Mark Andrew Stokes

Gendered inequalities in wellbeing among women from culturally and linguistically diverse (CALD) backgrounds remain insufficiently understood, despite evidence of intersecting constraints related to caregiving, employment, language, and social participation. Vietnamese migrant (VM) women represent a significant and understudied CALD group, offering a valuable case study for examining these dynamics in a Western settlement context. Drawing on subjective wellbeing homeostasis and intersectionality theories, this study examines gender differences in wellbeing among VM adults in Australia. It explores how migration may be associated with women’s wellbeing. Data were pooled from two community-based studies involving VM in Australia ( N = 240, 81.3% women, aged 18–65 years). Wellbeing was assessed using a culturally validated Vietnamese-language version of the Personal Wellbeing Index-Adults (PWI). Hierarchical regression analyses examined gender differences in overall and domain-specific wellbeing, controlling for study membership. A secondary exploratory comparison contrasted VM women ( n = 32) with women living in Vietnam ( n = 71). VM women reported lower wellbeing than men ( b = −9.49, SE = 4.60, t = −2.06, p = .040), lower satisfaction with standard of living ( b = −11.15 , SE = 5.02, t = −2.22, p = .027), health ( b = −11.58, SE = 5.29, t = −2.19, p = .030), and community connectedness ( b = −12.87, SE = 6.48, t = −1.99, p = .048). The exploratory comparison revealed no significant difference in wellbeing; however, VM women reported markedly lower community connectedness than women in Vietnam ( b = −8.57, SE = 4.01, t = −2.13, p = .035). These findings highlight gendered wellbeing disparities among VM women and suggest that migration may erode social resources central to women’s wellbeing, a pattern consistent with broader evidence on CALD women and underscoring the need for gender-responsive, culturally grounded post-migration supports.

Background: Culturally and linguistically diverse (CALD) parents of autistic children typically report poorer mental health, yet their subjective wellbeing (SWB) remains poorly understood. This study examined SWB among Vietnamese migrants (VM), one of Australia’s more socioeconomically disadvantaged CALD groups, focusing on those raising autistic children, and compared them with general population (GP) parents. Procedure: Participants were 487 Australian-residing parents ( M _age = 40.0, SD = 7.12, 71.9% female, 136 having an autistic child), including 197 VM parents. SWB was measured first, followed by mental health and demographic information, using an anonymous online survey available in English or Vietnamese. Hierarchical regression tested whether being VM, having an autistic child, or their interaction predicted SWB, controlling for income. Results: Having an autistic child was associated with lower SWB ( b  = −4.59, SE = 1.97, t  = −2.23, p  = .020) while being VM alone predicted higher SWB ( b = 3.71, SE = 1.62, t = 2.29, p  = .022). However, their interaction was significant and negative ( b  = −7.68, SE = 3.00, t  = −2.56, p= .011), indicating that VM parents of autistic children had the lowest SWB among all comparison groups. This result remained significant even after controlling for stress and depression. Conclusion: VM parents of autistic children experience markedly lower SWB than their GP counterparts, despite reporting lower psychological distress. These findings highlight culturally specific unmet needs and underscore the urgency of culturally responsive support for CALD families. Research using culturally-appropriate methodologies is essential to advance understanding of SWB in CALD communities.

Background: Difficulties in making and maintaining social relationships is common among autistic people. These difficulties are thought to be due to differences in autistic social interaction and social communication that have been theorized to be the result of reduced social motivation. We argue that this theory does not account for camouflaging, a combination of strategies that are employed frequently by many autistic individuals in pursuit of obtaining social relationships; however, its utility in achieving satisfactory friendship and intimate relationships for the individual is not clear. Method: This review synthesizes empirical evidence of camouflaging as a strategy for achieving friendships and/or intimate relationships among autistic adolescents and adults. A systematic search yielded 1421 records. Forty-nine full texts were screened, and eight qualitative studies were retained. Results: Results reveal that camouflaging was a main strategy in pursuit of friendship, with little evidence for intimate relationships, in this sample of autistic adolescents and adults. For most, camouflaging is exhausting, often ineffective and inefficient, and ultimately a challenge to one’s social authenticity. Discussion/Conclusion: Research suggests that many autistic individuals rely on camouflaging in pursuit of friendship and intimate relationships, although this is often a nonpreferred strategy. Some autistic individuals seek to replace camouflage with alternative strategies to obtain social relationships, yet outcomes typically remain dissatisfying. This demonstrates that we need to reconsider the social motivation theory, and to better understand alternative strategies that can help autistic individuals to obtain authentic, satisfactory social relationships, and to support opportunities to achieve these desired outcomes.

