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Predictors of mental health in employed adults with autism spectrum disorder (wiley.com)
92 points by laurex on Jan 29, 2019 | hide | past | favorite | 39 comments



"positive well‐being can be understood to encompass the hedonic experience of subjective happiness and life satisfaction, and the eudaimonic perspective of psychological functioning and self‐realization"

I had never heard the term "eudaimonic" before and it is an interesting idea.

http://positivepsychology.org.uk/the-concept-of-eudaimonic-w...


From an outsider's perspective, it seems like an obvious hypothesis that increased happiness is negatively correlated with depression.

My question is, is this work assessing whether an existing, confirmed hypothesis (e.g. happiness counters depression) holds true for a different population, or is it assessing whether this hypothesis holds true at all [0]?

The paper appears to focus entirely on ASD subjects, so this delineation was not clear to me, at least on an initial skim of the paper.

Also, I feel like a more detailed treatment of hedonic and eudaimonic happiness from the perspective of ASD would have been beneficial in providing a better context to the reader. Maybe this is well-known in the domain?

[0] and happens to focus on this population for access, funding, or other ancillary reasons


From the paper, apparently this is entirely consistent with the general population:

"These results are consistent with research in the general population [Teismann, Brailovskaia, et al., 2018; Teismann, Forkmann, et al., 2018; Wilhelm et al., 2010] that shows well‐being functions as a buffer or protective factor against depression."


"We studied mental health and well‐being in newly employed adults with autism who were participating in a supported employment program."

Is the study trying to show that people with autism get brought up to the general population's base-line when there is a supported employment program?


Yes.


"Our findings suggest that positive well‐being may protect against symptoms of depression in people with autism."

Wait, so the theory is that if you're generally happy, you're less likely to be depressed? I know that depression and sadness are very different things, and happy people get depressed, but... it sure seems like you'd expect a correlation.

Not only does this seem a little bit obvious, it also doesn't seem immediately useful. And further down it notes that this is entirely consistent with research in the general population, so this result is... also totally unsurprising. Is there a reason at all to believe that this would be true for people generally but not for people with ASD?


As far as I can tell, "well-being" specifically refers to the 14-item version of the "Warwick-Edinburgh Mental Wellbeing Scale", which contains items like "feeling useful" and "dealing with problems well" (things that you'd expect one would rate higher if you have a job).

https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs/

You literally self-rate the fourteen items on a scale from 1 to 5: https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs/w...


but also "optimistic about the future", "energy to spare", "feeling good about myself", "interested in new things", "feeling cheerful". How many depressed people could plausibly rate themselves high on those? Having no energy, being pessimistic, not interested in anything, and feeling bad about yourself are... pretty classic symptoms of depression, though I don't know what the exact clinical requirements are.


In the absence of a blood test that can report "you're 79% depressed, we have to rely on self-reporting. Which is error prone as the scales are highly individual.

As I understand it, and someone correct me if I don't, these self-reporting scales are just a loose diagnostic indicator. They're more useful over time, especially if receiving therapy or medication, as the change in responses can be tracked.


Right, sure, but the study treats well-being and symptoms of depression as separate things.

But if well-being is stuff like being optimistic and fulfilled, then it seems to me hardly a surprise that being optimistic and fulfilled makes you less likely to become depressed, in the same way that not being depressed today makes you less likely to be depressed tomorrow. So I'm trying to work out what this study is actually saying, other than non-depressed people (with ASD) are less likely to be depressed in the future than currently slightly-to-very depressed people.


What does it mean to score very poorly on this?

My therapist uses a different questionnaire that has more negative questions like "Little interest or pleasure in doing things" or "Poor appetite or overeating". I tend to do alright on that one.

However, I score over 2 on only a few of the items on the list you posted, and a lot of them are solidly 1. There's a feeling of tension, anger, and frustration I just can't shake.

There's a big difference (to me anyway) in the wording between "Feeling bad about yourself – or that you are a failure or have let yourself or family down" and "I’ve been feeling good about myself"

I wouldn't say that I feel like a failure (and I have nobody who cares enough to let down), but I sure haven't been feeling good either.

