="bib11" id="ref4">11</reflink>]; Jones et al., [<reflink idref="bib13" id="ref5">13</reflink>]; Kung, [<reflink idref="bib15" id="ref6">15</reflink>]; Murphy et al., [<reflink idref="bib20" id="ref7">20</reflink>]; Nobili et al., [<reflink idref="bib21" id="ref8">21</reflink>]; Pasterski et al., [<reflink idref="bib23" id="ref9">23</reflink>]; Stagg & Vincent, [<reflink idref="bib28" id="ref10">28</reflink>]; Vermaat et al., [<reflink idref="bib39" id="ref11">39</reflink>]). Nonetheless, comparisons between gender minority adults assigned male at birth and control males in these prior studies yielded mixed findings. In these studies, gender minority adults were recruited via clinics (Heylens et al., [<reflink idref="bib11" id="ref12">11</reflink>]; Jones et al., [<reflink idref="bib13" id="ref13">13</reflink>]; Nobili et al., [<reflink idref="bib21" id="ref14">21</reflink>]; Pasterski et al., [<reflink idref="bib23" id="ref15">23</reflink>]; Vermaat et al., [<reflink idref="bib39" id="ref16">39</reflink>]), online platforms and organisations specialising in gender minority issues (Hendriks et al., [<reflink idref="bib10" id="ref17">10</reflink>]; Kung, [<reflink idref="bib15" id="ref18">15</reflink>]; Murphy et al., [<reflink idref="bib20" id="ref19">20</reflink>]; Stagg & Vincent, [<reflink idref="bib28" id="ref20">28</reflink>]), or selected from a large general population sample (Warrier et al., [<reflink idref="bib40" id="ref21">40</reflink>]). All these prior studies included transgender men and transgender women, and two of the studies also included separate groups of non-binary individuals (Kung, [<reflink idref="bib15" id="ref22">15</reflink>]; Stagg & Vincent, [<reflink idref="bib28" id="ref23">28</reflink>]).</p> <p>Alongside research assessing autistic traits in gender minority individuals, research focusing on clinical populations has examined the co-occurrence of autism and gender dysphoria. For instance, studies have reported a higher rate of autism in individuals with gender dysphoria (e.g., Thrower et al., [<reflink idref="bib33" id="ref24">33</reflink>]; van der Miesen et al., [<reflink idref="bib38" id="ref25">38</reflink>]). Other studies have reported a higher rate of gender dysphoria or increased gender diversity in autistic individuals (e.g., George & Stokes, [<reflink idref="bib7" id="ref26">7</reflink>]; van der Miesen et al., [<reflink idref="bib36" id="ref27">36</reflink>]).</p> <p>Whilst there is an increasing number of studies examining the link between autistic traits and gender minority status, many more studies have focused on mental health outcomes in gender minority adults. It is well documented that gender minority adults experience more mental health difficulties, such as depression, anxiety, and suicidality, than do control adults (Valentine & Shipherd, [<reflink idref="bib35" id="ref28">35</reflink>]). The minority stress model is the most prominent explanatory theory for these health disparities (Hendricks & Testa, [<reflink idref="bib9" id="ref29">9</reflink>]; Meyer, [<reflink idref="bib18" id="ref30">18</reflink>], [<reflink idref="bib19" id="ref31">19</reflink>]). This model proposes that external and internal stressors specific to gender minorities, such as gender-related rejection/victimisation and internalised transphobia, contribute to mental health difficulties in gender minorities (Hendricks & Testa, [<reflink idref="bib9" id="ref32">9</reflink>]). A recent meta-analysis reviewing over 80 studies has shown that higher levels of external and internal gender minority stress are associated with poorer mental health in gender minorities (Pellicane & Ciesla, [<reflink idref="bib24" id="ref33">24</reflink>]). The studies reviewed in the meta-analysis included clinical, community, and general population samples, consisting of mostly adult participants. The vast majority of the studies in this research area have included binary transgender individuals only or have not reported separate analyses for non-binary individuals. Of the studies comparing binary transgender individuals and non-binary individuals, most have found more mental health difficulties in non-binary individuals (e.g., Clark et al., [<reflink idref="bib5" id="ref34">5</reflink>]; Goldberg et al., [<reflink idref="bib8" id="ref35">8</reflink>]; Lefevor et al., [<reflink idref="bib16" id="ref36">16</reflink>]; Scandurra et al., [<reflink idref="bib26" id="ref37">26</reflink>]; Thorne et al., [<reflink idref="bib32" id="ref38">32</reflink>]), although comparisons regarding levels of gender minority stress have yielded inconsistent findings (e.g., Aparicio-García et al., [<reflink idref="bib2" id="ref39">2</reflink>]; Scandurra et al., [<reflink idref="bib26" id="ref40">26</reflink>]).</p> <p>Research has also looked at the intersection of autistic traits, gender minority status, and mental health. Studies using community, large-scale population, as well as autistic samples have reported a positive association between autistic traits and mental health difficulties (e.g., Hull et al., [<reflink idref="bib12" id="ref41">12</reflink>]; Lundström et al., [<reflink idref="bib17" id="ref42">17</reflink>]; Richards et al., [<reflink idref="bib25" id="ref43">25</reflink>]; Taylor et al., [<reflink idref="bib30" id="ref44">30</reflink>]). Furthermore, it has been found that, amongst autistic individuals, those who are gender minorities or self-report wish to be of the opposite sex experience particularly high levels of mental health difficulties (Chang et al.,[<reflink idref="bib4" id="ref45">4</reflink>]; van der Miesen et al., [<reflink idref="bib36" id="ref46">36</reflink>]). Similarly, amongst gender minority individuals, those who are autistic or show high/clinical levels of autistic traits experience particularly high levels of mental health difficulties (Murphy et al., [<reflink idref="bib20" id="ref47">20</reflink>]).