PurposeDespite potential benefits of using social media for participant recruitment in mental health research, there are limited evaluations to guide researchers. This pilot study aims to explore feasibility of using social media in mental health research to recruit a population-representative, heterogeneous sample of adults from the general population.Design/methodology/approachThe global, top 15 most popular social media platforms were evaluated according to researchers' needs to determine use in this study. Recruitment, over three months, used standard, cost-free methods to recruit participants to a survey-based mental health study. In the last month of recruitment, researchers piloted the addition of paid advertising, to reduce sampling bias and aid recruitment. The evaluation aimed to monitor engagement of potential participants with social media.FindingsSurvey participants (n = 2,195) were mostly of white ethnicity, female and aged 18-24 years, indicating limited representation. Over one million individuals interacted with social media posts. Standard use averaged 1,124 people reached, 32 engagements, 6 link clicks per day on tracked social media posts, and on average 24 new participants per day. Paid advertising averaged 36,372 people reached, 5,959 engagements, 338 link clicks per day, and on average 22 new participants per day. Conversion rate differed between phase of recruitment, but sample diversity did not differ significantly. Paid advertising did not appear to make a difference.Originality/valueThis study highlights that social media is an exciting development in research and has potential to increase sample size. This study identifies practical challenges for researchers, such as adequate funding and understanding of social media.

BACKGROUND:Research indicates public stigma about mental health has reduced. Less is known about severe mental health conditions, such as psychosis and personality disorders. AIMS:This study evaluated public perceptions of psychosis and personality disorders. METHODS:A survey was shared on social media. Anyone 18-years-old and over was eligible to participate. Knowledge, attitudes, beliefs, and behaviour were evaluated using the Mental Health Knowledge Scale, Attitudes to Mental Illness Scale, Perceived Devaluation and Discrimination Scale, and Reported and Intended Behaviour Scale. Multiple regressions explored their associations with demographic characteristics. RESULTS:Participants (N = 1413; over 50% 18-24-year-olds; 77% female; 80% White ethnicity; 70% university-educated) lacked direct familiarity with these conditions and their knowledge varied. Attitudes and behaviour were generally positive, open-minded, and unprejudiced. A minority reported stigmatising views, which were associated with minoritised ethnicities and lower education and familiarity. Most participants believed the public would find it unacceptable that people with these conditions would work in childcare or certain professional roles. CONCLUSIONS:Anti-stigma organisations could tailor campaigns regarding severe mental health conditions to focus on these demographic groups. However, aspects of the demographic characteristics of the sample may bias the findings and limit their generalisability. Larger, more representative surveys will strengthen these findings.

BACKGROUND:Despite the higher prevalence of childhood traumatic experiences and post-traumatic stress disorder (PTSD) in autistic adults, research on trauma-related psychopathology and autistic traits in young people is lacking. This study examined if high autistic traits in childhood predispose individuals to traumatic experiences, the development of PTSD and general psychopathology, and greater functional impairment by age 18, in both the general population and a subsample of trauma-exposed young people. METHODS:Data were utilised from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative cohort of 2,232 same-sex twins born in 1994-1995 across England and Wales. Participants were a subset of children whose parents completed the Childhood Autism Spectrum Test (CAST), during assessments at ages 8, 9 and/or 12 years (N = 1,504). We tested associations between autistic traits in childhood and age-18 reports of lifetime trauma exposure, lifetime PTSD diagnosis, general psychopathology ('p-factor') and NEET status ('not in employment, education or training'). Analyses were conducted controlling for sex, family socioeconomic status (SES), intelligence quotient (IQ) and accounting for family clustering. RESULTS:Higher autistic traits in childhood were significantly associated with greater reports of lifetime trauma exposure (Odd Ratio [OR] = 1.26, 95% Confidence Intervals [CI] = 1.03; 1.54), lifetime PTSD diagnosis (OR = 1.91, 95% CI = 1.29; 2.82), general psychopathology (beta = 3.22, 95% CI = 1.84; 4.60) and NEET status (OR = 1.48, 95% CI = 1.05; 2.09) at age 18. Only the associations of autistic traits with PTSD and general psychopathology were robust to adjustment for potential confounders. Among trauma-exposed children, autistic traits were also significantly associated with lifetime PTSD diagnosis (OR = 1.75, 95% CI = 1.15; 2.68) and psychopathology (beta = 3.36, 95% CI = 0.68; 6.04) at age 18, but only the association with PTSD held when adjusted for confounders. CONCLUSIONS:Our findings suggest a need to develop targeted assessments and evidence-based treatments for PTSD to meet the needs of children with high autistic traits. However, whether our findings extend to diagnosed autistic children requires further investigation.

