ArticleJournal of autism and developmental disorders2026
Autistic Masking and Mental Health Outcomes in Autistic Women: A Systematic Review (2015-2025).
Article in Journal of autism and developmental disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeAutistic masking-the behavioral and cognitive strategies through which autistic individuals conceal or compensate for their autistic traits to navigate neurotypical social environments-has been consistently linked to adverse mental health outcomes, with women disproportionately affected. This systematic review examined the association between autistic masking and anxiety, depression, autistic burnout, and suicidality in autistic adult women, and identified which mental health indicators are most consistently predicted by masking.
methodsA systematic search was conducted across five databases (PubMed, Web of Science Core Collection, Scopus, APA PsycINFO, and ProQuest One Psychology) covering publications from January 2015 to December 2025, following PRISMA 2020 guidelines (PROSPERO: CRD420261342682). Eligibility criteria required autistic adult women (≥ 18 years) with formal diagnosis, explicit measurement of masking, and at least one specified mental health outcome. Methodological quality was assessed using the Newcastle-Ottawa Scale and CASP.
resultsNine studies (2018-2025) were included, with a combined analytic sample exceeding 1,500 women across seven countries. Masking was consistently associated with anxiety (β = 0.21-0.22; d = 0.93) and depression (g = 0.56; Nagelkerke R² = 0.358 via structured lifetime diagnosis), and constituted an independent predictor of suicidality (β = 0.198; OR = 5.04 vs. general population). The CAT-Q assimilation subscale was the specific predictor of suicidal ideation in women, mediated by anxiety. No study assessed autistic burnout with validated instruments.
conclusionMasking constitutes a significant and independent psychosocial risk factor for mental health deterioration in autistic adult women. Systematic assessment using validated instruments such as the CAT-Q should be integrated into clinical mental health and suicide risk evaluation protocols for this population.
trial registrationThis review was prospectively registered in PROSPERO (CRD420261342682; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420261342682 ).
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