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Young women with autism had a higher risk for psychiatric disorders than young men with autism, according to a Swedish population-based cohort study.

Between the ages of 16 and 25, 77 of 100 autistic women and 62 of 100 autistic men received at least one psychiatric diagnosis, reported Miriam Martini, MSc, of the Karolinska Institutet in Stockholm, and colleagues.

Women with autism had statistically significant standardized risk differences for any psychiatric disorder compared with men (−0.18, 95% CI −0.26 to −0.10), which was larger for anxiety, depression, and sleep disorders, Martini and co-authors wrote in .

Moreover, autistic women (HR range 3.17 to 20.78) and men (HR range 2.98 to 18.52) had an increased risk for all psychiatric diagnoses compared with non-autistic people of the same sex. By age 25, 32 of 100 autistic women and 19 of 100 autistic men had a psychiatric hospitalization, compared with five of 100 non-autistic women and three of 100 non-autistic men.

Sex differences in psychiatric disorders have been observed in the general population, but few studies have specifically investigated those differences in autistic men and women, the researchers noted.

"The findings highlight the profound need for mental health services in the transitional period to adulthood among all autistic individuals, with increased clinical surveillance and support focusing on autistic females," Martini told MedPage Today.

Mental health is an area of priority for autism research and these data show "an absolutely clear need to focus on how we can improve quality of life and well-being" for autistic individuals, said Carla Mazefsky, PhD, of the University of Pittsburgh School of Medicine, who wasn't involved with the study.

"Overall this paper confirms what smaller studies have already suggested -- mental health conditions are highly prevalent in autistic adults," Mazefsky wrote in an email. "Moving forward, a broader approach may be needed as it seems likely that the highest rates may be among gender-diverse autistic individuals."

The study, based on a population-based cohort born in Sweden between 1985 and 1997, included 1,335,753 people in medical registers. Overall, 20,841 people had an autism diagnosis, 7,129 of whom (34.2%) were female. Participants were followed from age 16 through age 24 between 2001 and 2013.

The researchers matched 10 non-autistic individuals to each autistic individual based on sex and birth year. They defined individuals with autism as those receiving at least one clinical diagnosis of autism using ICD codes. Sex was based on biological attributes of being female or male as assigned at birth.

The findings of this study can inform clinical practice in two primary ways, Martini and colleagues pointed out. "Services for autistic adults are scarce and barriers to care are pervasive, subsequently causing gaps and delays in treatment," they wrote. There is a need to expand "mental health services in the transitional period from childhood to adulthood, particularly for female individuals," they continued.

Services also could be modified to suit the needs of autistic people, the researchers added. Female individuals with autism "often report a lack of autism knowledge and understanding of co-occurring psychiatric disorders among medical professionals, sometimes resulting in misdiagnosis," they observed.

Limitations of the study include the possibility of misdiagnosis, the researchers acknowledged. Gender information also was not included in register data.

"This is relevant because a comparably higher proportion of autistic than non-autistic individuals do not identify with their assigned sex at birth or a binary gender," Martini and co-authors wrote. "Nonbinary and non-conforming gender identity are particularly prevalent among autistic individuals assigned female at birth, potentially contributing to the observed sex differences."

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