Mental health conditions are common among autistic adults, with 50% of autistic adults having a co-occurring condition, like attention-deficit/hyperactivity disorder (ADHD), anxiety or depression.
Researchers from Drexel University's A.J. Drexel Autism Institute examined hospitalizations for mental health conditions in autistic adults to understand what features are associated with an increased risk for readmission to the hospital within a month of the initial discharge.
The study, which was recently published in Research in Autism, showed that hospitalizations for mental health conditions were common for autistic adults, with more than one-third, or 36%, of all admissions for autistic adults in 2019 for mental health hospitalizations. Among these hospitalizations, schizophrenia was the most common reason for admission – 30% of hospitalizations for mental health conditions had schizophrenia listed as the reason. Throughout the study, the research team compared findings for autistic adults – who were nearly 1.5 times more likely to be readmitted to the hospital within 30 days – to those from adults with ADHD, adults with intellectual disability and adults with other mental health conditions. For people without autism or intellectual disability, 12% of hospitalizations were for mental health conditions.
Researchers found that after discharge from the hospitalization, almost 1 in 5 autistic adults were readmitted to the hospital within 30 days of the initial admission. Readmission was also more common in adults with Medicare (compared to private insurance) and adults who had either a substance use disorder or schizophrenia as the reason for the initial hospitalization.
"Hospital readmissions are generally considered an unideal outcome," said Jessica Rast, PhD , assistant research professor at the Autism Institute and lead author of the study. "If a person is admitted to the hospital for a mental health crisis, they should receive outpatient care upon discharge that helps resolve the crisis situation."
Rast explained that with accessible mental health care and support, a readmission to the hospital should not typically be necessary. A lack of accessible outpatient mental health care may mean that support after discharge is limited or unavailable.
The research team was surprised to find that in autistic adults, women had greater rates and odds of readmission than autistic men.
"This is the opposite of what is seen in non-autistic populations, both in our study and in previous research," said Rast. "This may suggest more inadequate inpatient and outpatient follow-up care for autistic women than men. Much research and clinical attention has focused on autism in males, with only recent attention paid to the differences in presentation and support needs for autistic women."
Rast added that autistic women may also face additional risk factors for poor mental health, including increased camouflaging and masking behaviors, which is typically a conscious or unconscious strategy to appear non-autistic in social settings. This difference of readmission rates between autistic men and women highlights the need for further attention on the population of autistic women generally, and their mental health needs, in particular, according to the researchers.
The study showed that the highest rates of readmission were seen in adults with intellectual disability, with and without autism.
"There are many reasons this may be true, including a lack of accessible outpatient mental health care for this group, the need for and receipt of different types of services from many different places – including co-occurring health conditions, behavioral supports and support with activities of daily living," said Rast. "There is also lack of mental health interventions targeted for this group and a lack of providers with training or confidence in treating patients with intellectual disability."
For the study, the research team used data from the National Readmission Database (NRD) 2019, which is a national record of inpatient hospitalizations in the U.S. The 2019 data is comprised of about 35 million discharges from the 30 states where readmissions can be seen and was the most recent and relevant data at the time of the study. This data is collected by the U.S. Agency for Healthcare Research and Quality, through a project called the Healthcare Cost and Utilization Project.
Researchers identified all hospitalizations that were for mental health conditions, including mood disorders, substance use disorders, schizophrenia and other psychoses, and suicidal ideation or attempt. They then examined the rate of readmission to the hospital within 30 days of the discharge for the first hospitalization for a mental health condition. They examined the reason for the initial hospitalization and the readmission, as well as characteristics of the initial hospitalization that are associated with a greater risk of readmission.
"For example, there are few treatments for mental health conditions that are adapted for autistic adults ," said Rast. "Further, many clinicians that support mental health feel inadequately prepared to serve autistic patients, for a variety of reasons including limited education on this population in formal training programs."
According to the researchers, the findings that readmission rates are so high suggest that there are barriers to comprehensive mental health care in autistic people, and particularly people with intellectual disability. They explained that there are gaps in mental health care, and many of the care systems that people rely on are disconnected or siloed. For example, adults with autism and intellectual disability may receive support through state developmental disability services, while adults with schizophrenia may seek support through mental health systems and providers. A person with both conditions may have difficulty finding providers that feel confident managing both.
"The identification of such high rates of both mental health hospitalizations and readmissions should be an impetus for more research into improving the systems that currently mis-serve autistic people with mental health concerns," said Rast.
She added that this includes the accessibility and appropriateness of mental health care, and the connection of service systems that are currently siloed. This connection will involve changes to policy and to insurance reimbursement structures.
The research team noted that autistic adults are a growing population — some estimates are that 2% of adults are autistic — and is one the that currently is not receiving accessible mental health care. Previous studies show that mental health conditions are more common in autistic adults than in adults without autism. So, more targeted attention is needed in this specific group to improve health and mental health outcomes.
Read the full study here: https://www.sciencedirect.com/science/article/pii/S3050656525000549?via%3Dihub .
