# Racial disparities in depression and mental health service use among black and white autistic adults

## TL;DR

This study finds that Black autistic adults experience high depression symptoms regardless of diagnosis, highlighting the need for better mental health care.

## Contribution

The study compares mental health outcomes and service use between Black and White autistic adults, revealing disparities and gaps in care.

## Key findings

- Black autistic adults with and without depression diagnosis report similar high depression and anxiety symptoms.
- Black participants with depression diagnosis have higher income, education, and employment rates than those without.
- Findings suggest mental health services may not fully address distress among Black autistic individuals.

## Abstract

Studies have reported that autistic individuals are diagnosed with major depressive disorder (depression) at rates significantly higher than their non-autistic peers. While studies have shown that Black autistic individuals may be particularly vulnerable to experiencing depression, few studies have examined rates of lifetime depression diagnosis and symptom burden within this population in comparison to other racial groups, in particular White autistic individuals. This study addresses this gap by comparing demographic differences and mental health diagnosis, symptoms, and service use for Black and White autistic adults with and without a lifetime depression diagnosis, offering insights to guide future research and clinical practice to address the mental health needs of autistic individuals. Data were drawn from the Relationships, Employment, Autonomy, and Life Satisfaction (REALS) study, which includes self-reported history of mental health diagnoses, as well as measures of current anxiety and depression symptoms. Bivariate analyses were conducted to examine demographic, mental health service use, and clinical differences among an age- and income-matched sample of Black and White autistic participants, stratified by whether they had received a depression diagnosis in their lifetime (past and/or current). The study included 179 autistic adults (93 Black, 86 White). Black autistic adults with a lifetime depression diagnosis had higher income, education, and employment rates than those without a lifetime depression diagnosis. White participants showed no such differences. Further, Black participants reported similarly high current depression symptoms and anxiety, regardless of whether they had a depression diagnosis or not. That is, Black autistic adults without a lifetime depression diagnosis report experiencing comparable levels of current depressive symptoms as those with a lifetime depression diagnosis, which for both groups fall near clinical cutoffs. Findings underscore the need for more nuanced mental health services that address the complex needs of autistic adults, particularly Black individuals who remain underrepresented in autism research. The similarly high anxiety and depression symptom levels across Black autistic adults with and without a lifetime depression diagnosis suggest that those with depression and who have access to mental health services may not find that such services fully address ongoing distress. The elevated rates of co-occurring mental health conditions among those with a history of depression point to the importance of integrated, intersectional approaches to care that consider both racial identity and neurodivergence.