</p> <p>Autistic traits and gender minority stress have been studied separately, but it remains unknown if the two are related. It has been argued that the elevated autistic traits observed in gender minority individuals are a consequence of gender minority stress (Fortunato et al., [<reflink idref="bib6" id="ref48">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref49">34</reflink>]; but see Strang et al., [<reflink idref="bib29" id="ref50">29</reflink>] and van der Miesen et al., [<reflink idref="bib37" id="ref51">37</reflink>] for alternative perspectives). This recent perspective argues that autism-like traits observed in certain gender minority individuals are "forms of psychological defences" and "a reversible condition" but do not reflect "intrinsic socio-cognitive difficulties" (Fortunato et al., [<reflink idref="bib6" id="ref52">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref53">34</reflink>]). However, there is limited research testing the link between autistic traits and gender minority stress. Moreover, although gender minority stress and autistic traits have been separately related to mental health, little is known about the relative importance of autistic traits and gender minority stress in predicting mental health outcomes. The present study addresses these research gaps in a sample of transgender and non-binary adults. Based on the recent perspective (Fortunato et al., [<reflink idref="bib6" id="ref54">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref55">34</reflink>]), it was hypothesised that there would be a positive association between autistic traits and gender minority stress. Based on prior empirical research (e.g., Lundström et al., [<reflink idref="bib17" id="ref56">17</reflink>]; Pellicane & Ciesla, [<reflink idref="bib24" id="ref57">24</reflink>]; Taylor et al., [<reflink idref="bib30" id="ref58">30</reflink>]), it was hypothesised that gender minority stress and autistic traits would positively predict mental health difficulties. No specific hypotheses for the relative importance of gender minority stress and autistic traits in predicting mental health were formulated due to a lack of relevant theoretical frameworks and empirical findings.</p> <hd id="AN0177351477-3">Methods</hd> <p></p> <hd id="AN0177351477-4">Participants</hd> <p>In 2017, an online sample of gender minority adults were recruited through support groups, organisations, and charities in the UK and the US (Kung, [<reflink idref="bib15" id="ref59">15</reflink>]). Participants completed a survey on Qualtrics. Response options for the "sex assigned at birth" question were: "male", "female", and "other". Response options for the "gender identity" question were: "man", "woman", "non-binary", and "other". 16 gender minority participants who did not complete the measures, 10 cisgender participants, and 2 participants choosing "other" for the sex assigned at birth question were excluded from the present study. The current sample included 90 transgender women (individuals assigned male at birth and identify as a woman), 72 transgender men (individuals assigned female at birth and identify as a man), 48 non-binary AMAB (individuals assigned male at birth and identify as non-binary), and 98 non-binary AFAB (individuals assigned female at birth and identify as non-binary). The overall sample (192 from the UK, 116 from the US) had a mean age of 36.07 (<emph>SD</emph> = 15.74; range = 18–76).</p> <hd id="AN0177351477-5">Measures</hd> <p>The present study employed the Autism Spectrum Quotient (AQ; 50-item) (Baron-Cohen et al., [<reflink idref="bib3" id="ref60">3</reflink>]), the external stressors (ES; 17-item) and internalised transphobia (IT; 8-item) subscales of the Gender Minority Stress and Resilience Measure (GMSRM) (Testa et al., [<reflink idref="bib31" id="ref61">31</reflink>]), the Center for Epidemiologic Studies Depression 10-Item Scale (CES-D-10) (Andresen et al., [<reflink idref="bib1" id="ref62">1</reflink>]), the Generalized Anxiety Disorder 7-Item Scale (GAD-7) (Spitzer et al., [<reflink idref="bib27" id="ref63">27</reflink>]), and the Suicide Behaviors Questionnaire-Revised (SBQ-R; 4-item) (Osman et al., [<reflink idref="bib22" id="ref64">22</reflink>]). Noteworthy is that the present study specifically measured ES and IT but not other aspects of gender minority stress, because ES and IT are the most widely studied amongst the relevant constructs and have been consistently related to mental health outcomes in gender minority individuals (Pellicane & Ciesla, [<reflink idref="bib24" id="ref65">24</reflink>]).</p> <p>Psychometric properties and scoring methods of these widely employed measures can be found in the validation studies (Andersen et al., 1994; Baron-Cohen et al., [<reflink idref="bib3" id="ref66">3</reflink>]; Osman et al., [<reflink idref="bib22" id="ref67">22</reflink>]; Spitzer et al., [<reflink idref="bib27" id="ref68">27</reflink>]; Testa et al., [<reflink idref="bib31" id="ref69">31</reflink>]). Higher scores on these measures indicate higher levels of autistic traits, gender minority stress, and mental health difficulties. The measures had good internal consistency (Cronbach's <emph>α</emph>) in the present study (AQ: 0.87; ES-GMSRM: 0.87; IT-GMSRM: 0.90; CES-D-10: 0.88; GAD-7: 0.92; SBQ-R: 0.79). Recommended clinical cut-off scores are ≥ 10 for CES-D-10, ≥ 10 for GAD-7, and ≥ 7 for SBQ-R (Andersen et al., 1994; Baron-Cohen et al., [<reflink idref="bib3" id="ref70">3</reflink>]; Osman et al., [<reflink idref="bib22" id="ref71">22</reflink>]; Spitzer et al., [<reflink idref="bib27" id="ref72">27</reflink>]). A cut-off score of ≥ 35 on the AQ has been used to categorise individuals as having the narrow autism phenotype (Jones et al., [<reflink idref="bib13" id="ref73">13</reflink>]; Kung, [<reflink idref="bib15" id="ref74">15</reflink>]; Wheelwright et al., [<reflink idref="bib41" id="ref75">41</reflink>]). Descriptive statistics for the four subgroups are summarised in Table 1. Although data concerning subgroup differences in autistic traits were published in a prior study (Kung et al., 2020), data from the other five measures have not been previously reported.</p> <p>Table 1 Descriptive statistics for the subgroups</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left"><p>Transgender Women (<italic>n</italic> = 90)</p></th><th align="left"><p>Transgender Men (<italic>n</italic> = 72)</p></th><th align="left"><p>Non-Binary AMAB (<italic>n</italic> = 48)</p></th><th align="left"><p>Non-Binary AFAB (<italic>n</italic> = 98)</p></th></tr></thead><tbody><tr><td align="left"><p>Continuous Scores</p></td><td align="left" colspan="4"><p>Mean (<italic>SD</italic>)</p></td></tr><tr><td align="left"><p> Autistic Traits</p></td><td align="left"><p>20.37</p></td><td align="left"><p>22.98</p></td><td align="left"><p>22.00</p></td><td align="left"><p>26.55</p></td></tr><tr><td align="left" /><td align="left"><p>(7.76)</p></td><td align="left"><p>(9.02)</p></td><td align="left"><p>(7.05)</p></td><td align="left"><p>(8.38)</p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>7.32</p></td><td align="left"><p>8.51</p></td><td align="left"><p>6.23</p></td><td align="left"><p>6.68</p></td></tr><tr><td align="left" /><td align="left"><p>(4.69)</p></td><td align="left"><p>(4.24)</p></td><td align="left"><p>(4.74)</p></td><td