I don't know quite how to express this doctors and mental health professionals in a way they understand, though, and this scale really kind of illustrates it for me, so I'm wondering what that means?


I don't have specific advice regarding the score, but I do suggest any advice provided here be taken with a grain of salt. Not because of the community (I like to think we're all well-intending here, it isn't about that) but because we're simply strangers, and we don't know enough about you to provide an accurate answer.

Find a good mental health professional who will take the time and care to understand you, and show them the same thoughts you've shared here.

You shouldn't have to change your vernacular with a mindful professional. There's plenty of leads they can follow here -- And if you want effective answers about your feelings, that's who should be doing it! A true professional dedicated to figuring these things out with you.


The questionnaire you're describing is the PHQ-9. It's the industry standard screener for depression.


I think you read too much into the summary (I did the same.) Took a while to grok it but:

People with ASD have much, (much, much,) higher incidence rates of mental health problems usually stemming from loss/lack of employment viability.

What this study concludes is that the supportive employment program buffers against those health issues that effect so many with ASD.

Couple years old but I recall this talk being vaguely relevant.

https://youtu.be/NCAErePScO0

(Mental health info around 11:20)

So yes, kind of obvious, and seemingly useless information alas we have the statistics, we have the problem, and now we know of one such solution.

Non ASD would likely benefit from the employment program as well but to the same extent? Unlikely - but only because there is less room to improve.


Something extremely important to keep in mind is that, with psychological studies, many things that people assume as obvious are completely wrong after a study demonstrates it and other things, that people would never guess, seem completely obvious after a study demonstrates it.


This is true for any scientific field. That's kind of the point: to do research to remove as many assumptions as possible.


It applies double so to popular psychology. The key is that obviousness is often a post-hoc illusion.


My guess is that they set out to find anything specific about causes of mental health issues in people with autism, and found that it manifests basically the same as everyone else.


I'm confused, where does it say the sample of people with ASD is generalizable to people without ASD?


i think theres lot of mis self diagnoses going on right now.

99% of people who are self diagnosed ASD, are 80% more likely to self diagnose.

This means that for the vast majority of engineers going around wearing their Aspergers badge are not on the autism spectrum disorder.


You know, I'm not sure why people get so snooty about self-diagnosed ASD. (Speaking as some who was formally diagnosed as a child.) Our definition of autism is based on symptoms. This isn't like someone with a rash deciding it's caused by imbalanced humors. It's more like someone noting that their skin is red, itchy, and has little bumps on it, and deciding that they have a rash.

Also, the study specifically dealt with people who had formal diagnoses already, so I'm really not sure how your comment is even relevant.


> Our definition of autism is based on symptoms. This isn't like someone with a rash deciding it's caused by imbalanced humors. It's more like someone noting that their skin is red, itchy, and has little bumps on it, and deciding that they have a rash.

No, it's not. A rash is a symptom, not a disorder diagnosed from a complex combination of symptoms; it's more like self-diagnosis of AIDS prior to the discovery of the role of HIV, and the use of HIV testing.


Our definition of autism, like many psychological conditions, is based on symptoms--behavior and development--not causes. We're learning more about the underlying reasons why brains work the way they do, so that may change eventually. But right now, if you have a large number of autistic symptoms, you most likely meet the diagnostic criteria for ASD.

In young children, the visible symptoms of autism may mimic other developmental conditions, so a professional diagnosis is important. An intelligent adult can make the distinction for themselves, given enough information. (Though they'll still need a diagnosis to seek treatment or accommodations.)


> Our definition of autism, like many psychological conditions, is based on symptoms--behavior and development--not causes.

That's also true of many physical conditions with unknown causes, hence the comparison to pre-knowledge-of-HIV AIDS as a more apt comparison than a rash.

> But right now, if you have a large number of autistic symptoms, you most likely meet the diagnostic criteria for ASD.

By DSM 5 criteria, you need either two or three symptoms (depending on exactly where you bound así for symptom) symptoms, manifesting by a particular time, with specific social impact, and all the potential symptoms (and the impact) are defined in a way that even an intelligent layman in a position to be objective rather than applying a bias from their own position is likely to have trouble applying them well.


