People who are autistic and transgender/gender diverse have poorer health and health care
Researchers at the Autism Research Centre at Cambridge University found that these individuals also report experiencing lower quality healthcare than both autistic and non-autistic people whose gender identity matches their sex assigned at birth (cisgender).
The findings have important implications for the healthcare and support of autistic transgender/gender diverse (TGD) individuals. This is the first large-scale study on the experiences of autistic TGD people and the results are published today in Molecular Autism.
Previous research suggests that both autistic people and TGD people separately have poorer healthcare experiences and are more likely to be diagnosed with physical and mental health conditions than other people. In addition, a 2020 study of over 640,000 people, carried out by the Autism Research Centre in Cambridge, found that TGD people are more likely to be autistic and have higher levels of autistic traits than other people. Several other studies now confirm this finding and show that autistic people are more likely to experience gender dysphoria than others. Despite these findings, there are no studies that consider risks of mental health conditions, physical health conditions, and healthcare quality among autistic TGD people.
In the largest study to date on this topic, the team at the Autism Research Centre used an anonymous, self-report survey to compare the experiences of 174 autistic TGD individuals, 1,094 autistic cisgender individuals, and 1,295 non-autistic cisgender individuals.
The survey assessed rates of mental health conditions and physical health conditions, as well as the quality of 51 different aspects of healthcare experiences. The healthcare experiences questions were wide-ranging and included questions about communication, anxiety, access and advocacy, system-level issues, and sensory experiences among others. They addressed several very basic aspects of healthcare, including asking participants to endorse statements such as ‘If I need to go to see a healthcare professional, I am able to get there’, ‘I am able to describe how bad my pain feels’, and ‘I usually understand what my healthcare professional means when they discuss my health’.
Both autistic TGD and autistic cisgender adults reported significantly poorer healthcare experiences across 50 out of 51 items compared with non-autistic cisgender people, confirming that autistic people appear to have poorer quality healthcare than non-autistic cisgender individuals, regardless of their own gender identity.
Compared to non-autistic cisgender individuals, autistic TGD people were three to 11 times more likely to report anxiety, shutdowns, and meltdowns related to common healthcare experiences.
For every 10 cisgender non-autistic adults who endorsed the following statements, on average, only two autistic cisgender adults and only one autistic TGD adult stated that they: (i) understood what their healthcare professional meant when discussing their health; (ii) knew what was expected of them when seeing a healthcare professional; or (iii) were able to describe how bad their pain felt.
Autistic TGD people and autistic cisgender people were more likely to report both long-term physical and mental health conditions that were formally diagnosed, suspected, or that had been recommended for assessment by clinicians. For every 10 non-autistic cisgender people who had at least one diagnosed physical health condition, there were 15 autistic cisgender people and 23 autistic TGD people. For every 10 non-autistic cisgender people who reported at least one diagnosed mental health condition, there were 50 autistic cisgender people and 109 autistic TGD people who reported the same.
Alarmingly, it is now well-established that autistic people and TGD people are each at a much higher risk of suicide and suicide-related behaviours than other people. In 2023, the Department of Health and Social Care specifically recognized autistic people as a priority group in their Suicide prevention strategy for England: 2023 to 2028. The new study found that, compared to people who are non-autistic and cisgender, autistic cisgender individuals were 4.6 times more likely and autistic TGD people were 5.8 times more likely to report self-harm.
Dr Elizabeth Weir, a postdoctoral scientist at the Autism Research Centre, and one of the lead researchers of the study, said: “These findings add to the growing body of evidence that many autistic people experience unacceptably poor mental health and are at a very high risk of suicide-related behaviours. We need to consider how other aspects of identity, including gender, influence these risks.”
These results emphasise the importance of considering intersectionality in clinical settings, including health risks for individuals who hold multiple minoritised identities. The researchers say clinicians should be aware of these risks and the unique barriers to healthcare that autistic TGD people may experience. The findings also underscore that people who are autistic and transgender/gender diverse experience particularly high rates of mental health conditions and risks of self-harm.