align="left"><p>(4.12)</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>19.69</p></td><td align="left"><p>21.24</p></td><td align="left"><p>19.79</p></td><td align="left"><p>20.29</p></td></tr><tr><td align="left" /><td align="left"><p>(9.04)</p></td><td align="left"><p>(9.09)</p></td><td align="left"><p>(8.00)</p></td><td align="left"><p>(8.27)</p></td></tr><tr><td align="left"><p> Depressive Symptoms</p></td><td align="left"><p>11.63</p></td><td align="left"><p>13.69</p></td><td align="left"><p>13.13</p></td><td align="left"><p>16.07</p></td></tr><tr><td align="left" /><td align="left"><p>(7.08)</p></td><td align="left"><p>(7.53)</p></td><td align="left"><p>(6.84)</p></td><td align="left"><p>(5.69)</p></td></tr><tr><td align="left"><p> Anxiety Symptoms</p></td><td align="left"><p>6.70</p></td><td align="left"><p>9.29</p></td><td align="left"><p>7.89</p></td><td align="left"><p>10.80</p></td></tr><tr><td align="left" /><td align="left"><p>(5.62)</p></td><td align="left"><p>(6.24)</p></td><td align="left"><p>(5.73)</p></td><td align="left"><p>(5.43)</p></td></tr><tr><td align="left"><p> Suicidality</p></td><td align="left"><p>9.11</p></td><td align="left"><p>10.28</p></td><td align="left"><p>7.67</p></td><td align="left"><p>9.85</p></td></tr><tr><td align="left" /><td align="left"><p>(4.24)</p></td><td align="left"><p>(4.06)</p></td><td align="left"><p>(3.68)</p></td><td align="left"><p>(3.67)</p></td></tr><tr><td align="left"><p>Proportion of High-Scoring</p></td><td align="left" colspan="4"><p><italic>n</italic> (%)</p></td></tr><tr><td align="left"><p> Autistic Traits</p></td><td align="left"><p>3</p></td><td align="left"><p>11</p></td><td align="left"><p>1</p></td><td align="left"><p>19</p></td></tr><tr><td align="left" /><td align="left"><p>(3%)</p></td><td align="left"><p>(15%)</p></td><td align="left"><p>(2%)</p></td><td align="left"><p>(19%)</p></td></tr><tr><td align="left"><p> Depressive Symptoms</p></td><td align="left"><p>54</p></td><td align="left"><p>46</p></td><td align="left"><p>33</p></td><td align="left"><p>86</p></td></tr><tr><td align="left" /><td align="left"><p>(60%)</p></td><td align="left"><p>(64%)</p></td><td align="left"><p>(69%)</p></td><td align="left"><p>(88%)</p></td></tr><tr><td align="left"><p> Anxiety Symptoms</p></td><td align="left"><p>25</p></td><td align="left"><p>35</p></td><td align="left"><p>17</p></td><td align="left"><p>59</p></td></tr><tr><td align="left" /><td align="left"><p>(28%)</p></td><td align="left"><p>(49%)</p></td><td align="left"><p>(35%)</p></td><td align="left"><p>(60%)</p></td></tr><tr><td align="left"><p> Suicidality</p></td><td align="left"><p>57</p></td><td align="left"><p>56</p></td><td align="left"><p>28</p></td><td align="left"><p>79</p></td></tr><tr><td align="left" /><td align="left"><p>(63%)</p></td><td align="left"><p>(78%)</p></td><td align="left"><p>(58%)</p></td><td align="left"><p>(81%)</p></td></tr></tbody></table> </ephtml> </p> <hd id="AN0177351477-6">Analytical approach</hd> <p>Prior studies on gender minority adults found subgroup differences in autistic traits (Hendriks et al., in press; Heylens et al., [<reflink idref="bib11" id="ref76">11</reflink>]; Jones et al., [<reflink idref="bib13" id="ref77">13</reflink>]; Kung, [<reflink idref="bib15" id="ref78">15</reflink>]; Murphy et al., [<reflink idref="bib20" id="ref79">20</reflink>]; Nobili et al., [<reflink idref="bib21" id="ref80">21</reflink>]; Pasterski et al., [<reflink idref="bib23" id="ref81">23</reflink>]; Stagg & Vincent, [<reflink idref="bib28" id="ref82">28</reflink>]; Vermaat et al., [<reflink idref="bib39" id="ref83">39</reflink>]) as well as in mental health (Goldberg et al., [<reflink idref="bib8" id="ref84">8</reflink>]; Lefevor et al., [<reflink idref="bib16" id="ref85">16</reflink>]; Scandurra et al., [<reflink idref="bib26" id="ref86">26</reflink>]; Thorne et al., [<reflink idref="bib32" id="ref87">32</reflink>]). Also, there have been growing calls for researchers to examine subgroup differences in mental health issues in gender minority adults (Pellicane & Ciesla, [<reflink idref="bib24" id="ref88">24</reflink>]; Valentine & Shipherd, [<reflink idref="bib35" id="ref89">35</reflink>]). Conventional statistical approaches based on the entire sample may mask important subgroup-specific effects, especially when the sample is not large. Hence, in the present study, statistical analyses were conducted within each of the four subgroups. Information regarding proportions of high-scoring (≥ cut-offs) participants are provided in Table 1 as part of description of sample characteristics, but categories based on cut-offs were not used in analyses due to small cell sizes. Only continuous scores were analysed. All tests were two-tailed with alpha set at 0.05. The <emph>p</emph>-values reported were not corrected for multiple comparisons.</p> <hd id="AN0177351477-7">Results</hd> <p></p> <hd id="AN0177351477-8">Relation between autistic traits and gender minority stress</hd> <p>Correlations between the measures in the subgroups are shown in Table 2. A significant positive correlation was found between autistic traits and internalised transphobia in both the non-binary AMAB and AFAB groups and the effect sizes were similar across the two groups (<emph>r</emph> =.29 and <emph>r</emph> =.35). There were no other significant correlations between autistic traits and gender minority stress. The correlation between external gender minority stress and internalised transphobia was significant in transgender women (<emph>r</emph> =.23), marginally significant in non-binary AFAB (<emph>r</emph> =.19), but non-significant in transgender men and non-binary AMAB.</p> <p>Table 2 Correlations between measures in the subgroups</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Correlations in Transgender Groups</p></th><th align="left" /><th align="left" /><th align="left" /><th align="left" /><th align="left" /><th align="left" /></tr></thead><tbody><tr><td align="left" /><td align="left"><p>1.</p></td><td align="left"><p>2.</p></td><td align="left"><p>3.</p></td><td align="left"><p>4.</p></td><td align="left"><p>5.</p></td><td align="left"><p>6.