My son (8) is going through a diagnosis at the moment, in fact tomorrow we will be going to the last meeting with a pediatrician to effectively get my sons "Autism" badge ( Which here in NZ will open up a lot of funding for assisitance ).

Do you have any advice on things that were beneficial for you? Or alternatively things that were super horrible and should be avoided?


Hmmm. It was the '80s, so I don't remember a lot of the specifics. But there's a lot more public awareness and support now than when I was growing up, so there's that.

I guess the main thing for dealing with any autistic people is to remember that they're bad both at emoting and at reading others' emotions. If he seems insensitive sometimes, it may be that he doesn't realize he's being hurtful, or it may be that he's actually very upset but is shutting down and can't express himself effectively. We can learn to be better at both of those, but it doesn't come naturally.

This was less of a problem for me, but I've heard about autistic kids who frequently got yelled at/punished and genuinely didn't understand why, and that can be very damaging; you wind up afraid to do anything for fear of violating unknown and unspoken rules. So, I guess, try to be patient and talk to him when he acts out. Remember also that he may not be able to put his reasons for things into words, especially if he's upset or feeling pressured; that doesn't mean he doesn't have a reason.

Be patient, do your homework, listen to his doctors, be willing to talk to his teachers and go to bat for him at school, and I'm sure you'll do all right.


This is clearly a possibility, but is it just guesswork on your part? Are there actual stats on the false positive rate of self diagnosis that you can point to?


>99% of people who are self diagnosed ASD, are 80% more likely to self diagnose.

Wouldn't "99% of self-diagnosed ASD are not" be more accurate and clear, even if the stat is a guess.


I was self-diagnosed for years, was tested for autism as a child (age 5), was borderline and back then there was no spectrum, you was either full on autistic or not. Few years later things changed, though it wasn't until I was in my early 40's that I got a formal diagnoses for aspergers.

This was mainly brought on due to numerous employment experiences and mostly the last one in which the company I worked for sent me to America to work for 3 weeks. Simple enough, though fiscally they utterly destroyed me. Chap from Canada (company base) was also over there. For me to cover expenses over there they sorted me out a pittance expense advance. Chap from Canada, had 5x that advanced! Equally my boss messed up the form, did it as salary advance and upshot was first week there I realised I was going to be paid nothing end of the month, be owed a bucket load of expenses and my rent and all my bills would bounce. Short version, boss failed to sort it out, complained to HR about me chassing him about it and my subsequent breakdown, lossed the job, home, everything. Still not recovered from that.

More to the story, things like started low salary, told would get big pay rise after few month, never happened. Promoted without pay rise, did most of the work (including peers stealing credit for my work.

But then, get many things that upset you in work. Recall in another company, having time off for family funeral, arraged return date and come back to work to find somebody sitting at my desk!

I will say one issue that I wished I'd identified early was never to mix work with pashions. As I literally burned myself out so many time that the toll has been horrendous. Made lots of people very rich, but got taken advantage off something rotten.

Had I had an earlier diagnoses, life would of been easier for sure. That I have no doubts and I'd of been in better shape today mentally.

So anybody self-diagnosing - just get formally diagnosed, just to protect yourself from being abused.

That said, I have found that in some area's of life, your better of not even saying you have mental health quirks. AS you end up getting patronised and somewhat ignored. I've had personal experience with the UK Police and frankly it's shocking how bad you can be treated.

Still, encouraging that some companies being properly mindful about such people and with that, not just giving lip-service. Just a bit late for me alas, I'm a spent force in mid 50's now.


i thought i had aspergers but it turned out I was actually transgendered.

im willing to bet that the number of transgender population is a lot higher.

unabomber was also diagnosed to be transgender using modern definition.

my theory is ted bundy was also a transgender. there exists a sort of misogynistic jealousy towardsthe opposite sex but he is an extreme and rarely example along with unabomber.

people who are transgender are literally in a constant state of mental anguish. then you have normies and the social structure which is tilted to hetrosexual cis-gender populace.

i only found out i was transgender after decades of denial. its important to never lie to yourself. its amazing how much you can trick yourself in to believing in the image that those around you have set.

screaming someone misgendered you won't do jack shit.

as a transwoman my career options are now prostitution, pornography, and the drug trade but probably will be overlaps.


