{"title":"Autistic Masking and Mental Health Outcomes in Autistic Women: A Systematic Review (2015-2025).","authors":"E Cuni, M Cantero-García","doi":"10.1007/s10803-026-07557-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Autistic masking-the behavioral and cognitive strategies through which autistic individuals conceal or compensate for their autistic traits to navigate neurotypical social environments-has been consistently linked to adverse mental health outcomes, with women disproportionately affected. This systematic review examined the association between autistic masking and anxiety, depression, autistic burnout, and suicidality in autistic adult women, and identified which mental health indicators are most consistently predicted by masking.</p><p><strong>Methods: </strong>A systematic search was conducted across five databases (PubMed, Web of Science Core Collection, Scopus, APA PsycINFO, and ProQuest One Psychology) covering publications from January 2015 to December 2025, following PRISMA 2020 guidelines (PROSPERO: CRD420261342682). Eligibility criteria required autistic adult women (≥ 18 years) with formal diagnosis, explicit measurement of masking, and at least one specified mental health outcome. Methodological quality was assessed using the Newcastle-Ottawa Scale and CASP.</p><p><strong>Results: </strong>Nine studies (2018-2025) were included, with a combined analytic sample exceeding 1,500 women across seven countries. Masking was consistently associated with anxiety (β = 0.21-0.22; d = 0.93) and depression (g = 0.56; Nagelkerke R² = 0.358 via structured lifetime diagnosis), and constituted an independent predictor of suicidality (β = 0.198; OR = 5.04 vs. general population). The CAT-Q assimilation subscale was the specific predictor of suicidal ideation in women, mediated by anxiety. No study assessed autistic burnout with validated instruments.</p><p><strong>Conclusion: </strong>Masking constitutes a significant and independent psychosocial risk factor for mental health deterioration in autistic adult women. Systematic assessment using validated instruments such as the CAT-Q should be integrated into clinical mental health and suicide risk evaluation protocols for this population.</p><p><strong>Trial registration: </strong>This review was prospectively registered in PROSPERO (CRD420261342682; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420261342682 ).</p>","PeriodicalId":15148,"journal":{"name":"Journal of Autism and Developmental Disorders","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Autism and Developmental Disorders","FirstCategoryId":"102","ListUrlMain":"https://doi.org/10.1007/s10803-026-07557-0","RegionNum":2,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHOLOGY, DEVELOPMENTAL","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Autistic masking-the behavioral and cognitive strategies through which autistic individuals conceal or compensate for their autistic traits to navigate neurotypical social environments-has been consistently linked to adverse mental health outcomes, with women disproportionately affected. This systematic review examined the association between autistic masking and anxiety, depression, autistic burnout, and suicidality in autistic adult women, and identified which mental health indicators are most consistently predicted by masking.
Methods: A systematic search was conducted across five databases (PubMed, Web of Science Core Collection, Scopus, APA PsycINFO, and ProQuest One Psychology) covering publications from January 2015 to December 2025, following PRISMA 2020 guidelines (PROSPERO: CRD420261342682). Eligibility criteria required autistic adult women (≥ 18 years) with formal diagnosis, explicit measurement of masking, and at least one specified mental health outcome. Methodological quality was assessed using the Newcastle-Ottawa Scale and CASP.
Results: Nine studies (2018-2025) were included, with a combined analytic sample exceeding 1,500 women across seven countries. Masking was consistently associated with anxiety (β = 0.21-0.22; d = 0.93) and depression (g = 0.56; Nagelkerke R² = 0.358 via structured lifetime diagnosis), and constituted an independent predictor of suicidality (β = 0.198; OR = 5.04 vs. general population). The CAT-Q assimilation subscale was the specific predictor of suicidal ideation in women, mediated by anxiety. No study assessed autistic burnout with validated instruments.
Conclusion: Masking constitutes a significant and independent psychosocial risk factor for mental health deterioration in autistic adult women. Systematic assessment using validated instruments such as the CAT-Q should be integrated into clinical mental health and suicide risk evaluation protocols for this population.
Trial registration: This review was prospectively registered in PROSPERO (CRD420261342682; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420261342682 ).
目的：自闭掩饰——自闭个体通过隐藏或补偿其自闭特征以适应神经典型社会环境的行为和认知策略——一直与不良的心理健康结果相关联，女性受到的影响尤为严重。本系统综述研究了成年女性自闭症患者的自闭症掩蔽与焦虑、抑郁、自闭症倦怠和自杀之间的关系，并确定了掩蔽最能预测哪些心理健康指标。方法：系统检索五个数据库（PubMed, Web of Science Core Collection, Scopus， APA PsycINFO和ProQuest One Psychology），涵盖2015年1月至2025年12月的出版物，遵循PRISMA 2020指南（PROSPERO: CRD420261342682）。入选标准要求成年自闭症女性（≥18岁）具有正式诊断、明确的掩蔽测量和至少一项特定的心理健康结果。采用纽卡斯尔-渥太华量表和CASP评估方法学质量。结果：纳入了9项研究（2018-2025），综合分析样本超过了7个国家的1500多名女性。掩盖与焦虑（β = 0.21-0.22; d = 0.93）和抑郁（g = 0.56；通过结构化终身诊断Nagelkerke R²= 0.358）一致相关，并且构成自杀倾向的独立预测因子（β = 0.198; OR = 5.04）。CAT-Q同化子量表是女性自杀意念的特定预测因子，由焦虑介导。没有研究用有效的工具评估自闭症倦怠。结论：掩蔽是成年自闭症女性心理健康恶化的一个重要的、独立的社会心理危险因素。应将使用CAT-Q等有效工具的系统评估纳入这一人群的临床心理健康和自杀风险评估方案。试验注册：本综述在PROSPERO前瞻性注册（CRD420261342682; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420261342682）。
期刊介绍：
The Journal of Autism and Developmental Disorders seeks to advance theoretical and applied research as well as examine and evaluate clinical diagnoses and treatments for autism and related disabilities. JADD encourages research submissions on the causes of ASDs and related disorders, including genetic, immunological, and environmental factors; diagnosis and assessment tools (e.g., for early detection as well as behavioral and communications characteristics); and prevention and treatment options. Sample topics include: Social responsiveness in young children with autism Advances in diagnosing and reporting autism Omega-3 fatty acids to treat autism symptoms Parental and child adherence to behavioral and medical treatments for autism Increasing independent task completion by students with autism spectrum disorder Does laughter differ in children with autism? Predicting ASD diagnosis and social impairment in younger siblings of children with autism The effects of psychotropic and nonpsychotropic medication with adolescents and adults with ASD Increasing independence for individuals with ASDs Group interventions to promote social skills in school-aged children with ASDs Standard diagnostic measures for ASDs Substance abuse in adults with autism Differentiating between ADHD and autism symptoms Social competence and social skills training and interventions for children with ASDs Therapeutic horseback riding and social functioning in children with autism Authors and readers of the Journal of Autism and Developmental Disorders include sch olars, researchers, professionals, policy makers, and graduate students from a broad range of cross-disciplines, including developmental, clinical child, and school psychology; pediatrics; psychiatry; education; social work and counseling; speech, communication, and physical therapy; medicine and neuroscience; and public health.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
