Symptom change in depression and anxiety during psychological therapy for autistic adults

Autistic people are less likely to benefit from currently recommended mental health treatments, but little is known about how outcomes vary across individuals. This gap makes it difficult to adapt therapies (or develop new ones) to meet diverse needs among autistic people. Here we show that autistic people receiving routine psychological therapies for anxiety and depression in English primary care mental health services followed different symptom pathways: several improved, others remained stable, whereas others experienced worsening symptoms. Our analysis used data from 7,175 autistic adults who accessed services in England between 2012 and 2019, linked with national healthcare records drawn from the MODIFY dataset. We used growth mixture models to identify five patterns of depression change and seven patterns of anxiety change and a regression model to understand how risk factors related to the type of change. Being from an ethnically minoritized background was linked to a higher likelihood of worsening anxiety compared with White participants. More difficulties with functioning in daily living—such as managing social leisure activities—were linked to poorer outcomes for severe anxiety and depression. These findings highlight the need for therapies that are culturally responsive and affirming of neurodivergent experiences. Support for daily living tasks including social leisure (attending to camouflaging and burnout) may be a helpful focus for additional neurodiversity-affirming support. Pender et al. evaluated depression and anxiety symptom trajectories in autistic adults receiving routine therapy in UK primary care.