</p></td></tr><tr><td align="left"><p>1. Autistic Traits</p></td><td align="left"><p>-</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.15</p></td><td align="left"><p>0.18<sup>†</sup></p></td><td align="left"><p>0.21<sup>†</sup></p></td></tr><tr><td align="left"><p>2. External Gender Minority Stress</p></td><td align="left"><p>− 0.02</p></td><td align="left"><p>-</p></td><td align="left"><p>0.23*</p></td><td align="left"><p>0.27*</p></td><td align="left"><p>0.27*</p></td><td align="left"><p>0.34**</p></td></tr><tr><td align="left"><p>3. Internalised Transphobia</p></td><td align="left"><p>− 0.20</p></td><td align="left"><p>.13</p></td><td align="left"><p>-</p></td><td align="left"><p>0.55***</p></td><td align="left"><p>0.52***</p></td><td align="left"><p>0.38***</p></td></tr><tr><td align="left"><p>4. Depressive Symptoms</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.22<sup>†</sup></p></td><td align="left"><p>0.60***</p></td><td align="left"><p>-</p></td><td align="left"><p>0.80***</p></td><td align="left"><p>0.54***</p></td></tr><tr><td align="left"><p>5. Anxiety Symptoms</p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.26*</p></td><td align="left"><p>0.49***</p></td><td align="left"><p>0.77***</p></td><td align="left"><p>-</p></td><td align="left"><p>0.58***</p></td></tr><tr><td align="left"><p>6. Suicidality</p></td><td align="left"><p>0.21<sup>†</sup></p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.31**</p></td><td align="left"><p>0.41***</p></td><td align="left"><p>0.38**</p></td><td align="left"><p>-</p></td></tr><tr><td align="left"><p>Correlations in Non-Binary Groups</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>1.</p></td><td align="left"><p>2.</p></td><td align="left"><p>3.</p></td><td align="left"><p>4.</p></td><td align="left"><p>5.</p></td><td align="left"><p>6.</p></td></tr><tr><td align="left"><p>1. Autistic Traits</p></td><td align="left"><p>-</p></td><td align="left"><p>0.13</p></td><td align="left"><p>0.29*</p></td><td align="left"><p>0.29*</p></td><td align="left"><p>0.40**</p></td><td align="left"><p>0.32*</p></td></tr><tr><td align="left"><p>2. External Gender Minority Stress</p></td><td align="left"><p>0.06</p></td><td align="left"><p>-</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.44**</p></td><td align="left"><p>0.38**</p></td><td align="left"><p>0.38**</p></td></tr><tr><td align="left"><p>3. Internalised Transphobia</p></td><td align="left"><p>0.35***</p></td><td align="left"><p>0.19<sup>†</sup></p></td><td align="left"><p>-</p></td><td align="left"><p>0.36*</p></td><td align="left"><p>0.26<sup>†</sup></p></td><td align="left"><p>0.32*</p></td></tr><tr><td align="left"><p>4. Depressive Symptoms</p></td><td align="left"><p>0.51***</p></td><td align="left"><p>0.12</p></td><td align="left"><p>0.39***</p></td><td align="left"><p>-</p></td><td align="left"><p>0.82***</p></td><td align="left"><p>0.60***</p></td></tr><tr><td align="left"><p>5. Anxiety Symptoms</p></td><td align="left"><p>0.37***</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.18<sup>†</sup></p></td><td align="left"><p>0.71***</p></td><td align="left"><p>-</p></td><td align="left"><p>0.55***</p></td></tr><tr><td align="left"><p>6. Suicidality</p></td><td align="left"><p>0.38***</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.27**</p></td><td align="left"><p>0.51***</p></td><td align="left"><p>0.45***</p></td><td align="left"><p>-</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> For both transgender and non-binary groups, correlations for individuals assigned male at birth (transgender women, <emph>n</emph> = 90; non-binary AMAB, <emph>n</emph> = 48) are presented to the right and above the diagonal, and correlations for individuals assigned female at birth (transgender men, <emph>n</emph> = 72; non-binary AFAB, <emph>n</emph> = 98) are presented to the left and below the diagonal. <sups>†</sups><emph>p</emph> <.10 *<emph>p</emph> <.05 **<emph>p</emph> <.01 ***<emph>p</emph> <.001</p> <hd id="AN0177351477-9">Autistic traits and gender minority stress as predictors of mental health outcomes</hd> <p>Across all four subgroups, there were 24 correlations relating the gender minority stress measures (external gender minority stress and internalised transphobia) to the mental health measures (depressive symptoms, anxiety symptoms, suicidality), and all these correlations were in the expected direction. Of the 24 correlations, 17 were significant (<emph>r</emph>s: 0.26 to 0.60) and 3 were marginally significant (<emph>r</emph>s: 0.18 to 0.26). These findings suggest that individuals with higher levels of gender minority stress experience more mental health difficulties.</p> <p>Autistic traits significantly correlated with all the mental health measures in both the non-binary AMAB and AFAB groups (<emph>r</emph>s: 0.29 to 0.51). Autistic traits also significantly or marginally significantly correlated with suicidality in all four subgroups (<emph>r</emph>s: 0.21 to 0.38). These findings suggest that higher levels of autistic traits may predict more mental health difficulties in gender minority adults, but its importance as a predictor may vary across subgroups and mental health outcomes.</p> <p>Next, hierarchical linear regression analyses were conducted to test whether or not, after considering age and country (step 1) as well as external gender minority stress and internalised transphobia (step 2), autistic traits (step 3) would significantly predict and explain additional variance of mental health outcomes. These regression analyses in the subgroups, including findings per step and outcome, are summarised in Table 3. Overall, gender minority stress measures, especially internalised transphobia, were the most consistent and robust predictors of different mental health outcomes across subgroups. The gender minority stress measures in step 2 significantly accounted for additional variance in 10 of the 12 hierarchical regression models (significant ∆<emph>R</emph><sups>2</sups> statistics indicating 7 to 32% of additional variance explained; non-significant in models predicting anxiety symptoms in non-binary AFAB and suicidality in transgender men). The effects of autistic traits in step 3 were most salient in non-binary AFAB, accounting for significant additional variance of all mental health outcomes in the subgroup (significant ∆<emph>R</emph><sups>2</sups> statistics indicating 9 to 17% of additional variance explained). Also, in non-binary AFAB, for all mental health outcomes, autistic traits accounted for more variance than did gender minority stress. In addition, autistic traits significantly or marginally significantly accounted for an additional 3 to 9% of variance of suicidality in 3 of the 4 subgroups (non-significant in non-binary AMAB). Autistic traits also significantly accounted for an additional 7 to 12% of variance of anxiety symptoms in the non-binary subgroups.