Perceived stress and emotion regulation mediate associations between camouflaging and internalizing symptomatology among autistic adults

Abstract

Camouflaging is associated with anxiety and depression in autistic adults; however, what drives these associations is unclear. We examined two potential drivers of the association between camouflaging and anxiety/depression: perceived stress and emotion regulation. 787 autistic adults (18.2-78.2 years) recruited via Simons Powering Autism Research (SPARK) Research Match completed questionnaires, including the Camouflaging Autistic Traits Questionnaire (CAT-Q), and measures of autistic traits, depressive and anxious symptomatology, perceived stress, and emotion regulation. Four moderated mediation models were tested. In all models the independent variable was CAT-Q total score, and the moderator variable was birth-sex. The dependent variable was depressive or anxious symptomatology, and the mediator variable was perceived stress or emotion regulation. In what is, to our knowledge, the first study to examine potential drivers of associations between camouflaging and depression/anxiety, we found that perceived stress and emotion regulation each significantly mediated the associations between camouflaging and both depression and anxiety. In the model with perceived stress and anxiety, sex moderated the mediation, with females showing a stronger mediation. There was no significant moderation in any of the other models. We contextualize the findings within the broader literature on camouflaging as a response to stigma and other facets of minority stress.