Background: Autistic adults have a high incidence of mental health challenges, including suicidal thoughts and behavior (STB). Our objective was to gain a nuanced understanding of autistic adults’ experiences in seeking and receiving support for their mental health, including STB, presented in a format that could be operationalized to improve service provision for autistic adults. Methods: We applied an integrated codesign approach involving autistic adults at every stage of the research, acknowledging them as experts on their own lives. Thirty-three autistic adults with a history of STB participated in semi-structured narrative interviews, discussing their experiences seeking and receiving support for their mental health. We analyzed data using reflexive thematic analysis. Results: We constructed an overarching theme, “We Don’t Know What We Don’t Know,” representing the bidirectional misunderstandings that occur between health care providers and autistic people. Within the overarching theme were four central themes: (1) Communicate with Me (understanding the uniqueness of autistic communication); (2) Understand Me (developing a nuanced understanding of autism and being autistic); (3) Help Me to Understand Myself (developing self-understanding); and (4) Support Me (empowerment when supported). We constructed an underpinning theme, “Trust and Safety,” representing the need for psychological safety in all domains of mental health care. We centered the lived experiences of autistic adults to acknowledge the need for autistic people to feel safe and for service providers to build trust to effectively support the mental health of autistic adults. Conclusions: Our analysis demonstrates the need to facilitate access to mental health care and improve the quality and effectiveness of service utilization for autistic adults. Recommendations include improving understanding of and communication with autistic people, embedding education, cultural humility, and psychological safety, acknowledging power imbalances, adapting interventions, and validating autistic experience. Our thematic map serves as a framework to inform and improve health care services for autistic people. Community Brief: Why is this an important issue?: Autistic adults often experience great difficulty accessing services for their mental health. They may also not benefit from health care services as much as nonautistic people if the services are not suited to their needs. This is important because autistic adults can experience more mental health challenges than nonautistic people. Compared with the general population, autistic adults also experience more suicidal thoughts and behavior. This includes higher rates of suicide death. Improving mental health services for autistic adults may improve their quality of life and prevent suicide. What was the purpose of this study?: We wanted to understand the experiences of autistic adults when they looked for support for their mental health, including experiences of suicidal thoughts and behavior. We wanted to find out how to improve support for autistic adults with mental health challenges. What did the researchers do?: We asked 33 autistic adults who had previously experienced suicidal thoughts or behavior about their experiences seeking support for their mental health. We asked them who they reached out to for support, what the experience was like, and what could be improved. An autistic researcher analyzed these conversations to identify common themes between the research participants. We looked for problems with health care services that might make it difficult for autistic adults with mental health challenges to access and receive appropriate support. What were the results of the study?: We found that challenges accessing health care services included: (1) communication between autistic adults and service providers, (2) (mis)understanding of autism and autistic people, (3) difficulties autistic adults experience in understanding themselves and their support needs, and (4) finding appropriate services and supports. We found that misunderstanding between autistic adults and health care service providers was common, and that autistic people may not feel safe when using mental health care services. This made it very difficult for autistic adults to receive the support they needed for their mental health. What do these findings add to what was already known?: Our findings build on previous research through our development of a new framework. This framework can be used to identify gaps between what is provided by health care services and the unmet needs of autistic adults. We suggest that health care providers can use this framework to critically assess their service offerings from the perspective of people with lived experience. What are potential weaknesses in the study?: We excluded autistic adults with intellectual disability and complex communication needs from our study. Our results might not apply to autistic people who have those challenges. We also excluded self-identified autistic adults, even though this group also experiences more mental health challenges than nonautistic people. How will these findings help autistic adults now or in the future?: Our findings can be used to help health care service providers to better understand and meet the needs of autistic adults.

Research has identified intersectional effects of autism and gender for experiences of interpersonal violence; however, findings have been mixed and vary by violence type. This systematic review and meta-analysis examined gender differences in autistic experiences of interpersonal violence prevalence. We identified 64 studies examining physical, sexual, or psychological violence, bullying, and homicide among autistic people, varying by gender, age, and support needs. We conducted a meta-analysis over 24 studies, and found increased violence experienced by autistic cis-females (d = 0.32) and gender minorities (d = 0.73) compared to cis-males. This review suggests autistic people experience disproportionate rates of violence compared to the general population, and highlights concerningly high rates of lifetime and poly-victimization, particularly among gender-marginalized groups.

Background: Autistic people are at significant risk for suicidal thoughts and behaviors (STBs) and nonsuicidal self-injury (NSSI). We examined STB and NSSI in different age-groups, considering sex- and age-based effects, in a pooled multinational sample of English-speaking autistic children and adults. Methods: We administered the Columbia-Suicide Severity Rating Scale to 245 autistic people without intellectual disability (139 youth and 106 adults; 46.1% female sex; M _age = 24.8, SD _age = 16.3 years, range = 7–70) or their caregivers in Australia, Canada, and the United States. The study samples were enriched with autistic people experiencing depression and suicidality. Results: Most participants (87.8%) reported suicidal ideation and NSSI (56.3%). Nearly one-third of autistic people (31.0%) reported a lifetime suicide attempt ( M = 2.9 attempts; range = 1–26); overdosing was the most common method of suicide attempt. Sex was not a significant risk factor for suicidal ideation, behavior, or NSSI. Increases in lifetime suicidal ideation were observed across older age-groups, with those aged over 18 years reporting more severe and longer-lasting ideation than in children or adolescents. The youngest age of suicide attempt was 7 years in this sample, and the average ages of first/initial, most lethal, and most recent suicide attempts in youth ( n = 24) and adults ( n = 42) were 16.6, 19.2, and 20.8 years old, respectively. Conclusion: Regardless of age-group, autistic people across the lifespan constitute a high-priority group for suicide prevention strategies, development of appropriate assessments, and evaluation of system-level programs that effectively address the problem of preventable death by suicide.