</p> <p>Table 3 Hierarchical regressions predicting depressive symptoms (model 1), anxiety symptoms (model 2), and suicidality (model 3)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="2"><p>Transgender Women (<italic>n</italic> = 90)</p></th><th align="left" colspan="2"><p>Transgender Men (<italic>n</italic> = 72)</p></th><th align="left" colspan="2"><p>Non-Binary AMAB (<italic>n</italic> = 48)</p></th><th align="left" colspan="2"><p>Non-Binary AFAB (<italic>n</italic> = 98)</p></th></tr><tr><th align="left" /><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>p</italic></p></th><th align="left"><p><italic>β</italic></p></th><th align="left"><p><italic>p</italic></p></th></tr></thead><tbody><tr><td align="left"><p>Model 1 (Depressive Symptoms)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Step 1:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.02</p></td><td align="left"><p>0.872</p></td><td align="left"><p>− 0.28</p></td><td align="left"><p><bold>0.015</bold></p></td><td align="left"><p>0.08</p></td><td align="left"><p>0.591</p></td><td align="left"><p>− 0.24</p></td><td align="left"><p><bold>0.016</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.206</p></td><td align="left"><p>− 0.30</p></td><td align="left"><p><bold>0.009</bold></p></td><td align="left"><p>0.04</p></td><td align="left"><p>0.781</p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.254</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 0.95, <italic>p</italic> =.392</p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.17, <italic>F</italic> = 6.80, <italic>p</italic> = <bold>.002</bold></p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.01, <italic>F</italic> = 0.20, <italic>p</italic> =.824</p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.07, <italic>F</italic> = 3.60, <italic>p =</italic><bold>.031</bold></p></td></tr><tr><td align="left"><p> Step 2:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.449</p></td><td align="left"><p>− 0.17</p></td><td align="left"><p><bold>0.084</bold></p></td><td align="left"><p>− 0.15</p></td><td align="left"><p>0.281</p></td><td align="left"><p>− 0.19</p></td><td align="left"><p><bold>0.046</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.04</p></td><td align="left"><p>0.695</p></td><td align="left"><p>− 0.23</p></td><td align="left"><p><bold>0.015</bold></p></td><td align="left"><p>0.06</p></td><td align="left"><p>0.644</p></td><td align="left"><p>0.12</p></td><td align="left"><p>0.199</p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.145</p></td><td align="left"><p>0.20</p></td><td align="left"><p><bold>0.036</bold></p></td><td align="left"><p>0.44</p></td><td align="left"><p>< <bold>0.001</bold></p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.450</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.53</p></td><td align="left"><p>< <bold>0.001</bold></p></td><td align="left"><p>0.48</p></td><td align="left"><p><bold>< 0.0001</bold></p></td><td align="left"><p>0.41</p></td><td align="left"><p><bold>0.006</bold></p></td><td align="left"><p>0.34</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.31, <italic>F</italic> = 19.29, <italic>p</italic> < <bold>.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.28, <italic>F</italic> = 17.06, <italic>p</italic> < <bold>.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.32, <italic>F</italic> = 10.32, <italic>p</italic><bold><.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.13, <italic>F</italic> = 7.58, <italic>p</italic> < <bold>.001</bold></p></td></tr><tr><td align="left"><p> Step 3:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.495</p></td><td align="left"><p>− 0.15</p></td><td align="left"><p>0.109</p></td><td align="left"><p>− 0.17</p></td><td align="left"><p>0.248</p></td><td align="left"><p>− 0.17</p></td><td align="left"><p><bold>0.046</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.782</p></td><td align="left"><p>− 0.24</p></td><td align="left"><p><bold>0.011</bold></p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.817</p></td><td align="left"><p>0.18</p></td><td align="left"><p><bold>0.032</bold></p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.146</p></td><td align="left"><p>0.20</p></td><td align="left"><p><bold>0.036</bold></p></td><td align="left"><p>0.42</p></td><td align="left"><p><bold>0.002</bold></p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.403</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.52</p></td><td align="left"><p>< <bold>0.001</bold></p></td><td align="left"><p>0.51</p></td><td align="left"><p><bold>< 0.0001</bold></p></td><td align="left"><p>0.37</p></td><td align="left"><p><bold>0.015</bold></p></td><td align="left"><p>0.19</p></td><td align="left"><p><bold>0.038</bold></p></td></tr><tr><td align="left"><p> Autistic Traits</p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.232</p></td><td align="left"><p>0.13</p></td><td align="left"><p>0.166</p></td><td align="left"><p>0.16</p></td><td align="left"><p>0.244</p></td><td align="left"><p>0.44</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.01, <italic>F</italic> = 1.45, <italic>p</italic> =.232</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 1.96, <italic>p</italic> =.166</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 1.39, <italic>p</italic> =.244</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.17, <italic>F</italic> = 24.51, <italic>p</italic> < <bold>.001</bold></p></td></tr><tr><td align="left"><p>Model 2 (Anxiety Symptoms)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Step 1:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.08</p></td><td align="left"><p>0.465</p></td><td align="left"><p>− 0.33</p></td><td align="left"><p><bold>0.004</bold></p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.850</p></td><td align="left"><p>− 0.37</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.15</p></td><td align="left"><p>0.175</p></td><td align="left"><p>− 0.11</p></td><td align="left"><p>0.323</p></td><td align="left"><p>0.20</p></td><td align="left"><p>0.187</p></td><td align="left"><p>0.19</p></td><td align="left"><p><bold>0.041</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.04, <italic>F</italic> = 1.59, <italic>p</italic> =.210</p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.12, <italic>F</italic> = 4.84, <italic>p</italic> = <bold>.011</bold></p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.04, <italic>F</italic> = 0.93, <italic>p</italic> =.401</p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.17, <italic>F</italic> = 9.72, <italic>p</italic> < <bold>.001</bold></p></td></tr><tr><td align="left"><p> Step 2:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.994</p></td><td align="left"><p>− 0.25</p></td><td align="left"><p><bold>0.017</bold></p></td><td align="left"><p>− 