Background Autistic adults have a heightened risk of developing mental health conditions, but limited access to autism-informed community support, which is an internationally recognised issue. Consequently, the risk of crisis and hospitalisation is increased. Intensive Support Teams (ISTs) were created as part of the NHS Transforming Care Agenda (TCA) to work directly with autistic people and/or people with an intellectual disability and their families or indirectly with other professionals to prevent hospitalisation. Little is known about the functions of ISTs for autistic people, a pertinent issue given the rising number admitted to mental health hospitals in England. The present qualitative study aimed to explore the perspectives of multidisciplinary professionals working within ISTs for autistic adults in England to provide insight into team functions and barriers or facilitators to reducing hospitalisation. Methods Using convenience sampling, eight multidisciplinary professionals from four NHS England Trusts completed a brief demographic survey and individual semi-structured interviews conducted online. Data were transcribed verbatim and thematically analysed (Braun and Clarke, 2006). Results Four overarching themes and eleven subthemes were identified: (1) Developing new autism-informed approaches to care, (2) Policy in practice, (3) Gaps in mental health provision, and (4) Transforming care. Conclusion The present findings highlight factors which enable ISTs to reduce hospital admissions of autistic adults, for example, utilising a collaborative and flexible approach. It also highlights the systemic issues which hinder the function of the IST, including a lack of autism-informed community support and a lack of resources. Suggestions of changes to the IST and wider mental health system may support international incentives to reduce reliance on mental health hospitals and to improve mental health support in the community for autistic adults. Further research conducted with autistic people and their families, and staff working in/with ISTs is now needed to clarify inconsistencies in IST eligibility criteria and better understand facilitators for change.

Research suggests autistic people experience greater post-traumatic stress disorder symptom severity than non-autistic people following traumatic events. Post-trauma appraisals are fundamental in cognitive models of post-traumatic stress disorder, but have not been explored in autistic people. We aimed to explore whether we could replicate effects of heightened trauma exposure and post-traumatic stress disorder symptom severity in autistic adults, and examine how post-traumatic appraisals affect the association between autism and post-traumatic stress disorder symptom severity. Two hundred forty-two autistic (n = 148) and non-autistic adults (n = 94) completed a survey measuring trauma exposure, post-traumatic stress disorder symptom severity and post-trauma appraisals. Exposure to types of traumatic events did not differ significantly between the groups, but the autistic group endorsed more events that 'happened to me' directly. Post-traumatic stress disorder symptom severity and endorsement of negative post-traumatic appraisals were significantly higher in the autistic group, specifically alienation, shame and fear appraisals. These appraisals mediated the association between autism and post-traumatic stress disorder symptom severity. Therefore, as in the general population, greater endorsement of negative post-traumatic appraisals may be a risk factor for post-traumatic stress disorder symptom development in autistic adults, particularly appraisals of shame, fear and alienation. Longitudinal designs are required to confirm the direction of these effects and to elucidate factors underlying these negative appraisals in autistic people.Lay SummaryMany people experience intrusive memories and anxiety after a traumatic event. However, for some, these symptoms last longer and they might be diagnosed with post-traumatic stress disorder. Research suggests that autistic people might be more likely to develop post-traumatic stress disorder and experience more severe symptoms compared to non-autistic people after traumatic events. One factor that is important in post-traumatic stress disorder development is how people think about the trauma. These might be thoughts like 'It was my fault', 'I'm not safe', 'I'm disconnected from other people'. There has not been research into how autistic people think about traumatic events compared to non-autistic people, and this could be important for making post-traumatic stress disorder treatments more effective for them, as many of these focus on thoughts. In this study, we asked 148 autistic people and 94 non-autistic people in the United Kingdom to complete an online survey about their trauma history, post-traumatic stress disorder symptoms and thoughts about a traumatic event. We found that autistic people experienced more types of traumatic events directly (it happened to them), but they did not experience more types of traumatic events overall. Interestingly, both groups reported events like bullying or the death of a loved one as traumatic, but these events would not meet the official diagnostic criteria for post-traumatic stress disorder. As expected, autistic people reported worse post-traumatic stress disorder symptoms than non-autistic people and were more likely to meet the cut-off for post-traumatic stress disorder diagnosis. Autistic people also reported more negative thoughts about the trauma, especially feeling unsafe, disconnected, ashamed or that the trauma was their fault. Having more thoughts like this was associated with being autistic and experiencing more severe post-traumatic stress disorder symptoms. Our findings suggest that therapies focusing on these negative thoughts could be helpful for autistic people with post-traumatic stress disorder. Future research should explore why autistic people have more of these thoughts after traumatic events and should use longitudinal or experimental designs to explore how these factors influence one another over time. Efforts to prevent negative experiences, challenge negative attitudes in society towards autism and support positive autistic identity and well-being will be helpful for changing this in the future. It is also important that mental health services offer support for post-traumatic stress disorder even when events do not meet the current diagnostic criteria, as this might prevent autistic and non-autistic people who need support with post-traumatic stress disorder getting help.