Professor Sir Simon Baron-Cohen, Director of the Autism Research Centre and a member of the team, said: “We need to consider how to adapt healthcare systems and individual care to meet the needs of autistic transgender/gender diverse people. Policymakers, clinicians, and researchers should work collaboratively with autistic people to improve existing systems and reduce barriers to healthcare.”
Reference
Green, K.*, Weir, E.*, Wright, L.*, Allison, C., & Baron-Cohen, S. Autistic and transgender/gender diverse people’s experiences of health and healthcare. Molecular Autism; 21 Jan 2025; DOI: 10.1186/s13229-024-00634-0
Autistic transgender/gender diverse individuals are more likely to have long-term mental and physical health conditions, including alarmingly high rates of self-harm, new research from the University of Cambridge suggests.
These findings add to the growing body of evidence that many autistic people experience unacceptably poor mental health and are at a very high risk of suicide-related behavioursElizabeth WeirKyle (Unsplash)Woman with transgender flag make-up
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Cambridge leads governmental project to understand impact of smartphones and social media on young people
The work has been commissioned by the UK government’s Department for Science, Innovation and Technology after a review by the UK Chief Medical Officer in 2019 found the evidence base around the links to children’s mental health were insufficient to provide strong conclusions suitable to inform policy.
The project – led by a team at the University of Cambridge, in collaboration with researchers at several leading UK universities – is aimed at improving policymakers’ understanding of the relationship between children’s wellbeing and smartphone use, including social media and messaging. It will help direct future government action in this area.
Project lead Dr Amy Orben from the Medical Research Council Cognition and Brain Sciences Unit (MRC CBU) at the University of Cambridge said: “There is huge concern about the impact of smartphone use on children's health, but the evidence base remains fairly limited. While the government is under substantial time pressure to make decisions, these will undoubtedly be better if based on improved evidence.
“This is a complex and rapidly evolving issue, with both potential harms and benefits associated with smartphone use. Technology is changing by the day, and scientific evidence creation needs to evolve and innovate to keep up.
“Our focus will be on deepening our causal understanding of the effects of new technologies, particularly over short timescales, to ensure that decisions are informed, timely and evidence-based.”
Dr Orben will lead a Project Delivery Team, with Consortium Members from the universities of Bath, Birmingham, Bristol, Glasgow, Manchester, Nottingham, Oxford and York and the London School of Economics. It will aim to identify which research methods and data sources will be most effective at identifying potential causal relationships between social media, smartphones, and the health and development of children and young people
Deputy project lead Dr Amrit Kaur Purba, also from the MRC CBU at Cambridge, said: “The impact of social media on young people is a pressing issue, and our project will ensure the research community is in a strong position to provide policymakers with the causal and high-quality insights they need. While we don’t expect this to be straightforward, our research will leverage diverse expertise from across the UK to deliver a comprehensive and informed response to make recommendations for how research in this area should be supported in future.”
The researchers will review and summarise existing research on the impact of smartphones and social media on children and young people’s mental health, wellbeing, physical health, lifestyle and health behaviours, and educational attainment. The review will recognise the diversity of perspectives that exist in this area and consider where further research could add valuable new insights to the evidence base.
They will assess the various methods and data available to understand the causal impacts, including recognising that online habits and emerging technologies are changing at a rapid pace, and considering how the experiences of vulnerable children and young people – for example, LGBTQ+ young people and those with special needs or mental health issues – can be captured in future research projects.
This will allow the team to recommend and outline how future research studies could deliver robust and causal evidence on the impact of smartphones and social media on child development factors in the next two to three years.
Technology Secretary Peter Kyle, said: "The online world offers immense opportunities for young people to connect and learn. Ensuring they can do so in an environment which puts their safety first is my priority and will guide this government’s action on online safety.
“That’s why we have launched new research, led by the University of Cambridge with support from other top UK universities, to better understand the complex relationship between technology and young people's wellbeing.
“This vital research will build a trusted evidence base for future action, helping us to protect and empower the next generation towards a safer and more positive digital future."
Cambridge researchers are leading the first phase of a new research project that will lay the groundwork for future studies into the impact on children of smartphone and social media use.
