Autistic Adults’ Perceived Stress Mediates the Relationship between Social Satisfaction and Self-Rated Mental Health

Background and Purpose: Despite growing recognition of autistic psychosocial disparities by mental health clinicians, the pathways through which social factors shape overall mental health outcomes in autistic adults continue to be underexplored. Social satisfaction may be a particularly relevant predictor of overall mental health for autistic adults given that they often encounter social challenges and report lower levels of social support than non-autistic peers (Bishop-Fitzpatrick et al., 2018; Charlton et al., 2023). Consistent with this framework, both social support and perceived stress have been identified as independent predictors of quality of life in autistic adults. However, whether perceived stress formally mediates the relationship between social satisfaction and self-rated mental health in this population has not been tested.

Methods: Participants were 411 autistic adults included in the All of Us Controlled Tier Dataset v8. Social satisfaction served as the predictor variable. The Perceived Stress Scale-10 (Cohen et al., 1983) served as the mediator, and self-rated mental health was the outcome variable. Covariates were gender, race, and education level. Mediation analysis was conducted using nonparametric bootstrap confidence intervals for 1,000 simulations to estimate the average causal mediation effect, the average direct effect, the total effect, and the proportion of the total effect mediated by perceived stress.

Results: All paths in the mediation model were statistically significant (all p < .001). Higher social satisfaction was associated with lower perceived stress (path a = -0.375, SE = 0.046), and lower perceived stress was in turn associated with better self-rated mental health (path b = -0.379, SE = 0.044). Social satisfaction also had a significant direct effect on mental health (c’ = 0.459, SE = 0.044). The indirect (mediated) effect through perceived stress was 0.142 (95% CI [0.095, 0.198]), with perceived stress accounting for approximately 23.7% of the total effect (95% CI [16.1%, 33.5%]). These results indicate partial mediation.

Conclusions and Implications: These findings indicate that perceived stress partially mediates the association between social satisfaction and self-rated mental health in autistic adults. Greater social satisfaction was associated with lower perceived stress, which in turn predicted better mental health. This pattern aligns with prior work demonstrating that both perceived stress and social support independently predict quality of life in autistic adults (Bishop-Fitzpatrick et al., 2018; McQuaid et al., 2022), and extends this literature by formally testing the mediating role of stress. Notably, a substantial direct effect of social satisfaction on mental health remained after accounting for perceived stress, suggesting that social satisfaction also promotes well-being through mechanisms outside of perceived stress, such as feelings of belonging, meaning, social identity, etc. Given the disproportionate mental health burden autistic adults carry, these findings point toward social satisfaction as a scalable, modifiable target for population-level mental health promotion efforts, one that complements individual-level stress management approaches and a person-in-environment perspective.