High stress levels experienced by young adults were exacerbated by COVID-19 and traditional stress management techniques can be challenging. Virtual reality (VR) relaxation appears promising and is accessible remotely; however, research on young adults is limited, especially in naturalistic settings. This remotely delivered and controlled mixed-methods study investigated feasibility and acceptability of VR relaxation for young adults ( N = 23, mean age = 22.96) at home during the pandemic. VR participants ( N = 11) were asked to complete daily VR relaxation sessions (scenes of virtual beaches, mountains, the sea, and more) for a 14-day intervention period, alongside visual analogue scales (VAS) of psychological well-being pre- and post-VR sessions. Post-intervention, VR participants completed semi-structured interviews. Control participants ( N = 12) received no intervention. Both groups completed outcome measures of psychological well-being pre- and post-intervention periods to evaluate feasibility of remote data collection. VAS results indicated acceptability of daily VR, with significant short-term increases in relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness within VR participants. VR usage and 100% completion of outcome measures indicated feasibility of VR relaxation and remote data collection. Qualitative findings suggest participants found the VR relaxing, but interest diminished over time and technical issues hindered user experience. This suggests a more informal, less prescriptive frequency of VR use may be more appealing for young adults, although adherence may relate to technical issues. Greater interactivity and remote technical assistance within VR could increase engagement. Future research should investigate optimal frequency of use, longer-term impact, and technical issues with a larger sample.

Complex post-traumatic stress disorder (CPTSD) was introduced in the International Classification of Diseases (ICD) 11 in 2013 to simplify diagnosis and increase clinical utility. Given the recent ICD-11 conceptualisation, there is no standard approach for its assessment, and a review of research is necessary. This systematic review focuses on ICD-11 CPTSD assessment in young people aged 7 to 17 and adults aged 18 and above, examining measures, differentiating features and clinical considerations. Data from five databases are reviewed using a narrative synthesis approach and the quality of evidence is assessed and discussed. A total of 36 studies involving 5901 participants recruited from clinical settings and 1458 professionals with CPTSD assessment experience were included. Studies predominantly focused on adults, and the most used measure for assessment was the International Trauma Questionnaire. Papers focusing on differentiating features highlighted increased symptom severity, impairment and difficulties in individuals with CPTSD, compared to those with PTSD across various characteristics in both young people and adults. This review also identified the importance of a sensitive clinical approach with adaptations based on culture and age. Although gold-standard recommendations cannot be made, this paper offers tentative clinical practice recommendations and considerations regarding ICD-11 CPTSD assessment.

