The Relationship Between Habitual Emotion Regulation, Anxiety, and Depression in Adolescents and Young Adults on the Autism Spectrum

Background: Anxiety and depression are among the most common and disabling comorbid psychiatric conditions in individuals on the autism spectrum. However, factors that may account for high rates of anxiety and depression in autism are currently not well understood. Although some studies suggest that age, gender and severity of autism traits might influence the presence of these internalising problems, it has been argued that non-autism specific traits, which vary across individuals, might be more important; one such trait is emotion regulation. Emotion regulation strategies such as suppression have been found to be associated with poorer mental health in the general population.  It has been proposed that emotion regulation impairments are a risk factor for anxiety in autism as individuals on the spectrum tend to use suppression strategies more than typically developing individuals. Thus, while it might be expected that greater use of suppression strategies is associated with anxiety and depression in individuals on the autism spectrum, relationships between emotion regulation strategies and anxiety and depression have not been formally tested.

Objectives: To investigate whether or not the use of habitual emotion regulation strategies, specifically reappraisal and suppression, are related to anxiety and depression symptoms in individuals on the spectrum over and above age, gender and autism traits.

Methods: This study forms part of the Australian Autism CRC longitudinal study of school leavers; recruitment is ongoing. Participants aged 15 to 25 years were recruited Australia-wide via various channels.  As part of the longitudinal study, participants completed the Emotion Regulation Questionnaire (ERQ), the Adult Autism Spectrum Quotient (AQ), the DSM-5 Cross-cutting Dimensional Anxiety Scale (Cross-D), and the Patient Health Questionnaire-9 (PHQ-9), which measures depression.  To date, 37 individuals on the spectrum (25 males and 12 females; M_age= 18.59 years, SD_age= 2.37) have completed the questionnaires. Preliminary data are presented here; for our presentation, data will be re-analysed with the inclusion of all new participants.

Results: Pearson’s correlation analyses were conducted to assess the relationships between age, gender, AQ, Cross-D, and PHQ-9 total scores, and suppression and reappraisal scores from the ERQ.  PHQ-9 and Cross-D scores were significantly correlated with both reappraisal and AQ scores, but not with age, gender, or suppression score.  Partial correlation was then used to explore the relationship between reappraisal, and anxiety and depression scores, while controlling for scores on AQ.  There were significant moderate, negative correlations between reappraisal and anxiety, r = -.42, p = .02, and between reappraisal and depression, r = -.45, p = .01.

Conclusions: This is the first study to assess the relationships between emotion regulation strategies and anxiety and depression in individuals on the spectrum.  Although it has been shown that individuals on the autism spectrum use suppression more frequently, the findings suggest reduced use of cognitive reappraisal is associated with increased levels of anxiety and depression symptoms over and above the influence of age, gender and autism traits. These findings have potential clinical implications and future work should replicate these results with a larger sample.