0.16</p></td><td align="left"><p>0.280</p></td><td align="left"><p>− 0.35</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.600</p></td><td align="left"><p>− 0.07</p></td><td align="left"><p>0.471</p></td><td align="left"><p>0.21</p></td><td align="left"><p>0.123</p></td><td align="left"><p>0.20</p></td><td align="left"><p><bold>0.039</bold></p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.146</p></td><td align="left"><p>0.24</p></td><td align="left"><p><bold>0.022</bold></p></td><td align="left"><p>0.37</p></td><td align="left"><p><bold>0.007</bold></p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.876</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.48</p></td><td align="left"><p>< <bold>0.001</bold></p></td><td align="left"><p>0.38</p></td><td align="left"><p><bold>< 0.001</bold></p></td><td align="left"><p>0.33</p></td><td align="left"><p><bold>0.032</bold></p></td><td align="left"><p>0.20</p></td><td align="left"><p>0.226</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.26, <italic>F</italic> = 15.79, <italic>p</italic> < <bold>.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.22, <italic>F</italic> = 11.05, <italic>p <</italic><bold>.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.22, <italic>F</italic> = 6.46, <italic>p</italic> = <bold>.004</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 0.84, <italic>p</italic> =.437</p></td></tr><tr><td align="left"><p> Step 3:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.926</p></td><td align="left"><p>− 0.25</p></td><td align="left"><p>0.022</p></td><td align="left"><p>− 0.18</p></td><td align="left"><p>0.208</p></td><td align="left"><p>− 0.34</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.04</p></td><td align="left"><p>0.707</p></td><td align="left"><p>− 0.08</p></td><td align="left"><p>0.439</p></td><td align="left"><p>0.16</p></td><td align="left"><p>0.239</p></td><td align="left"><p>0.25</p></td><td align="left"><p><bold>0.006</bold></p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.14</p></td><td align="left"><p>0.146</p></td><td align="left"><p>0.24</p></td><td align="left"><p><bold>0.022</bold></p></td><td align="left"><p>0.35</p></td><td align="left"><p><bold>0.010</bold></p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.872</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.47</p></td><td align="left"><p>< <bold>0.001</bold></p></td><td align="left"><p>0.40</p></td><td align="left"><p><bold>< 0.001</bold></p></td><td align="left"><p>0.25</p></td><td align="left"><p><bold>0.098</bold></p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.927</p></td></tr><tr><td align="left"><p> Autistic Traits</p></td><td align="left"><p>0.15</p></td><td align="left"><p>0.114</p></td><td align="left"><p>0.08</p></td><td align="left"><p>0.469</p></td><td align="left"><p>0.29</p></td><td align="left"><p><bold>0.036</bold></p></td><td align="left"><p>0.37</p></td><td align="left"><p>< <bold>0.001</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 2.55, <italic>p</italic> =.114</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.01, <italic>F</italic> = 0.53, <italic>p</italic> =.469</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.07, <italic>F</italic> = 4.69, <italic>p</italic> = <bold>.036</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.12, <italic>F</italic> = 15.81, <italic>p</italic> < <bold>.001</bold></p></td></tr><tr><td align="left"><p>Model 3 (Suicidality)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Step 1:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.18</p></td><td align="left"><p><bold>0.097</bold></p></td><td align="left"><p>− 0.45</p></td><td align="left"><p><bold>< 0.001</bold></p></td><td align="left"><p>0.15</p></td><td align="left"><p>0.302</p></td><td align="left"><p>− 0.15</p></td><td align="left"><p>0.158</p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.21</p></td><td align="left"><p><bold>0.054</bold></p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.78</p></td><td align="left"><p>0.27</p></td><td align="left"><p><bold>0.064</bold></p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.998</p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.09, <italic>F</italic> = 4.52, <italic>p</italic> = <bold>.014</bold></p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.21, <italic>F</italic> = 8.93, <italic>p</italic><bold><.001</bold></p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.10, <italic>F</italic> = 2.47, <italic>p</italic> = <bold>.096</bold></p></td><td align="left" colspan="2"><p><italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 1.01, <italic>p =</italic>.367</p></td></tr><tr><td align="left"><p> Step 2:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.15</p></td><td align="left"><p>0.152</p></td><td align="left"><p>− 0.41</p></td><td align="left"><p><bold>< 0.001</bold></p></td><td align="left"><p>− 0.05</p></td><td align="left"><p>0.756</p></td><td align="left"><p>− 0.12</p></td><td align="left"><p>0.250</p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.10</p></td><td align="left"><p>0.311</p></td><td align="left"><p>0.06</p></td><td align="left"><p>0.592</p></td><td align="left"><p>0.28</p></td><td align="left"><p><bold>0.032</bold></p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.981</p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.25</p></td><td align="left"><p><bold>0.015</bold></p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.515</p></td><td align="left"><p>0.35</p></td><td align="left"><p><bold>0.009</bold></p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.286</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.27</p></td><td align="left"><p><bold>0.008</bold></p></td><td align="left"><p>0.21</p></td><td align="left"><p><bold>0.074</bold></p></td><td align="left"><p>0.34</p></td><td align="left"><p><bold>0.022</bold></p></td><td align="left"><p>0.23</p></td><td align="left"><p><bold>0.030</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.15, <italic>F</italic> = 8.54, <italic>p</italic> < <bold>.001</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.05, <italic>F</italic> = 2.16, <italic>p</italic> =.124</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.21, <italic>F</italic> = 6.60, <italic>p</italic> = <bold>.003</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.07, <italic>F</italic> = 3.70, <italic>p</italic> = <bold>.028</bold></p></td></tr><tr><td align="left"><p> Step 3:</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p> Age</p></td><td align="left"><p>− 0.16</p></td><td align="left"><p>0.117</p></td><td align="left"><p>− 0.38</p></td><td