I'm not sure if this is a bait or not...

> i thought i had aspergers but it turned out I was actually transgendered.

As a trans woman, I must say that I am confused as to how you might mix up those two. The symptoms are really different. Those are not exclusive either.

> people who are transgender are literally in a constant state of mental anguish

Only until you get therapy and treatment. Once my gender dysphoria was under control, I was free of any negative mental health issues related to being transgender.

> as a transwoman my career options are now prostitution, pornography, and the drug trade but probably will be overlaps.

Nope, still working in STEM. I know quite a few trans programmers.


transwomen's individual lives differ drastically

good on you that you are in STEM

I was in STEM but being transgender excluded me.

Trans people are treated like freaks. As far as I know, I don't exist. I am fine with this.

but it irks me when ppl humble brag


Well, as far as I can gather from your posting history you are from Vancouver.

I know several people from western Canada that live openly trans and work without any issues. Don't give up because of a handful of bad employers and some bad experiences.

They added protection to the B.C. Human Rights Code in 2016 and there are a lot of protections Canada wide.

This is not an humble brag, this is your rights. You have the right to work in any field you want. In STEM we even have the opportunity to work remotely, which helps if you are too uncomfortable to be out in public.


every fucking position i applied to i was turned down because it had 'client facing roles'

I even said i would use my male voice on the phone because I don't wanna weird people out

This was an issue also at my old job.

I feel that I wasted a decade in the tech industry, mostly startups.

now im in my early 30s, im totally fucked.

i think lot of pornstars do it just so they can prostitute themselves.

Vancouver has social liberal rights with none of it actually respected by the population. theres still the old judeo-christian ethics along with sino ethics which make it way worse.

I'm considered a freak and will be so .

Society doesn't want to see me, or acknowledge me. what options are there for me?

what options are there for the negroes in detroit ghetto?

what options are there for people who are completely shunned and unwanted by mainstream society and even family and friends?

Fuck you. You haven't walked in my shoes.


I don't understand why you are so hostile with me.

All I'm doing is telling you that you have rights and that you should not give up. That there are people living in your city with similar situations as yours that have managed to make it through.

I know one person who moved from Québec to B.C. to start a new life as their true gender, so I have a hard time believing that the situation is as bad as you describe it. I'm sure it feels that way, being trans is absolutely crushing but our perception of the world around us is often flawed.

Looking at your posting history here, most of your recent comments are either dead or negative. That's people who have no idea you are trans. In my eyes, the issue lies elsewhere. You act very crudely and I can only hope that you do not act the same way at the workplace or during job interviews.

Have you considered moving to another province instead of changing career? There are a lot of LGBTQ+ friendly cities across Canada.

Don't give up, keep fighting.


I've seen firsthand how shitty things can be for trans people. I'm sorry. I hope you can find a support system that meets your needs.

> i thought i had aspergers but it turned out I was actually transgendered.

Is it possible that you're trans and Asperger's? There's research suggesting that they appear together more often than chance would suggest. It would explain the surprising frequency of trans people in tech fields, as well. Anecdotally, three of the four trans people I'm close to are diagnosed ASD, and I have my suspicions about the fourth.


my point was lot of people who think they have aspergers actually dont


My point is that you don't have any standing to claim that, and you're probably wrong.

Given how many hoops the medical establishment makes trans people jump through to "prove" that they're really trans and need treatment, I'd think you'd be more sympathetic.


> Given how many hoops the medical establishment makes trans people jump through to "prove" that they're really trans and need treatment

There's not a lot of hoops to jump through as an adult in Canada.

You can simply find a therapist and ask for an informed consent form. Sign it and you get access to Hormone replacement therapy.

The gender marker change is even easier, all you need is to fill a form that you can order at anytime for $140. On that form you write your new name and correct gender. Then, you only need someone else to sign under oath with you.




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