Despite very high rates of suicidal thoughts and behaviors (STB) in autistic adults, the key psychosocial drivers of this phenomenon remain unknown. To investigate, we examined how lifetime stressor exposure and severity, which have been found to predict STB in non-autistic populations, related to STB in a multinational dataset of 226 autistic adults from the United Kingdom and Australia (67% female; M _age = 41.8, SD = 13.6, range = 19–73 years old). Results revealed that autistic men and women differ with respect to the count, severity, and type of stressors they experienced over the life course. Whereas autistic men were exposed to more numerous legal/crime-related stressors, autistic women experienced more stressors related to social relationships and chronic humiliation and typically experienced stressors as more severe. In addition, whereas chronic interpersonal loss was related to STB for men, acute stressors involving physical danger and lower exposure to chronic entrapment were related to STB in autistic women. These findings indicate that certain lifetime stressors may be differentially experienced, and relevant to STB, in autistic men versus women. They also suggest that screening for lifetime stressor exposure may help identify autistic individuals at greatest risk of suicide. Lay When we encounter life events that we experience as stressful (“stressors”), it sets off a biological stress response that can impact mental health and contribute to suicidal thoughts and behaviors (STB). Although we know about specific stressors that are associated with STB in the general population, little is known about the kinds of stressors that increase the risk of STB in autistic people and whether these associations differ by gender. To examine this issue, we cataloged the life stressors that autistic men and women experienced over the entire life course and investigated how these stressors were related to STB. Data were derived from a multinational sample of 226 autistic adults from the United Kingdom and Australia who completed the Stress and Adversity Inventory for Adults. We found that autistic men and women differed in terms of both the lifetime stressors they experienced as well as their perceived severity. Whereas men experienced more legal/crime-related stressors, women experienced more stressors related to relationships with other people and more long-lasting stressors associated with humiliation. Autistic women often perceived life stressors as more severe than men, which is important given that it is the perceived severity of stressors that most strongly affects our health. We also found that different stressors may predict STB in autistic men versus women. Whereas loss of loved ones was most strongly associated with STB for men, for women, physically dangerous stressors were most relevant. In addition, women with fewer lifetime stressors involving entrapment had higher lifetime STB. These results suggest that lifetime stressor exposure may be important to assess to understand suicide risk in autistic people. Additional research is needed to confirm these associations and to examine possible mechanisms linking stress and STB.

The increased prevalence of suicide among autistic people highlights the need for validated clinical suicide screening and assessment instruments that are accessible and meet the unique language and communication needs of this population. We describe the preliminary preregistered psychometric validation of the Suicide Assessment Kit-Modified Interview, in a sample of 98 autistic adults (58% women, 34% men, 7% nonbinary; M _AGE = 41.65, SD = 12.96). A four-item negative affect score derived from the Suicide Assessment Kit-Modified Interview demonstrated adequate reliability (ω = 0.796, BCa 95% confidence interval = [0.706, 0.857]), as well as good convergent validity with related measures. Ordinal Suicide Assessment Kit-Modified Interview “categories” (1–5) demonstrated divergent validity ( r s = −0.067 to 0.081) and good convergent validity, strongly correlating with mental health ( r s = 0.446 to 0.744) and suicide assessment instruments ( r s = 0.576 to 0.696). Suicide Assessment Kit-Modified Interview categories showed strong ability to predict participants identified by clinicians as “above low risk” of future suicide attempt (area under the curve = 0.887, posterior Mdn = 0.889, 95% credible interval = [0.810, 0.954], P _{AUC > 0.8} = 0.976). Suicide Assessment Kit-Modified Interview classifications > “Category 3” provided an observed sensitivity of 0.750 ( Mdn = 0.810, [0.669, 0.948], P _{Se > 0.8} = 0.544) and an observed specificity of 0.895 ( Mdn = 0.899, [0.833, 0.956], P _{Sp > 0.8} = 0.995) for “above low risk” status. Our findings indicate that the Suicide Assessment Kit-Modified Interview is a psychometrically strong clinical assessment tool for suicidal behavior that can be validly administered to autistic adults without intellectual disability. Lay People with a diagnosis of autism are at increased risk of death by suicide. There is a need for clinical instruments that are adapted to the needs of autistic people. In this study, we modified and evaluated a clinical suicide interview (Suicide Assessment Kit-Modified Interview) for use with autistic people who do not have an intellectual disability. Autistic people helped us to modify the original version of the instrument by improving the questions, providing explanations for difficult terms or concepts, and recommending that we use different rating scales. Our results support the use of Suicide Assessment Kit-Modified Interview for assessing autistic adults without intellectual disability for suicidal thoughts and behavior. In the future, we will test how well Suicide Assessment Kit-Modified Interview works in clinical settings and with different clinical populations.