Autistic females more likely to be diagnosed with psychiatric disorder, hospitalized

Autistic women and girls were more likely to be diagnosed with a psychiatric disorder, as well as be hospitalized for a psychiatric incident, compared with autistic men and boys, researchers reported in JAMA Psychiatry.

Miriam I. Martini, MSc, of the department of medical epidemiology and biostatistics at Karolinska Institute in Stockholm, Sweden, and colleagues aimed to examine sex differences in psychiatric diagnoses and hospitalizations among autistic and non-autistic young adults.

Martini and colleagues conducted a population-based study among all individuals born in Sweden between 1985 and 1997. A total of 1,335,753 people were followed up from age 16 through 24 years between 2001 and 2013.

The authors defined autism as having at least one clinical diagnosis of autism based on the International Classification of Diseases. They estimated the cumulative incidence of 11 psychiatric diagnoses up until age 25 years. Birth year-standardized risk differences were used to compare autistic female and male individuals directly. Analyses were repeated for inpatient diagnoses to assess psychiatric hospitalization.

Of the 1,335,753 individuals, 650,314 were female (48.7%). A total of 20,841 people (1.6%; 34.2% female; mean age, 16 years) had received a clinical autism diagnosis.

By the age of 25 years, 77 of 100 autistic women and girls had received at least one psychiatric diagnosis, compared with 62 of 100 autistic men and boys. Martini and colleagues reported a significant standardized risk difference between the two sexes for any psychiatric disorder (–0.18; 95% CI, –0.26 to –0.10), and specifically for anxiety, depression and sleep disorders.

In addition, 32 of 100 autistic women were hospitalized for a psychiatric incident, compared with 19 of 100 autistic men. Yet, both had a higher risk for psychiatric hospitalization compared with non-autistic men and women (women, HR range [95% CI], 5.55 [4.63-6.66]-26.30 [21.5-32.16]; men, HR range [95% CI], 3.79 [3.22-4.45]-29.36 [24.04-35.87]).

Additionally, compared with all non-autistic same-sex individuals, autistic women (HR range [95% CI], 3.17 [2.5-4.04]-20.78 [18.48-23.37]) and autistic men (HR range [95% CI], 2.98 [2.75-3.23]-18.52 [17.07-20.08]) were both at an increased risk for all psychiatric diagnoses.

“These findings highlight the need for profound mental health services among autistic young adults,” Martini and colleagues wrote. “Autistic female individuals, who experience more psychiatric difficulties at different levels of care, require increased clinical surveillance and support.”