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Clinical Summary

Autistic Adults Overlooked for Mental Health Services


  • Psychological therapy offered in primary care and via community mental health care services might provide declines in depression or anxiety in autistic adults; however, the recovery rate is well below the national 50% target mandated by the UK Government.
  • Researchers retrospectively examined case records from 211 clinical commissioning group areas in England for changes in symptoms of depression and/or anxiety following a course of psychology therapy in autistic adults attending the NHS’s Talking Therapies for Anxiety and Depression, 2012-2019.
  • Propensity score was used to match 8593 autistic adults ages 18-110 years who completed >2 sessions between 2012 and 2019 and had linked records.
  • Depression was measured using the Patient Health Questionnaire (PHQ)-9, and anxiety was measured using the Generalised Anxiety Disorder (GAD)-7 scales. Functional impairment was measured using the Work and Social Adjustment Scale (WSAS).
  • The study was also geared toward learning how therapy differed for autistic adults vs adults without identified autism.
  • A subgroup analysis was geared toward evaluating if therapy outcomes differed according to sociodemographic factors.


  • 1,927,265 individuals were included in the primary analysis, 8761 of whom were autistic (58% male, 42% female) matched to 1,918,504 who were not (33% male, 67% female). Post-propensity score matching comprised 8593 autistic individuals matched to an individual in the comparison group. 
  • For the primary outcome, autistic adults were likely to experience slight improvements in depression and anxiety but at a significantly reduced likelihood compared to nonautistic adults for reliable improvement (56.1% vs 61.7%, respectively) and deterioration (9.2% vs 7.2%, respectively).
  • Similar results were seen for all secondary outcomes, with smaller declines in symptom scores in autistic individuals vs the comparison group (PHQ-9, adjusted mean difference −0.97), GAD-7 (adjusted mean difference −0.80), and the WSAS score (adjusted mean difference −1.01).
  • In the secondary analysis, high levels of socioeconomic desperation reduced the odds for reliable improvement vs the comparison group. Even employed autistic adults had lower odds of reaching reliable improvement after therapy. 

In practice

  • Clinicians are encouraged to ensure appropriate mental health care linkage and devise strategies to improve adherence, including regular follow-up and identification of social determinants of health that might detract from positive outcomes. 


  • The study was led by Céline El Baou, MsC, Research Department of Clinical, Educational, and Health Psychology at University College London, and it will be published online in The Lancet Psychiatry in December. 


  • Limitations include poor access to services, and representativeness (the comparison group did not include individuals with undiagnosed autism). It remains unknown if GAD-7 measures are reliable and transferable to autistic adults and those with intellectual disabilities.


  • The study was funded by the Alzheimer’s Society. El Baou has received support grants from the Alzheimer’s Society and has worked as a consultant to Eli Lilly and Company; Scott has been a consultant to the NHS Wales Shared Services Partnership. The other co-authors disclosed unrelated projects but declared no competing interests.