The association between COVID ‐19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults
Open accessAbstract
The COVID-19 pandemic has had a significant impact on the mental health and wellbeing of the world's population, with particularly negative effects on vulnerable populations, including autistic people. Although some consensus regarding specific impact on aspects of wellbeing and mental health in autism is starting to emerge, it is unclear whether the pandemic has increased suicide risk. The goals of this study were to examine (a) potential associations between COVID-19 impact and depression, personal wellbeing, and suicide risk factors in Australian autistic adults and (b) age and gender effects. The COVID-19 Impact Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the Suicide Behavior Questionnaire, Revised (SBQ-R), were administered to 111 autistic adults aged 20 to 71 years during the second wave of the COVID-19 pandemic in Australia. COVID-19 impact showed small associations with poorer personal wellbeing (r = -0.224, p = 0.023, [-0.409, -0.016]) and higher depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not associated with the SBQ-R suicide risk score (r = 0.081, p = 0.418, [-0.118, 0.264). No significant effects were identified for age. Although model results were similar for women and men, the strength of the associations between personal wellbeing and depression (z = -2.16, p = 0.015), and depression and SBQ-R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. Qualitative analysis of an open response question from the CIS suggested that the pandemic had both positive and negative impacts on participants. The COVID-19 pandemic has had a large impact on the mental health and wellbeing of the world's population, particularly vulnerable populations such as autistic people. It is not known if these impacts on mental health and wellbeing have increased suicide risk. Our findings suggest that the impact of the COVID-19 pandemic may be associated with poorer wellbeing and higher depression, but is not associated with suicide risk. Overall, autistic people reported both positive and negative impacts of the pandemic on their lives.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Qualitative findings showed that many participants believed WFH improved their productivity and mental health.
“and improved their productivity and mental health [45].”
From Homeworking experiences of neuro-divergent workers: systematic review (2024) · cites this paper as [45]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · cited 1× · see citing works
“Responses were coded thematically using a deductive approach (Braun & Clarke, 2006) into one of three categories: (a) no change/neutral impact; (b) mild/positive impact; and (c) moderate or severe/ negative impact.”
MethodStatistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,588 · see citing works
Tabachnick, B. G., & Fidell, L. S. (1983) · Cited by 79,888 · see citing works
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2008.08.010 · Cited by 51,384 · cited 5× · see citing works
“The study was approved by the La Trobe University Human Research Ethics Committee (HEC20235).”
MethodInfluentialAn Introduction to the Bootstrap
Efron, B., & Tibshirani, R. J. (1994) · doi:10.1201/9780429246593 · Cited by 40,500 · see citing works
The REDCap consortium: building an international community of software platform partners
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O'Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., et al. (2019) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2019.103208 · Cited by 24,013 · see citing works
An Introduction to the Bootstrap
Efron, B., & Tibshirani, R. J. (1993) · doi:10.1007/978-1-4899-4541-9 · Cited by 21,230 · see citing works
The psychological impact of quarantine and how to reduce it: Rapid review of the evidence
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30460-8 · Cited by 16,378 · cited 1× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
Background(2017) · Cited by 16,319 · see citing works
(2007) · Cited by 10,092 · see citing works
A test of missing completely at random for multivariate data with missing values
Little, R. J. A. (1988) · Journal of the American Statistical Association · doi:10.1080/01621459.1988.10478722 · Cited by 8,963 · see citing works
Statistical Methods for Psychology.