align="left"><p><bold>< 0.001</bold></p></td><td align="left"><p>− 0.06</p></td><td align="left"><p>0.699</p></td><td align="left"><p>− 0.10</p></td><td align="left"><p>0.292</p></td></tr><tr><td align="left"><p> Country</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.398</p></td><td align="left"><p>0.04</p></td><td align="left"><p>0.711</p></td><td align="left"><p>0.26</p></td><td align="left"><p><bold>0.056</bold></p></td><td align="left"><p>0.05</p></td><td align="left"><p>0.618</p></td></tr><tr><td align="left"><p> External Gender Minority Stress</p></td><td align="left"><p>0.25</p></td><td align="left"><p><bold>0.014</bold></p></td><td align="left"><p>0.07</p></td><td align="left"><p>0.506</p></td><td align="left"><p>0.33</p></td><td align="left"><p><bold>0.012</bold></p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.266</p></td></tr><tr><td align="left"><p> Internalised Transphobia</p></td><td align="left"><p>0.26</p></td><td align="left"><p><bold>0.010</bold></p></td><td align="left"><p>0.26</p></td><td align="left"><p><bold>0.026</bold></p></td><td align="left"><p>0.30</p></td><td align="left"><p><bold>0.049</bold></p></td><td align="left"><p>0.12</p></td><td align="left"><p>0.265</p></td></tr><tr><td align="left"><p> Autistic Traits</p></td><td align="left"><p>0.18</p></td><td align="left"><p><bold>0.062</bold></p></td><td align="left"><p>0.24</p></td><td align="left"><p><bold>0.026</bold></p></td><td align="left"><p>0.16</p></td><td align="left"><p>0.253</p></td><td align="left"><p>0.32</p></td><td align="left"><p><bold>0.002</bold></p></td></tr><tr><td align="left" /><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.03, <italic>F</italic> = 3.59, <italic>p</italic> = <bold>.062</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.06, <italic>F</italic> = 5.21, <italic>p</italic> = <bold>.026</bold></p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.02, <italic>F</italic> = 1.35, <italic>p</italic> =.253</p></td><td align="left" colspan="2"><p>∆<italic>R</italic><sup>2</sup> = 0.09, <italic>F</italic> = 10.09, <italic>p</italic> = <bold>.002</bold></p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> Standardised regression coefficients are reported. Significant and marginally significant <emph>p</emph>-values are bolded. Codes for country: 0 = UK and 1 = US.</p> <hd id="AN0177351477-10">Discussion</hd> <p>The present study found a positive association between internalised transphobia and autistic traits in non-binary individuals. This finding provides partial support for the hypothesis that there would be a positive association between autistic traits and gender minority stress. The hypothesis was formulated based on a recent perspective suggesting that the elevated autistic traits in gender minority individuals are a consequence of gender minority stress (Fortunato et al., [<reflink idref="bib6" id="ref90">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref91">34</reflink>]). Nonetheless, the perspective primarily focuses on the link between external stressors and autistic traits in individuals with gender dysphoria, who tend to be transgender individuals (Fortunato et al., [<reflink idref="bib6" id="ref92">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref93">34</reflink>]). By contrast, the present study found a link between internalised transphobia and autistic traits in non-binary individuals. In addition, the perspective seems to imply that gender minority stress causally increases autistic traits or risk for autism (Fortunato et al., [<reflink idref="bib6" id="ref94">6</reflink>]; Turban & van Schalkwyk, [<reflink idref="bib34" id="ref95">34</reflink>]), but the current findings are correlational and cannot establish causality or the direction of effects. It is possible that autistic traits are the cause instead of the consequence; socio-cognitive difficulties might affect how individuals view their own gender minority identity. Whilst it would be difficult to establish causality, further cross-lagged longitudinal research may help address the directionality issue.</p> <p>The current findings support the hypothesis that there would be a positive association between gender minority stress and mental health difficulties. More specifically, in the present study, higher levels of gender minority stress were generally related to more mental health difficulties across gender minority subgroups. These findings provide further support for the minority stress model (Hendricks & Testa, [<reflink idref="bib9" id="ref96">9</reflink>]; Meyer, [<reflink idref="bib18" id="ref97">18</reflink>], [<reflink idref="bib19" id="ref98">19</reflink>]) and are in line with the recent meta-analysis demonstrating significant pooled bi-variate relations between gender minority stress and mental health outcomes (Pellicane & Ciesla, [<reflink idref="bib24" id="ref99">24</reflink>]).</p> <p>In the present study, autistic traits accounted for unique additional variance above and beyond gender minority stress when predicting certain outcomes in certain subgroups. These findings provide some support for the hypothesis that there would be a positive association between autistic traits and mental health difficulties. Some prior studies using community, large-scale population, and autistic samples reported that individuals with higher levels of autistic traits had poorer mental health (e.g., Hull et al., [<reflink idref="bib12" id="ref100">12</reflink>]; Lundström et al., [<reflink idref="bib17" id="ref101">17</reflink>]; Richards et al., [<reflink idref="bib25" id="ref102">25</reflink>]; Taylor et al., [<reflink idref="bib30" id="ref103">30</reflink>]). Although in the present study gender minority stress was generally a stronger predictor, correlational and regression analyses suggest that autistic traits may be particularly important in explaining suicidality across different gender minority subgroups and mental health outcomes in non-binary individuals. In addition, in non-binary AFAB, for all mental health outcomes, autistic traits was a stronger predictor compared with gender minority stress. Taken together, many studies on mental health in gender minorities have focused on the detrimental effects of gender minority stress, but the current findings highlight that autistic traits may also be an important predictor.