Individuals diagnosed with autism, attachment disorders, emotionally unstable personality disorder (EUPD) or complex post-traumatic stress disorder (CPTSD) can present with similar features. This renders differential and accurate diagnosis of these conditions difficult, leading to diagnostic overshadowing and misdiagnosis. The purpose of this study was to explore professionals' perspectives on the differential diagnosis of autism, attachment disorders and CPTSD in young people; and of autism, CPTSD and EUPD in adults. A co-produced three-round Delphi study gathered information through a series of questionnaires from 106 international professionals with expertise in assessing and/or diagnosing at least one of these conditions. To provide specialist guidance and data triangulation, working groups of experts by experience, clinicians and researchers were consulted. Delphi statements were considered to have reached consensus if at least 80% of participants were in agreement. Two hundred and seventy-five Delphi statements reached consensus. Overlapping and differentiating features, methods of assessment, difficulties encountered during differential diagnosis and suggestions for improvements were identified. The findings highlight current practices for differential diagnosis of autism, attachment disorders, CPTSD and EUPD in young people and adults. Areas for future research, clinical and service provision implications, were also identified.

Adverse life events and mental health conditions are unfortunately common amongst autistic adults and children; this may present a vulnerability to developing post-traumatic stress disorder (PTSD). This systematic review provides an update of Rumball’s ( Review Journal of Autism and Developmental Disorders , 6 , 294–324, 2019) systematic review of PTSD in autistic individuals and identifies 18 new studies published from 2017 to 2022, reflecting increased research interest in PTSD in autistic populations. Included literature suggests that autistic adults and children experience more severe PTSD symptoms compared to their non-autistic peers, with at least comparable rates of occurrence. We provide a comprehensive overview of this emerging field and identify the need for future research to validate PTSD symptom assessment tools and treatment strategies and investigate unique manifestations of trauma-related symptoms in autistic individuals.

Purpose Autistic individuals are at increased risk of trauma exposure and post-traumatic stress disorder (PTSD). Diagnostic overshadowing, however, often results in PTSD symptoms being mislabelled as autistic traits. This study aims to develop professional consensus on the identification and assessment of co-occurring PTSD in autistic adults. Design/methodology/approach An online modified Delphi design was used to gather professionals’ perspectives on key aspects of the identification and assessment of PTSD in autistic adults. Data were gathered qualitatively in Round 1 and then synthesised using content analysis into a list of statements that were rated in Round 2. Statements reaching 60–79% consensus and additional suggestions were sent out for rating in Round 3. Consensus for the final statement list was set at 80% agreement. Findings Overall, 108 statements reached consensus. These form the basis of professional-informed recommendations to facilitate the identification and assessment of PTSD symptoms in autistic adults. Practical implications The final Delphi statements provide a framework to assist with the assessment and recognition of traumatic stress reactions in autistic adults presenting to mental health, diagnostic or social services. Originality/value To the best of the authors’ knowledge, this is the first study to explore the presentation and identification of PTSD in autistic adults (with and without intellectual disability), using a bottom-up approach informed by professional consensus.

People with acute psychiatric conditions experience heightened stress, which is associated with worsened symptoms and increased violence on psychiatric wards. Traditional stress management techniques can be challenging for patients. Virtual reality (VR) relaxation appears promising to reduce stress; however, research on VR for psychiatric wards is limited. This mixed-methods study investigated feasibility and acceptability of integrating a VR relaxation clinic within acute psychiatric services. The study evaluated a VR relaxation session for inpatients and outpatients with acute psychiatric conditions (N = 42) and therapists' (N = 6) experience facilitating VR sessions for patients. Self-report assessments of psychological wellbeing were completed by patients pre-and post-VR. Patients and therapists provided qualitative feedback. The number of violent incidents and restrictive practices on the wards in the 12 weeks before VR implementation was compared to the first 12 weeks of VR. Post-VR, there were statistically significant increases in patients' relaxation, happiness, and connectedness to nature, and decreases in stress, anxiety, and sadness. Qualitative findings indicate patients found sessions enjoyable, relaxing, and helpful. Therapists provided positive feedback but highlighted practical challenges. Violent incidents and restrictive practices halved during VR implementation. VR relaxation appears feasible and acceptable in acute services. Larger studies should evaluate potential impact on psychiatric wards.

