Depression in autism: Unmasking the mediating role of mentalization, attachment, perceived social support, and psychological flexibility

Abstract

Amid the rising prevalence of autism spectrum disorder (ASD), understanding its comorbidities, especially the frequent and severe co-occurrence of depression, has never been more critical. This study investigates the underlying mechanisms linking depressive symptoms and autistic traits by examining the roles of mentalization, attachment, social support, and psychological flexibility. Utilising a large sample (N=2409) including individuals both diagnosed with autism (N=133) and from the general population, we employed a spectrum approach to analyse the relationship between autistic traits (AQ) and depressive symptom severity (BDI). Our findings reveal that mentalization, perceived social support, and psychological flexibility act as significant mediators, indicating complete mediation of the relationship between AQ and BDI, while the direct effect of AQ on BDI was not statistically significant. Psychological flexibility emerged as the strongest mediator across both ASD and non-ASD groups. Despite significant differences in scores between the ASD and non-ASD groups, the mediating effects of mentalization, social support, and psychological flexibility were consistent, underscoring the complex interplay between autistic traits and mental health. The study highlights the high propensity for depressive symptoms in individuals with high AQ scores, coupled with mentalization deficits, reduced perception of social support, and psychological inflexibility. These findings align with existing literature and emphasise the clinical relevance of addressing mentalization and psychological flexibility in therapeutic strategies for individuals with autism. Future research should aim to develop and validate ASD-specific mentalization-based interventions to improve reflective function and emotional resilience, ultimately enhancing the quality of life for individuals across the autism spectrum.Lay abstractThis study explores whether autism itself increases the risk of depression or if other factors contribute to this susceptibility. We conducted an online survey with people diagnosed with autism and people from the general population. The analysis showed that the ability to understand different mental states (mentalization), the recognition of help from others (perceived social support), and the capacity to cope with difficult experiences (psychological resilience) fully explained the relationship between autistic traits and depressive symptoms. There was no direct link between autistic traits and depression. Psychological resilience was the most influential factor in both groups. The study found that individuals with more autistic traits are more prone to depressive symptoms due to difficulties in mentalization, reduced perception of social support, and lower psychological flexibility. These findings highlight the need for targeted interventions to improve mentalization, social skills, and emotional resilience, which could enhance the quality of life for people with autism.