</p> <hd id="AN0177351477-11">Limitations</hd> <p>The autistic traits and mental health measures employed are not diagnostic tools, although they can offer insights into varying levels of autistic traits and mental health difficulties. The present study recruited a "non-clinical" online sample. Nonetheless, not all gender minorities require or have access to clinical services or have gender dysphoria, and so the current sampling approach is perhaps more inclusive compared with clinic-based recruitment. Another issue is that the present study was not able to examine and control for a wide range of sociodemographic variables such as educational levels and income. Further research may usefully explore whether and how different sociodemographic variables may affect the link between autistic traits and gender minority stress as well as their relative importance in predicting mental health outcomes.</p> <p>Based on small subgroups, the present study conducted multiple tests and did not adjust individual <emph>p</emph>-values. Considering the study design, sample size, and number of statistical tests, it is important to note that the current findings are preliminary and correlational and should be interpreted with caution. However, across and within different subgroups, several clear patterns emerged and the effects were neither small nor negligible. For instance, all 24 correlations relating gender minority stress and mental health outcomes were in the expected direction across subgroups (with significant ones ranging from <emph>r</emph> =.26 to <emph>r</emph> =.60), and autistic traits significantly correlated with all the mental health measures in both non-binary groups (<emph>r</emph>s: 0.29 to 0.51). Also, in regression models where autistic traits significantly accounted for additional variance of mental health outcomes, the amount of additional variance explained ranged from 6 to 17%. Hence, whilst further research is needed to replicate the current findings, it is unlikely that these clear patterns and significant results are merely a product of Type I errors or spurious effects.</p> <hd id="AN0177351477-12">Conclusion</hd> <p>The current findings show that there is a positive association between autistic traits and internalised transphobia in non-binary individuals. The present study shows that gender minority adults with higher levels of autistic traits and gender minority stress tend to have poorer mental health. Autistic traits can sometimes account for unique additional variance of mental health outcomes above and beyond gender minority stress. It appears that autistic traits are particularly important in explaining suicidality in gender minorities and mental health outcomes in non-binary individuals. Further longitudinal research with larger samples is needed to corroborate the current findings and address the directionality issue.</p> <hd id="AN0177351477-13">Acknowledgements</hd> <p>The author would like to thank all the participants who made this research possible.</p> <hd id="AN0177351477-14">Author contribution</hd> <p>KTFK designed the study, collected and analysed the data, wrote and approved the manuscript.</p> <hd id="AN0177351477-15">Funding</hd> <p>KTFK was supported by the Early Career Scheme of the Hong Kong Research Grants Council.</p> <hd id="AN0177351477-16">Data Availability</hd> <p>The dataset generated and analysed during the current study is available from the corresponding author on reasonable request.</p> <hd id="AN0177351477-17">Declarations</hd> <p></p> <hd id="AN0177351477-18">Competing Interests</hd> <p>The author declares no competing interests.</p> <hd id="AN0177351477-19">Ethics Approval</hd> <p>Ethics approval was obtained from the Cambridge Psychology Research Ethics Committee, University of Cambridge. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Karson+T%2E+F%2E+Kung%22">Karson T. F. Kung</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-1598-1513">0000-0002-1598-1513</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2024 54(4):1389-1397.
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 9
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2024
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+Variables%22">Stress Variables</searchLink><br /><searchLink fieldCode="DE" term="%22LGBTQ+People%22">LGBTQ People</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+Health%22">Mental Health</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Bias%22">Social Bias</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-022-05875-7
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The present study investigated the relation between autistic traits and gender minority stress and the relative importance of autistic traits and gender minority stress in predicting mental health outcomes in gender minority adults. An online survey was completed by 90 transgender women, 72 transgender men, 48 non-binary individuals assigned male at birth (AMAB), and 98 non-binary individuals assigned female at birth (AFAB). Autistic traits positively correlated with internalised transphobia in the non-binary groups. In general, higher autistic traits and gender minority stress correlated with poorer mental health outcomes. After controlling for gender minority stress, autistic traits accounted for additional variance of suicidality across gender minority groups, anxiety symptoms in the non-binary groups, and all mental health outcomes in non-binary AFAB.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2024
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  Label: Accession Number
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  Data: EJ1418449
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      – Type: doi
        Value: 10.1007/s10803-022-05875-7
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 9
        StartPage: 1389
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Stress Variables
        Type: general
      – SubjectFull: LGBTQ People
        Type: general
      – SubjectFull: Mental Health
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Correlation
        Type: general
      – SubjectFull: Social Bias
        Type: general
      – SubjectFull: Anxiety
        Type: general
    Titles:
      – TitleFull: Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults
        Type: main
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            NameFull: Karson T. F. Kung
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 0162-3257
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              Value: 1573-3432
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              Value: 54
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              Value: 4
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            – TitleFull: Journal of Autism and Developmental Disorders
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