The Relationship Between Mental Health, Employment and Quality of Life: Findings from the Autism Spectrum Cohort-UK

Background:

Autism is a lifelong neurodevelopmental condition usually diagnosed during child or adulthood, and rarely during older age. Most autism research has been undertaken with children and young people. Much less is known about the course of autism through the many transitions across the lifespan. There is a lack of evidence about effective interventions and little research knowledge regarding the impact of ageing for autistic adults. Very little research has been undertaken to investigate the mental health and personal needs of adults on the autism spectrum.

Objectives:

To examine the prevalence of mental health/neurological conditions of autistic adults, their association with employment status and whether this is mediated by quality of life.

Methods:

Participants are autistic adults, and relatives/carers acting as ‘consultees’ for adults lacking capacity to consent for themselves to research participation who are part of the Autism Spectrum Cohort–UK (ASC-UK), a longitudinal research project aiming to investigate the life experiences of adults on the autism spectrum. Autistic adults were recruited through health teams, voluntary sector organisations, and the autism community. They completed questions on any current mental/neurological health diagnoses, and employment status. By July 2016, 576 adults had consented to join ASC-UK (males=319, females=245, other gender=12; range=17-86 years; mean age=39.6 years). This included participants across the following age bands: 16-25 years=123, 26-40 years=192, 41-60 years=217, 61+ years=44. 367 autistic adults also completed the World Health Organisation Quality of Life–BREF (QoL).

Results:

Autistic adults reported high current rates of diagnosed depression (46.9%), anxiety (49.7%) and other mental health conditions. 71.9% reported that they had previously tried to access services, of whom 40.6% reported receiving the necessary services. Reasons for not accessing services included a lack of availability or referral routes into services. Having a mental health/neurological condition negatively predicted physical, psychological, social, and environmental QoL (β=-.194 to -.274; all p<.001) whereas being employed positively predicted physical QoL only (β=.118, p<.001). Autistic adults aged 41-60 years were more likely to report mental health/neurological diagnoses if they were unemployed compared to employed (Mann-Whitney U=2350.5, z=-4.2, p<.001). In this age group, employment status was related to mental health/neurological conditions (β=1.612, p<.01), and employment status was related to physical QoL (β=.320, p<.001). Physical QoL acted as a mediator between employment status and mental health/neurological conditions (β=-.414, p<.001) such that the relationship between employment status and mental/neurological health conditions was no longer significant (β=.921, p=.151).

Conclusions:

Mental health/neurological conditions are common in autistic adults who, despite trying to access services, have difficulty getting the services that they need. For autistic adults between 41-60 years of age, satisfaction with physical QoL issues such as access to health services, may mediate the relationship between employment status and mental health/neurological conditions. Since autistic adults do not have increased rates of accessing mental health services compared to the general population (Adult Psychiatric Morbidity Survey 2016), increased availability of mental health interventions may be helpful to prevent individuals dropping out of employment in their 40s and 50s.