The World Health Organization ranks both anxiety and depressive disorders as major contributors to disability.
Autistic people are at higher risk for anxiety and depressive disorders compared to the general population. The
increased risk is at least in part due to genetics and neurobiology, as well as the high prevalence of co-
occurring physical health conditions. Though autistic young people are frequent utilizers of health services,
difficulties in communication for autistic young people, and their complex clinical presentation may further
complicate providers’ ability to make mental health diagnoses and therefore delay condition management.
Anxiety and depressive disorders tend to arise during adolescence or early adulthood, a developmental period
that sets the stage for outcomes later in adulthood. Outcomes among autistic adults are poor in the domains of
physical and mental health, independence, employment, social engagement, even compared to peers with
other developmental or intellectual disabilities. In line with the multiple minority theory, studies of anxiety and
depressive disorders suggest prevalence may be higher among already vulnerable groups. Females,
marginalized racial and ethnic groups, and individuals with co-occurring ID have established delays in
diagnosis for autism, and may be at increased risk for delays in anxiety or depression diagnosis.
Understanding the emergence of these conditions matters because early access to care for mental health
conditions can lead to better management of conditions, which can have positive downstream effects on
morbidity and mortality. The proposed project will follow nearly 600,000 autistic people ages 10-29 who are
Medicaid-enrolled over an 11-year period (2008-2019). Aim 1 of this project will describe the prevalence,
incidence, and profiles of treated anxiety and depressive disorders among Medicaid-enrolled autistic young
people. Aim 2 will identify group-based trajectories of healthcare utilization for anxiety and depressive
disorders to illuminate the emergence of these conditions. Aim 3 will investigate the quality of follow-up care
received by autistic young people following ED visits and hospitalization for anxiety and depressive disorders
using established healthcare quality measures. All study aims will examine differences in findings by important
subgroups within the autistic community: females, marginalized racial and ethnic groups, and individuals with
co-occurring ID. This project has multiple short- and long-term impacts on the autistic community. Short-term.
1) Advance the evidence base around emergence of treated anxiety and depressive disorders in autistic young
people (Aims 1 & 2). 2) Point toward improvements in the quality of follow-up care received after ED visits or
hospitalizations related to anxiety and depressive disorders, if needed, which could reduce readmissions and
risk of suicide (Aim 3). Long-term. 1) Guiding Medicaid resource allocation and planning for future
programmatic enrollment needs (Aim 1). 2) Supporting the ability of the Medicaid program to make available
the services that the autistic community need for anxiety and depressive disorders (Aims 1 & 2).