Using a mixed methods design, this study aimed to examine the impact of the COVID-19 pandemic on autistic and non-autistic adults. We conducted an online survey with 196 autistic and 228 non-autistic adults from Belgium, the Netherlands and the United Kingdom focusing on their experiences during the first period of the pandemic. Our results indicate rather diverse experiences within the group of autistic participants across all domains of life. In comparison with non-autistic adults, autistic adults reported less negative impact on their social life and more negative impact on health and support services. In the autism group, stress was mainly related to changing and unclear measures. A wide range of coping strategies were described as helpful in reducing stress during the pandemic.

Autistic individuals are at particular risk of experiencing mental health problems during the COVID-19 pandemic, yet little is known about personal characteristics that may underlie this vulnerability. This longitudinal questionnaire study with 149 autistic and 147 non-autistic adults investigated the association between perceived stress and anxiety and depressive symptoms, measured 4 months later. In addition, the moderating impact of intolerance of uncertainty and coping styles on this association was examined. Confirming previous studies, autistic adults reported poorer mental health than non-autistic individuals. Results demonstrated similar moderation models across individuals with versus without autism. Perceived stress at timepoint 1 was associated with anxiety and depression at timepoint 2. Across both participant groups, individuals with maladaptive coping strategies and higher levels of intolerance of uncertainty at timepoint 1 showed more internalizing symptoms at timepoint 2. The findings demonstrate the burden of the pandemic on the mental health of autistic adults, especially on those with high levels of perceived stress, maladaptive coping strategies, or intolerance of uncertainty. Interventions to support autistic adults during and after the pandemic might involve providing psychoeducation about the impact of stress, coping, and intolerance of uncertainty on internalizing symptoms, and teaching more adaptive ways to cope with difficult circumstances. Lay abstract More and more research shows us that autistic individuals are at risk of experiencing mental health problems in response to the COVID-19 pandemic. However, little is known about why this is the case. At two timepoints during the pandemic, we asked 149 autistic and 147 non-autistic adults about feelings of anxiety, depression, and stress, and about characteristics that may explain why some (autistic) people have a larger chance of developing anxiety and depression during this pandemic. In our study, autistic adults experienced more anxiety and depression than non-autistic adults. Across autistic and non-autistic individuals, the people who experienced more stress at timepoint 1 experienced more anxiety and depression 4 months later. This was especially the case for those individuals who use maladaptive coping styles, such as denial or venting, and for those who have difficulties dealing with uncertain situations. Our findings show the burden of the COVID-19 pandemic on the mental health of autistic adults. Interventions to support autistic adults during and after the pandemic are needed, and they may want to focus on the negative impact of stress and teach autistic (and non-autistic) adults more adaptive ways to cope with stressful circumstances.

Background: Individuals with Autism Spectrum Disorder (ASD) are known to be at increased risk of exposure to traumas such as maltreatment and abuse, however less is known about possible susceptibility towards the development of Posttraumatic Stress Disorder (PTSD) and associated risk factors. Aims: This study investigated the rates of trauma exposure and PTSD, and the role of cumulative trauma exposure and memory as risk factors for PTSD in adults who self-reported having received an ASD diagnosis, compared to a typically developing (TD) comparison group. Methods: Questionnaires assessing self-reported frequency of trauma exposure (LEC), PTSD symptomology (PCL-S) and memory (EMQ- R and BRIEF-A) were completed online by 38 ASD adults and 44 TD adults. Results: Rates of trauma exposure and PTSD symptomatology were significantly higher in the ASD group, compared to the TD group, with deficits in working memory and everyday memory mediating this association. Interestingly, a cumulative effect of trauma exposure on PTSD symptom severity was only found in the ASD group. Conclusions: High rates of trauma and probable PTSD in ASD adults highlight the importance of routine screening. Cumulative trauma exposure and memory deficits may act to increase risk of PTSD in ASD; longitudinal research is called for.

