A systematic review and meta-analysis of mental health outcomes associated with camouflaging in autistic people
Valeria Khudiakova, Emmeline Russell, Sophie Sowden, Andrew Surtees
Abstract
This systematic review and meta-analysis aimed to assess the strength and quality of the evidence for the relationship between camouflaging and its potential outcomes in autistic people. With the worryingly high proportions of autistic people experiencing mental illness and suicidality, it is important to understand whether camouflaging is a risk factor in that population. Searches of five databases (Web of Science, MEDLINE, PsycINFO, Embase, ProQuest Dissertations & Theses) yielded 16 studies eligible for a meta-analysis using correlations and six additional studies eligible for a narrative review, with 5897 autistic participants in total. Risk of bias was assessed for all studies using a bespoke tool. Based on the 16 studies eligible for the meta-analysis, we computed meta-correlations between camouflaging and anxiety, depression, social anxiety, and psychological wellbeing, using a random-effects model. Meta-regressions examined if study effect sizes were moderated by study quality, participants’ mean age, and proportions of female and clinically diagnosed participants. Results: We found significant moderate positive relationships between camouflaging and anxiety/generalised anxiety, depression, and social anxiety and a significant small negative relationship between camouflaging and mental wellbeing. There was no significant moderating effect of the aforementioned variables on study effect sizes. All of the studies were underpowered to detect small effects, and many used insufficiently validated measures. The established link between camouflaging and mental health difficulties is discussed with reference to future research and clinical practice. Longitudinal studies should also aim to establish causality. There was no funding associated with this review. The researchers have no conflicts of interest to disclose. The review was preregistered on PROSPERO (REDACTED FOR ANONYMISED PEER REVIEW). • Camouflaging was linked to increased anxiety, depression, and social anxiety and lower mental wellbeing in autistic people. • The relationships were unrelated to study quality, participant age, or the share of female or formally diagnosed participants. • There is a need for sufficiently powered, longitudinal studies into camouflaging and mental health in autistic people.