This is a complex and rapidly evolving issue, with both potential harms and benefits associated with smartphone use. Technology is changing by the day, and scientific evidence creation needs to evolve and innovate to keep upAmy OrbenOwen FrankenTeenager holding a smartphone
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Sex differences in brain structure present at birth
While male brains tended to be greater in volume than female brains, when adjusted for total brain volume, female infants on average had significantly more grey matter, while male infants on average had significantly more white matter in their brains.
Grey matter is made up of neuron cell bodies and dendrites and is responsible for processing and interpreting information, such as sensation, perception, learning, speech, and cognition. White matter is made up of axons, which are long nerve fibres that connect neurons together from different parts of the brain.
Yumnah Khan, a PhD student at the Autism Research Centre, who led the study, said: “Our study settles an age-old question of whether male and female brains differ at birth. We know there are differences in the brains of older children and adults, but our findings show that they are already present in the earliest days of life.
“Because these sex differences are evident so soon after birth, they might in part reflect biological sex differences during prenatal brain development, which then interact with environmental experiences over time to shape further sex differences in the brain.”
One problem that has plagued past research in this area is sample size. The Cambridge team tackled this by analysing data from the Developing Human Connectome Project, where infants receive an MRI brain scan soon after birth. Having over 500 newborn babies in the study means that, statistically, the sample is ideal for detecting sex differences if they are present.
A second problem is whether any observed sex differences could be due to other factors, such as differences in body size. The Cambridge team found that, on average, male infants had significantly larger brain volumes than did females, and this was true even after sex differences in birth weight were taken into account.
After taking this difference in total brain volume into account, at a regional level, females on average showed larger volumes in grey matter areas related to memory and emotional regulation, while males on average had larger volumes in grey matter areas involved in sensory processing and motor control.
The findings of the study, the largest to date to investigate this question, are published in the journal Biology of Sex Differences.
Dr Alex Tsompanidis who supervised the study, said: “This is the largest such study to date, and we took additional factors into account, such as birth weight, to ensure that these differences are specific to the brain and not due to general size differences between the sexes.
“To understand why males and females show differences in their relative grey and white matter volume, we are now studying the conditions of the prenatal environment, using population birth records, as well as in vitro cellular models of the developing brain. This will help us compare the progression of male and female pregnancies and determine if specific biological factors, such as hormones or the placenta, contribute to the differences we see in the brain.”
The researchers stress that the differences between males and females are average differences.
Dr Carrie Allison, Deputy Director of the Autism Research Centre, said: “The differences we see do not apply to all males or all females, but are only seen when you compare groups of males and females together. There is a lot a variation within, and a lot of overlap between, each group.”
Professor Simon Baron-Cohen, Director of the Autism Research Centre, added: “These differences do not imply the brains of males and females are better or worse. It’s just one example of neurodiversity. This research may be helpful in understanding other kinds of neurodiversity, such as the brain in children who are later diagnosed as autistic, since this is diagnosed more often in males.”
The research was funded by Cambridge University Development and Research, Trinity College, Cambridge, the Cambridge Trust, and the Simons Foundation Autism Research Initiative.
Reference
Khan, Y.T., Tsompanidis, A., Radecki, M.A. et al. Sex differences in human brain structure at birth. Biol Sex Differ; 17 Oct 2024; DOI: 10.1186/s13293-024-00657-5
Sex differences in brain structure are present from birth, research from the Autism Research Centre at the University of Cambridge has shown.
We know there are differences in the brains of older children and adults, but our findings show that they are already present in the earliest days of lifeYumnah KhanChayene RafaelaPhotograph of a young girl hugging a baby boy
The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.
Loneliness linked to higher risk of heart disease and stroke and susceptibility to infection
Researchers from the UK and China drew this conclusion after studying proteins from blood samples taken from over 42,000 adults recruited to the UK Biobank. Their findings are published today in the journal Nature Human Behaviour.
Social relationships play an important role in our wellbeing. Evidence increasingly demonstrates that both social isolation and loneliness are linked to poorer health and an early death. Despite this evidence, however, the underlying mechanisms through which social relationships impact health remain elusive.
One way to explore biological mechanisms is to look at proteins circulating in the blood. Proteins are molecules produced by our genes and are essential for helping our bodies function properly. They can also serve as useful drug targets, allowing researchers to develop new treatments to tackle diseases.
