The association between autism, camouflaging and anxiety with suicidal ideation in women

Introduction: Camouflaging behaviors in women have been associated with mental health outcomes, like anxiety and suicidality but the mechanisms underlying these relationships remain unclear. This study aimed to examine the relationship between autism, camouflaging and anxiety with suicidal ideation and to investigate the possible mediating role of anxiety in the relationship between camouflaging and suicidal ideation in women. Methods: Four hundred and seventy-one women (72 autistic, aged 18-64 years, and 399 non-autistic, aged 18-66 years) participated in this study. The Camouflaging Autistic Traits Questionnaire (CAT-Q), the General Anxiety Disorder 7 (GAD-7) and item 9 of the Patient Health Questionnaire 9 (PHQ-9) were used to assess camouflaging, anxiety and suicidal ideation, respectively. Results: The results showed that autistic women scored higher than non-autistic women on all measures. In addition, anxiety, having a depression diagnosis and the assimilation strategy were significantly associated with suicidal ideation. Furthermore, anxiety mediated the relationship between autism diagnosis and camouflaging with suicidal ideation. Discussion: The results highlight the importance of considering anxiety in the relationship between camouflaging and suicidal ideation, particularly among autistic women, and to recognise it as a target for intervention approaches aimed at reducing the likelihood of suicidal ideation.