Mental Health Precipitating Factors for Lesbian Gay Bisexual Transgender Queer Intersex Asexual, and Sexual or Gender Diverse Autistic Adults Utilizing Community Inclusive Methodology

Research Objectives: The objective of this study was to determine factors affecting the mental health of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) autistic adults.

Design: Researchers used a qualitative, participatory research design. LGBTQIA+ autistic co-researchers conducted the majority of data collection and analysis using an interpretative phenomenological analysis. Trustworthiness was established using an audit trail, checks for representativeness, and negative case analysis.

Setting: This study was conducted using video conferencing.

Participants: The participants were 57 LGBTQIA+ autistic adults living in the United States from diverse racial and ethnic backgrounds, many who experienced other disabilities as well.

Interventions: No intervention was provided.

Main Outcome Measures: A semi-structured interview guide was used by researchers to conduct interviews. The interview guide was predetermined by the research team, including LGBTQIA+ autistic researchers, and incorporated queer, crip, and intersectionality theory. Clarifying questions and probes were used as necessary. All interviews and focus groups were audio and text-recorded, transcribed verbatim, and checked for accuracy before analyzing.

Results: Participants reported “Contributing Factors” that led to “Mental Health Challenges” and other factors that contributed to “Tenacity” or positive mental health outcomes. “Contributing Factors” included social factors (e.g., people pleasing, masking to align with social norms, communication difficulties, and invalidation), safety/security (e.g., financial or job insecurity and discrimination, bullying, or abuse of power), and challenges with boundary setting. Ableism was a contributor to poor safety/security in healthcare settings. These “Contributing Factors” often led to “Mental Health Challenges”, which included anxiety, depression, trauma/post-traumatic stress disorder, crisis, and isolation. A few participants reported developing “Tenacity” by identifying the need for and setting healthy boundaries to promote positive mental health outcomes.

Conclusions: While healthy boundaries contribute to tenacity and positive mental health outcomes, healthcare providers also play a significant role in supporting positive mental health outcomes as well. Treatment programs with LGBTQIA+ autistic individuals should be client-centered and supplemental training for mental healthcare professionals should be provided to prevent ableism and assist individuals with boundary setting.

Author(s) Disclosures: No conflicts of interest.