The Association between Autistic Traits and Trajectories of Anxiety in Middle-Aged and Older Adults: An 8-year Growth Mixture Model Analysis

The Association between Autistic Traits and Trajectories of Anxiety in Middle-Aged and Older Adults: An 8-year Growth Mixture Model Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Association between Autistic Traits and Trajectories of Anxiety in Middle-Aged and Older Adults: An 8-year Growth Mixture Model Analysis Gavin Stewart, Aphrodite Eshetu, Saloni Ghai, Anne Corbett, Clive Ballard, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7543778/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted You are reading this latest preprint version Abstract Anxiety is common in autistic people, yet little is known about its course beyond midlife due to limited longitudinal research. We analysed data from 5,270 adults aged 50–91 (median 62; 75% female) in the PROTECT study. Participants completed the Autistic Spectrum Traits questionnaire and GAD-7. Sixty-six (~1.3%, 72.3% female) had high autistic traits (AST group), while 3,874 (~73.5%, 77.8% female) reported none (Control Older Adults; COA). Growth mixture modelling (GMM) identified anxiety trajectories over eight years. Associations between AST status and trajectory membership were examined using multinomial logistic regression.GMM revealed three trajectories: persistently minimal symptoms (‘lower-range minimal’ 85.6%; ‘upper-range minimal’ 12.4%), and a third showing rising anxiety from mild to clinical levels (1.9%). Regressions showed AST individuals were more likely than COA to follow the mild-to-clinical trajectory (RR 4.41, 95% CI 1.70–11.44). Elevated autistic traits increase risk of worsening anxiety with age, highlighting the need for tailored support. Health sciences/Diseases/Psychiatric disorders/Autism spectrum disorders Health sciences/Diseases/Psychiatric disorders/Anxiety Anxiety Autistic Traits Midlife Old Age Trajectory Longitudinal Full Text Additional Declarations There is NO Competing Interest. Cite Share Download PDF Status: Under Review Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7543778","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":522845829,"identity":"28da0c90-7962-41f7-8cd9-d6c8ec7a5061","order_by":0,"name":"Gavin Stewart","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYJCCAwhmRQIDH4SVQFCLBIR1JoGBjRgtDHAtB9uI0CLvfsbwcAFDXR2/RPKzzx/npcmzMTA//MDYloZTi+GZHIPDMxgOS0jOSDOecXBbjmEbA5uxBGNbDm4tDWkJh3kYDkgY3E4wZji4rSIB6DAzBsa2Ctxa+p+BtNRJ2N9O/8xwcA5IC/s3vFrkJZIPALUwSxhI5wBtacgBauEB2YLbYQYSj4FaDA5Lzrj/ppjhzLE0wzZmnmKJhHO4vS/fn9j8maeijp+/5/hmhoqaZHl+9vaNHz6UJeO25QCYRBZiZsAfkfINeCRHwSgYBaNgFIABAA9bTUokG2C4AAAAAElFTkSuQmCC","orcid":"","institution":"Kings College London","correspondingAuthor":true,"prefix":"","firstName":"Gavin","middleName":"","lastName":"Stewart","suffix":""},{"id":522845830,"identity":"7a4ed6fc-37ce-4878-8c1d-3ce309eb2354","order_by":1,"name":"Aphrodite Eshetu","email":"","orcid":"https://orcid.org/0009-0007-9146-2348","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Aphrodite","middleName":"","lastName":"Eshetu","suffix":""},{"id":522845831,"identity":"ed8be6f1-e1b0-4769-876c-8cf419a4e489","order_by":2,"name":"Saloni Ghai","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Saloni","middleName":"","lastName":"Ghai","suffix":""},{"id":522845832,"identity":"628d39ae-cc22-41c5-90d5-d4652507d002","order_by":3,"name":"Anne Corbett","email":"","orcid":"","institution":"College of Medicine and Health, University of Exeter, Exeter, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Anne","middleName":"","lastName":"Corbett","suffix":""},{"id":522845833,"identity":"5383f354-900d-49a4-8358-e240935af8cc","order_by":4,"name":"Clive Ballard","email":"","orcid":"","institution":"College of Medicine and Health, University of Exeter, Exeter, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Clive","middleName":"","lastName":"Ballard","suffix":""},{"id":522845834,"identity":"9221b5cc-fd0e-4233-92c6-ef86753d7c75","order_by":5,"name":"Adam Hampshire","email":"","orcid":"","institution":"Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, United Kingdom","correspondingAuthor":false,"prefix":"","firstName":"Adam","middleName":"","lastName":"Hampshire","suffix":""},{"id":522845835,"identity":"540d2922-e00c-4ad2-9d1b-c6aad4442d59","order_by":6,"name":"Elizabeth O'Nions","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"O'Nions","suffix":""},{"id":522845836,"identity":"7191b3bf-e0fc-4b29-8169-833008de80fa","order_by":7,"name":"Will