Extending the Minority Stress Model of Autism: Internalized Stigma and Loneliness as Predictors of Stress and Life Satisfaction

Authors

Abstract

Autistic people’s minority status makes them more vulnerable to minority stressors, such as stigmatization and victimization, which are linked to greater stress and lower life satisfaction. The Psychological Mediation Framework (PMF) proposes that cognitive, affective, and social-psychological processes help explain the relationships between these stressors and adverse outcomes. This cross-sectional study tested the PMF in autistic adults by examining how two of its key processes, internalized stigma and loneliness, are associated with stress and life satisfaction. Using self-report survey data from 831 autistic participants enrolled in the Netherlands Autism Register (NAR), aged 18–87 years (M age = 47.5; SD = 12.5; 408 women, 309 men, and 114 gender-diverse individuals), multiple regression analyses showed that internalized autism-related stigma, emotional loneliness, and social loneliness were each positively associated with stress and negatively associated with life satisfaction. Mediation analyses indicated that both types of loneliness partially mediated the relationship between internalized autism-related stigma and these outcomes. Supporting the PMF, the findings suggest that autism-related stigmas may become internalized and be associated with loneliness, which is linked to greater stress and lower life satisfaction. Future studies should build upon the PMF and explore strategies to mitigate underlying minority stressors. Lay Abstract Understanding stress and life satisfaction in autistic adults with the psychological mediation framework Why was this study done? Autistic adults often experience higher levels of stress and lower life satisfaction than non-autistic adults. Recently, research has suggested that these experiences are linked to them being part of a minority group—autistic people. Minorities often experience extra stress from experiences like stigma, sometimes called minority stressors. A theoretical model, the Psychological Mediation Framework (PMF), describes how minority stressors are linked to differences in people’s thoughts, emotions, and feelings. This study examined whether the PMF can also help explain the stress and life satisfaction of autistic adults. We did this by testing whether two important parts of the PMF, internalized autism-related stigma (negative beliefs about being autistic) and loneliness, were linked to their stress and life satisfaction (how content people feel with their lives overall). What did we do? We analyzed data from 831 autistic adults who filled out a survey. In our statistical models (mathematical analyses that test how variables are related), we took into account other factors that are more commonly used to examine which factors were statistically associated with stress and life satisfaction in autistic adults, such as the level of characteristics related to autism and education level. By doing this, we increased the chance that any relationships we found could be attributed to minority stressors. What did we find? Autistic adults who experienced more internalized autism-related stigma, emotional loneliness (feeling disconnected from close relationships), and social loneliness (lacking a broader social network) reported higher stress levels and lower life satisfaction. We also found that autistic adults with more internalized stigma felt lonelier, and this loneliness was linked to higher stress and lower life satisfaction. What do the findings mean? The results suggest that autistic adults may internalize autism-related stigmas, which are linked to greater loneliness, higher stress, and lower life satisfaction. As these findings align with the PMF, we believe future studies should continue using this model. Also, we recommend that researchers should study ways to reduce minority stressors and improve the mental health of autistic adults.

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