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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Hui CLM, Wong SMY, Yu TYT, Lau TTY, Choi O, Tsang S, Suen YN, Lam BYH, Wong CSM, Lui SSY, Chan KT, Wong MTH, Wong GHY, Chan SKW, Lee EHM, Chang WC, Wilkins A, Chen EYH. Visual-stress-related cortical excitability as a prospective marker for symptoms of depression and anxiety in young people. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01469-7. [PMID: 35972556 DOI: 10.1007/s00406-022-01469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
Visual stress is thought to reflect cortical excitability and has been associated with many neurological, neuropsychiatric, and neurodevelopmental conditions. However, its relationships with symptoms of depression and anxiety have not yet been elucidated. We conducted two separate studies to first examine visual stress in a longitudinal community sample of 104 participants (aged 12-24) in association with prospective symptoms of depression, anxiety, and distress after 3 months, and subsequently in a cross-sectional epidemiological sample of 530 participants (aged 15-24) to validate its associations with current mood and distress symptoms. The Pattern Glare Test was used to examine visual stress to three grating patterns with the spatial frequencies (SF) of 0.3, 2.3, and 9.4 cycles per degree (cpd). Other known factors of mental health, including functioning, as well as resilience, hopelessness, and loneliness, were also assessed at baseline. In both studies, we showed that perceptual distortions were highest toward the pattern with mid-SF (2.3 cpd). Multiple linear regression analyses revealed that greater visual stress was significantly associated with not only baseline but also 3-month symptom outcomes, even when accounting for age, years of education, days of no functioning, resilience, hopelessness, and loneliness. Our findings suggest the importance of visual stress in understanding and predicting poor mental health outcomes. As mental health can lead to far-reaching consequences that extend to adulthood, our findings may inform state-of-the-art innovative strategies for the prediction of poor mental health outcomes and suggest visual stress as a potential marker for early risk detection among young people.
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Affiliation(s)
- Christy Lai-Ming Hui
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Stephanie Ming-Yin Wong
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Terrence Yat-To Yu
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Terry Tak-Yee Lau
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Olivia Choi
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Samantha Tsang
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Yi-Nam Suen
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Bess Yin-Hung Lam
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Corine Sau-Man Wong
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Simon Sai-Yu Lui
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Kai-Tai Chan
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Michael Tak-Hing Wong
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Gloria Hoi-Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit-Wa Chan
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China
| | - Edwin Ho-Ming Lee
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
| | - Wing-Chung Chang
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China
| | - Arnold Wilkins
- Department of Psychology, University of Essex, Essex, UK
| | - Eric Yu-Hai Chen
- Department of Psychiatry, School of Clinical Medicine, Faculty of Medicine, Li Ka Shing, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China. .,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong, China.
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