Cross-cultural variation in experiences of acceptance, camouflaging and mental health difficulties in autism: A registered report

Recent findings suggest that stigma and camouflaging contribute to mental health difficulties for autistic individuals, however, this evidence is largely based on UK samples. While studies have shown cross-cultural differences in levels of autism-related stigma, it remains unclear whether camouflaging and mental health difficulties vary across cultures. Hence, the current study had two aims: firstly, to determine whether significant relationships between autism acceptance, camouflaging, and mental health difficulties replicate in a more diverse cross-cultural sample of autistic adults and, secondly, to compare these variables across cultures. To fulfil these aims, 306 autistic adults from eight countries (Australia, Belgium, Canada, Japan, New Zealand, South Africa, the United Kingdom, and the United States) completed an online survey. Our results revealed that external acceptance and personal acceptance predicted lower levels of depression but not camouflaging or stress. Higher camouflaging predicted elevated levels of anxiety. Significant differences were found across countries in external acceptance, personal acceptance, depression, anxiety, and stress, even after controlling for relevant covariates. Specifically, autistic individuals in Japan experienced lower levels of external and personal acceptance, and those in Belgium experienced lower levels of external acceptance, than at least one other country. Unique profiles of mental health difficulties were identified across countries. Nevertheless, autistic individuals in South Africa consistently experienced the highest mental health burden, displaying elevated levels of depression, anxiety, and stress, while those in the US experienced the lowest. Levels of camouflaging also differed across cultures, with those in Japan scoring lowest, however this became non-significant after controlling for covariates. These findings have significant implications for identifying priority regions for anti-stigma interventions and highlighting countries where greater support for mental health difficulties is needed.