A team led by scientists at the University of Cambridge, UK, and Fudan University, China, examined the ‘proteomes’ – the suite of proteins – in blood samples donated by over 42,000 adults aged 40-69 years who are taking part in the UK Biobank. This allowed them to see which proteins were present in higher levels among people who were socially isolated or lonely, and how these proteins were connected to poorer health.
The team calculated social isolation and loneliness scores for individuals. Social isolation is an objective measure based on, for example, whether someone lives alone, how frequently they have contact with others socially, and whether they take part in social activities. Loneliness, on the other hand, is a subjective measure based on whether an individual feels lonely.
When they analysed the proteomes and adjusted for factors such as age, sex and socioeconomic background, the team found 175 proteins associated with social isolation and 26 proteins associated with loneliness (though there was substantial overlap, with approximately 85% of the proteins associated with loneliness being shared with social isolation). Many of these proteins are produced in response to inflammation, viral infection and as part of our immune responses, as well as having been linked to cardiovascular disease, type 2 diabetes, stroke, and early death.
The team then used a statistical technique known as Mendelian randomization to explore the causal relationship between social isolation and loneliness on the one hand, and proteins on the other. Using this approach, they identified five proteins whose abundance was caused by loneliness.
Dr Chun Shen from the Department of Clinical Neurosciences at the University of Cambridge and the Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, said: “We know that social isolation and loneliness are linked to poorer health, but we’ve never understood why. Our work has highlighted a number of proteins that appear to play a key role in this relationship, with levels of some proteins in particular increasing as a direct consequence of loneliness.
Professor Jianfeng Feng from the University of Warwick said: "There are more than 100,000 proteins and many of their variants in the human body. AI and high throughput proteomics can help us pinpoint some key proteins in prevention, diagnosis, treatment and prognosis in many human diseases and revolutionise the traditional view of human health.
"The proteins we’ve identified give us clues to the biology underpinning poor health among people who are socially isolated or lonely, highlighting why social relationships play such an important part in keeping us healthy.”
One of the proteins produced in higher levels as a result of loneliness was ADM. Previous studies have shown that this protein plays a role in responding to stress and in regulating stress hormones and social hormones such as oxytocin – the so-called ‘love hormone’ – which can reduce stress and improve mood.
The team found a strong association between ADM and the volume of the insula, a brain hub for interoception, our ability to sense what's happening inside our body – the greater the ADM levels, the smaller the volume of this region. Higher ADM levels were also linked to lower volume of the left caudate, a region involved in emotional, reward, and social processes. In addition, higher levels of ADM were linked to increased risk of early death.
Another of the proteins, ASGR1, is associated with higher cholesterol and an increased risk of cardiovascular disease, while other identified proteins play roles in the development of insulin resistance, atherosclerosis (‘furring’ of the arteries) and cancer progression, for example.
Professor Barbara Sahakian from the Department of Psychiatry at the University of Cambridge said: “These findings drive home the importance of social contact in keeping us well. More and more people of all ages are reporting feeling lonely. That’s why the World Health Organization has described social isolation and loneliness as a ‘global public health concern’. We need to find ways to tackle this growing problem and keep people connected to help them stay healthy.”
The research was supported by the National Natural Sciences Foundation of China, China Postdoctoral Science Foundation, Shanghai Rising-Star Program, National Key R&D Program of China, Shanghai Municipal Science and Technology Major Project, 111 Project, Shanghai Center for Brain Science and Brain-Inspired Technology, and Zhangjiang Lab.
Reference
Shen, C et al. Plasma proteomic signatures of social isolation and loneliness associated with morbidity and mortality. Nat Hum Behav; 3 Jan 2025; DOI: 10.1038/s41562-024-02078-1
Interactions with friends and family may keep us healthy because they boost our immune system and reduce our risk of diseases such as heart disease, stroke and type 2 diabetes, new research suggests.
More and more people of all ages are reporting feeling lonely. We need to find ways to tackle this growing problem and keep people connected to help them stay healthyBarbara SahakianNoah SillimanPerson looking out through window
The text in this work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Images, including our videos, are Copyright ©University of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.
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