Mandy","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Will","middleName":"","lastName":"Mandy","suffix":""},{"id":522845837,"identity":"df71c9c7-9afb-4bab-b305-f6abf91d2fd7","order_by":8,"name":"Joshua Stott","email":"","orcid":"","institution":"University College London","correspondingAuthor":false,"prefix":"","firstName":"Joshua","middleName":"","lastName":"Stott","suffix":""},{"id":522845838,"identity":"6b580db4-2814-4925-bf0d-6489d174a527","order_by":9,"name":"Amber John","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Amber","middleName":"","lastName":"John","suffix":""},{"id":522845839,"identity":"09986c52-530f-42a4-b3ad-21062b01eb62","order_by":10,"name":"Gavin Stewart","email":"","orcid":"","institution":"Kings College London","correspondingAuthor":false,"prefix":"","firstName":"Gavin","middleName":"","lastName":"Stewart","suffix":""}],"badges":[],"createdAt":"2025-09-05 11:26:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7543778/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7543778/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92559005,"identity":"fba18f65-2c94-4e72-a0e8-3ae6b3607d79","added_by":"auto","created_at":"2025-10-01 04:02:26","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":449506,"visible":true,"origin":"","legend":"Article File","description":"","filename":"NMHAnxietyASTArticle.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7543778/v1_covered_6f979849-3c5d-486f-b998-be703acefca4.pdf"}],"financialInterests":"There is \u003cb\u003eNO\u003c/b\u003e Competing Interest.","formattedTitle":"The Association between Autistic Traits and Trajectories of Anxiety in Middle-Aged and Older Adults: An 8-year Growth Mixture Model Analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nature-portfolio","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"","title":"Nature Portfolio","twitterHandle":"","acdcEnabled":false,"dfaEnabled":false,"editorialSystem":"ejp","reportingPortfolio":"","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Anxiety, Autistic Traits, Midlife, Old Age, Trajectory, Longitudinal","lastPublishedDoi":"10.21203/rs.3.rs-7543778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7543778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Anxiety is common in autistic people, yet little is known about its course beyond midlife due to limited longitudinal research. We analysed data from 5,270 adults aged 50–91 (median 62; 75% female) in the PROTECT study. Participants completed the Autistic Spectrum Traits questionnaire and GAD-7. Sixty-six (~1.3%, 72.3% female) had high autistic traits (AST group), while 3,874 (~73.5%, 77.8% female) reported none (Control Older Adults; COA). Growth mixture modelling (GMM) identified anxiety trajectories over eight years. Associations between AST status and trajectory membership were examined using multinomial logistic regression.GMM revealed three trajectories: persistently minimal symptoms (‘lower-range minimal’ 85.6%; ‘upper-range minimal’ 12.4%), and a third showing rising anxiety from mild to clinical levels (1.9%). Regressions showed AST individuals were more likely than COA to follow the mild-to-clinical trajectory (RR 4.41, 95% CI 1.70–11.44). Elevated autistic traits increase risk of worsening anxiety with age, highlighting the need for tailored support.","manuscriptTitle":"The Association between Autistic Traits and Trajectories of Anxiety in Middle-Aged and Older Adults: An 8-year Growth Mixture Model Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 03:54:14","doi":"10.21203/rs.3.rs-7543778/v1","editorialEvents":[],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nature-mental-health","isNatureJournal":true,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"natmentalhealth","sideBox":"Learn more about [Nature Mental Health](https://www.nature.com/natmentalhealth/)","snPcode":"44220","submissionUrl":"https://mts-natmentalhealth.nature.com/cgi-bin/main.plex","title":"Nature Mental Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature Research","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"718d4649-3fc9-4d83-bddd-adafda7abf4f","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":55576218,"name":"Health sciences/Diseases/Psychiatric disorders/Autism spectrum disorders"},{"id":55576219,"name":"Health sciences/Diseases/Psychiatric disorders/Anxiety"}],"tags":[],"updatedAt":"2026-04-24T15:41:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 03:54:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7543778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7543778","identity":"rs-7543778","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}