Gudgeon, A. C., & Howell, D. C. (1994) · Journal of the Royal Statistical Society Series D (The Statistician) · doi:10.2307/2348956 · Cited by 8,364 · see citing works
The PHQ-9: A New Depression Diagnostic and Severity Measure
Kroenke, K., & Spitzer, R. L. (2002) · Psychiatric Annals · doi:10.3928/0048-5713-20020901-06 · Cited by 5,898 · cited 1× · see citing works
“6.3.4 | Depression Depressive symptoms were assessed with the Patient Health Questionnaire, eight-item (PHQ-8) (Kroenke et al., 2009; Kroenke & Spitzer, 2002), which is effective in screening for major and subthreshold depressive symptoms in clinical and general population samples (Kroenke et al.,…”
MethodInfluentialHolmes, E. A., O'Connor, R. C., Perry, V. H., Tracey, I., Wessely, S., Arseneault, L., Ballard, C., Christensen, H., Cohen Silver, R., Everall, I., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30168-1 · Cited by 5,715 · see citing works
The PHQ-8 as a measure of current depression in the general population
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.06.026 · Cited by 5,121 · see citing works
Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017) · Psychological Bulletin · doi:10.1037/bul0000084 · Cited by 3,784 · cited 2× · see citing works
“(Hudson et al., 2019; Lai et al., 2019; see Uljarevi c et al., 2020 for a review), which is strongly associated with suicidal thoughts and behavior (Franklin et al., 2017; Hedley, Uljarevi c, Wilmot, et al., 2018; Jokiranta-Olkoniemi et al., 2021; Nock et al., 2009; Nock et al., 2013).”
BackgroundResultSalari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M., Rasoulpoor, S., & Khaledi-Paveh, B. (2020) · Globalization and Health · doi:10.1186/s12992-020-00589-w · Cited by 3,560 · cited 3× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
BackgroundMental illness and/or mental health? Investigating axioms of the complete state model of health
Keyes, C. L. M. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.3.539 · Cited by 3,357 · cited 2× · see citing works
“When considering psychological distress, it is equally important to consider protective factors and resilience (Keyes, 2005; Keyes et al., 2002; Teismann, Forkmann, et al., 2018).”
BackgroundResultOptimizing well-being: The empirical encounter of two traditions.
Keyes, C. L. M., Shmotkin, D., & Ryff, C. D. (2002) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.82.6.1007 · Cited by 3,322 · cited 2× · see citing works
“When considering psychological distress, it is equally important to consider protective factors and resilience (Keyes, 2005; Keyes et al., 2002; Teismann, Forkmann, et al., 2018).”
BackgroundResultWhat Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis
Loomes, R., Hull, L., & Mandy, W. P. L. (2017) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2017.03.013 · Cited by 2,804 · cited 1× · see citing works
“Although similar in age and gender distribution to the longitudinal sample (Arnold et al., 2019), the study sample is not reflective of the male-to-female ratio of autism, which is about 3:1 (Loomes et al., 2017).”
BackgroundPierce, M., Hope, H., Ford, T., Hatch, S., Hotopf, M., John, A., Kontopantelis, E., Webb, R., Wessely, S., McManus, S., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30308-4 · Cited by 2,621 · see citing works
Osman, A., Bagge, C. L., Gutierrez, P. M., Konick, L. C., Kopper, B. A., & Barrios, F. X. (2001) · Assessment · doi:10.1177/107319110100800409 · Cited by 2,276 · cited 3× · see citing works
“6.3.5 | Suicide risk factors Suicide risk factors were assessed with the SBQ-R (Osman et al., 2001), a four-item self-report questionnaire designed to identify specific risk factors for suicide (e.g., threat of suicide attempt, self-reported likelihood of future suicidal behavior).”
MethodInfluentialViner, R. M., Russell, S. J., Croker, H., Packer, J., Ward, J., Stansfield, C., Mytton, O., Bonell, C., & Booy, R. (2020) · The Lancet Child & Adolescent Health · doi:10.1016/s2352-4642(20)30095-x · Cited by 2,213 · cited 1× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
BackgroundLai, M.-C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30289-5 · Cited by 1,892 · cited 2× · see citing works
“(Hudson et al., 2019; Lai et al., 2019; see Uljarevi c et al., 2020 for a review), which is strongly associated with suicidal thoughts and behavior (Franklin et al., 2017; Hedley, Uljarevi c, Wilmot, et al., 2018; Jokiranta-Olkoniemi et al., 2021; Nock et al., 2009; Nock et al., 2013).”
BackgroundNock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013) · JAMA Psychiatry · doi:10.1001/2013.jamapsychiatry.55 · Cited by 1,666 · cited 4× · see citing works
“, 2021), which are strong predictors of suicide attempt (Klonsky et al., 2017; Mars et al., 2019; Nock et al., 2009; Nock et al., 2013).”