BACKGROUND:Mental health problems are common amongst adults with an Autism Spectrum Disorder (ASD). Stressful and traumatic life events can trigger or exacerbate symptoms of anxiety, depression and PTSD. In the general population, transdiagnostic processes such as suppression and perseverative thinking are associated with responses to trauma and mental health symptoms.AIMS:This study explored the relationships between thought suppression, perseverative thinking and symptoms of depression, anxiety and PTSD in ASD adults who reported exposure to a range of DSM-5 and non-DSM-5 traumatic events.METHODS:59 ASD adults completed a series of online self-report questionnaires measuring trauma, transdiagnostic cognitive processes, and mental health symptoms.RESULTS:Probable PTSD rarely occurred in isolation and was associated with depression and anxiety symptoms in trauma-exposed ASD adults. All cognitive processes and mental health symptoms were positively associated with one another, regardless of whether the trauma met DSM-5 PTSD Criterion A. When accounting for both cognitive processes, only thought suppression significantly predicted PTSD and anxiety symptoms, while only perseverative thinking significantly predicted depression symptoms.CONCLUSIONS AND IMPLICATIONS:These preliminary results suggest that different cognitive processes more strongly affect anxiety/PTSD versus depression symptom severity in trauma-exposed ASD adults, although co-occurring symptoms are common. Implications for assessment, treatment and future research are discussed.

Research to date suggests that individuals with autistic spectrum disorder (ASD) may be at increased risk of developing post-traumatic stress disorder (PTSD) following exposure to traumatic life events. It has been posited that characteristics of ASD may affect perceptions of trauma, with a wider range of life events acting as possible catalysts for PTSD development. This study set out to explore the nature of "trauma" for adults with ASD and the rates of self-reported PTSD symptomatology following DSM-5 and non-DSM-5 traumas-the latter being defined as those that would not meet the standard DSM-5 PTSD trauma Criterion A. Fifty-nine adults with ASD who reported exposure to traumatic events took part in the study, which involved completing a series of online questionnaires. Thirty-three individuals reported experiencing a "DSM-5" traumatic event (i.e., an event meeting DSM-5 PTSD Criterion A) and 35 reported a "non-DSM-5" traumautic event. Trauma-exposed ASD adults were found to be at increased risk of PTSD development, compared to previous general population statistics, with PTSD symptom scores crossing thresholds suggestive of probable PTSD diagnosis for more than 40% of ASD individuals following DSM-5 or non-DSM-5 traumas. A broader range of life events appear to be experienced as traumatic and may act as a catalyst for PTSD development in adults with ASD. Assessment of trauma and PTSD symptomatology should consider possible non-DSM-5 traumas in this population, and PTSD diagnosis and treatment should not be withheld simply due to the atypicality of the experienced traumatic event. LAY SUMMARY: This study explored the experience of trauma and rates of probable post-traumatic stress disorder (PTSD) in adults with autistic spectrum disorder (ASD). We asked 59 autistic adults to complete online questionnaires about their experiences of stressful or traumatic events and related mental health difficulties. Autistic adults experienced a wide range of life events as traumatic, with over 40% showing probable PTSD within the last month and over 60% reporting probable PTSD at some point in their lifetime. Many of the life events experienced as traumas would not be recognized in some current diagnostic systems, raising concerns that autistic people may not receive the help they need for likely PTSD.

Patients with psychosis, other delusional states, or autism are also at risk

Individual differences are known to influence the risk of trauma exposure and development of posttraumatic stress disorder (PTSD). It has been suggested that features of autism spectrum disorder (ASD) may confer such risk. This article provides a systematic review of the assessment and treatment of PTSD in individuals with ASD, in addition to summarising the rates and presentation of PTSD within this population. Twenty-four studies met eligibility criteria. PTSD in children and adolescents was found to co-occur at a similar or greater rate compared to general population estimates, although current estimates come predominantly from treatment-seeking samples. Preliminary findings from case reports suggest traditional assessments and treatments for PTSD can be effective, although there is a shortage of well-controlled research.