Women With ASD Experience More Psychiatric Difficulties Than Men

Women diagnosed with autism spectrum disorder (ASD) are at increased risk for having psychiatric difficulties than men or those without ASD, according to study findings were published in JAMA Psychiatry.

Researchers conducted a population-based cohort study using data from several nationwide Swedish registers. Individuals (N=1,335,753) born between 1985 and 1997 were evaluated for psychiatric diagnoses and hospitalizations between 2001 and 2013 on the basis of having an ASD diagnosis.

A total of 1.6% of the population was diagnosed with ASD. Compared with the population without ASD, more individuals with ASD were diagnosed with attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), any psychiatric disorder, anxiety disorders, depressive disorders, obsessive-compulsive disorder (OCD), bipolar disorder (BD), psychotic disorders, anorexia nervosa, bulimia nervosa, other eating disorders, sleep disorders, alcohol use disorders (AUD), and self-harm.

Stratified by sex, the cumulative incidence of psychiatric diagnoses was higher among women with ASD (incidence, 0.52 vs 0.016) than men with ASD (incidence, 0.39 vs 0.001) compared with the women and men without ASD, respectively.

After adjusting for birth year, ADHD, and ID, women and men with ASD were at increased risk for the following:

• Any psychiatric disorder (adjusted hazard ratio [aHR] range, 1.71-2.04);
• Anxiety disorders (aHR range, 1.18-1.12);
• Depressive disorders (aHR range, 1.28-1.56);
• OCD (aHR range, 2.92-5.78), BD (aHR range, 1.69-2.18);
• Psychotic disorders (aHR range, 2.05-2.43);
• Anorexia nervosa (aHR range, 1.46-3.02); and
• Sleep disorders (aHR range, 1.90-2.15).

Women were at decreased risk for AUD (aHR range, 0.39-0.54) compared with women and men without ASD, respectively. Men with ASD were also at increased risk for other eating disorders (aHR, 2.58) and women with ASD at increased risk for self-harm (aHR, 1.36) compared with those without ASD.

Among the ASD cohort, men were at decreased risk for the following:

• Any psychiatric disorder (aHR, 0.84; 95% CI, 0.76-0.92; P <.001);
• OCD (aHR, 0.51; 95% CI, 0.38-0.67; P <.001);
• Other eating disorders (aHR, 0.47; 95% CI, 0.26-0.83; P =.01);
• Depressive disorders (aHR, 0.82; 95% CI, 0.71-0.95; P =.008); and
• Sleep disorders (aHR, 0.88; 95% CI, 0.79-0.99; P =.03).

Men were at increased risk for self-harm (aHR, 1.56; 95% CI, 1.24-1.97; P <.001) compared with women.

Both men and women were at increased risk for psychiatric hospitalizations compared with the gender-stratified general population (aHR range, 3.79-29.36).

These findings may have been limited by bias due to the possibility that some ASD diagnoses were misdiagnosed psychiatric conditions.

Study authors concluded, “In this cohort study, between ages 16 and 25 years, autistic female individuals experienced increased psychiatric difficulties at different levels of psychiatric care, from outpatient diagnoses to hospitalization, compared with autistic male individuals and nonautistic individuals. Higher rates compared with autistic male individuals were found for most psychiatric disorders with sex differences larger than among nonautistic individuals.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.