BackgroundInfluentialImpact of COVID-19 pandemic on utilisation of healthcare services: a systematic review
Moynihan, R. N., Sanders, S., Michaleff, Z. A., Scott, A. M., Clark, J. M., To, E. J., Jones, M., Kitchener, E., Fox, M. A., Johansson, M., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045343 · Cited by 1,444 · cited 2× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
BackgroundEncyclopedia of Measurement and Statistics
Salkind, N. J. (2007) · Sage eBooks · doi:10.4135/9781412952644 · Cited by 1,425 · see citing works
O'Connor, R. C., Wetherall, K., Cleare, S., McClelland, H., Melson, A. J., Niedzwiedz, C. L., O'Carroll, R. E., O'Connor, D. B., Platt, S., Scowcroft, E., et al. (2021) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.212 · Cited by 1,042 · see citing works
Premature mortality in autism spectrum disorder
Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P., & Bölte, S. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.114.160192 · Cited by 1,011 · see citing works
Nock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000123 · Cited by 912 · cited 3× · see citing works
“There is some evidence that the pandemic has brought upon an increase in suicidal thoughts (O’Connor et al., 2021; Sokoloff et al., 2021), which are strong predictors of suicide attempt (Klonsky et al., 2017; Mars et al., 2019; Nock et al., 2009; Nock et al., 2013).”
BackgroundResultBishara, A. J., & Hittner, J. B. (2012) · Psychological Methods · doi:10.1037/a0028087 · Cited by 766 · cited 1× · see citing works
“Bootstrapping with 5000 resamples was used to correct for non-normality of data (Bishara & Hittner, 2012; see also Field, 2018; Howell, 2013).”
MethodPirkis, J., John, A., Shin, S., DelPozo-Banos, M., Arya, V., Analuisa-Aguilar, P., Appleby, L., Arensman, E., Bantjes, J., Baran, A., et al. (2021) · The Lancet Psychiatry · doi:10.1016/s2215-0366(21)00091-2 · Cited by 734 · see citing works
Risk markers for suicidality in autistic adults
Cassidy, S., Bradley, L., Shaw, R., & Baron-Cohen, S. (2018) · Molecular Autism · doi:10.1186/s13229-018-0226-4 · Cited by 621 · cited 4× · see citing works
“Autistic adults tend to score higher on the SBQ-R, and are more likely to be in the clinical range than adults from the general population (Cassidy et al., 2018).”
BackgroundResultInfluentialIncrease in suicide following an initial decline during the COVID-19 pandemic in Japan
Tanaka, T., & Okamoto, S. (2021) · Nature Human Behaviour · doi:10.1038/s41562-020-01042-z · Cited by 614 · cited 1× · see citing works
“Although declines in suicide during the early stages of the pandemic were reported in Japan, there was an increase in suicide rates during the second wave (Tanaka & Okamoto, 2021).”
BackgroundMars, B., Heron, J., Klonsky, E. D., Moran, P., O'Connor, R. C., Tilling, K., Wilkinson, P., & Gunnell, D. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30030-6 · Cited by 546 · cited 2× · see citing works
“, 2021), which are strong predictors of suicide attempt (Klonsky et al., 2017; Mars et al., 2019; Nock et al., 2009; Nock et al., 2013).”
BackgroundLosada-Baltar, A., Jiménez-Gonzalo, L., Gallego-Alberto, L., Pedroso-Chaparro, M. D. S., Fernandes-Pires, J., & Márquez-González, M. (2021) · The Journals of Gerontology: Series B · doi:10.1093/geronb/gbaa048 · Cited by 508 · see citing works
Acute mental health responses during the COVID-19 pandemic in Australia
Newby, J. M., O’Moore, K., Tang, S., Christensen, H., & Faasse, K. (2020) · PLOS ONE · doi:10.1371/journal.pone.0236562 · Cited by 471 · cited 4× · see citing works
“, 2021), the potential for impact on mental health and wellbeing in Australia was substantial and borne out by research (Newby et al., 2020).”
BackgroundInfluentialPrevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: A Meta-Analysis
Hudson, C. C., Hall, L., & Harkness, K. L. (2019) · Journal of Abnormal Child Psychology · doi:10.1007/s10802-018-0402-1 · Cited by 411 · see citing works
Cooke, J. E., Eirich, R., Racine, N., & Madigan, S. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113347 · Cited by 360 · cited 2× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
BackgroundAbuse, self-harm and suicidal ideation in the UK during the COVID-19 pandemic.
Iob, E., Steptoe, A., & Fancourt, D. (2020) · The British Journal of Psychiatry · doi:10.1192/bjp.2020.130 · Cited by 297 · see citing works
Shin, C., Lee, S., Han, K., Yoon, H.-K., & Han, C. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.02.01 · Cited by 265 · cited 1× · see citing works
“…symptoms were assessed with the Patient Health Questionnaire, eight-item (PHQ-8) (Kroenke et al., 2009; Kroenke & Spitzer, 2002), which is effective in screening for major and subthreshold depressive symptoms in clinical and general population samples (Kroenke et al., 2009; Shin et al., 2019).”
MethodRisk and protective factors underlying depression and suicidal ideation in Autism Spectrum Disorder
Hedley, D., Uljarević, M., Foley, K.-R., Richdale, A., & Trollor, J. (2018) · Depression and Anxiety · doi:10.1002/da.22759 · Cited by 246 · see citing works
Self-citationCOVID-19: overcoming the challenges faced by individuals with autism and their families
Eshraghi, A. A., Li, C. N., Alessandri, M., Messinger, D. S., Eshraghi, R. S., Mittal, R., & Armstrong, F. D. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30197-8 · Cited by 232 · cited 2× · see citing works
“Consistent with others (Eshraghi et al., 2020; Oomen et al., 2021), COVID-19 had both positive and negative impacts on participant wellbeing.”
BackgroundMichalos, A. C. (2014) · Springer eBooks · doi:10.1007/978-94-007-0753-5_103021 · Cited by 208 · see citing works
Recent advances in differentiating suicide attempters from suicide ideators
Klonsky, E. D., Qiu, T., & Saffer, B. Y. (2017) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000294 · Cited by 193 · cited 1× · see citing works
“There is some evidence that the pandemic has brought upon an increase in suicidal thoughts (O’Connor et al., 2021; Sokoloff et al., 2021), which are strong predictors of suicide attempt (Klonsky et al., 2017; Mars et al., 2019; Nock et al., 2009; Nock et al., 2013).”
BackgroundA 20‐year study of suicide death in a statewide autism population
Kirby, A. V., Bakian, A. V., Zhang, Y., Bilder, D. A., Keeshin, B. R., & Coon, H. (2019) · Autism Research · doi:10.1002/aur.2076 · Cited by 192 · see citing works
Assessment of Suicidal Behaviors Among Individuals With Autism Spectrum Disorder in Denmark
Kõlves, K., Fitzgerald, C., Nordentoft, M., Wood, S. J., & Erlangsen, A. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.33565 · Cited by 191 · cited 2× · see citing works
“There is consistent evidence of increased suicide risk among the autistic population (Hirvikoski et al., 2016; Jokiranta-Olkoniemi et al., 2021; Kirby et al., 2019; Kõlves et al., 2021; see Hedley & Uljarevi c, 2018 for a review).”
BackgroundSystematic Review of Suicide in Autism Spectrum Disorder: Current Trends and Implications
Hedley, D., & Uljarević, M. (2018) · Current Developmental Disorders Reports · doi:10.1007/s40474-018-0133-6 · Cited by 176 · cited 2× · see citing works
“There is consistent evidence of increased suicide risk among the autistic population (Hirvikoski et al., 2016; Jokiranta-Olkoniemi et al., 2021; Kirby et al., 2019; Kõlves et al., 2021; see Hedley & Uljarevi c, 2018 for a review).”
BackgroundSelf-citationCOVID-19 Pandemic and Impact on Patients with Autism Spectrum Disorder
Baweja, R. K., Brown, S. L., Edwards, E. M., & Murray, M. J. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-04950-9 · Cited by 167 · cited 1× · see citing works
“…Autism spectrum disorder (ASD; henceforth ‘autism’) have a heightened vulnerability to mental ill-health (JokirantaOlkoniemi et al., 2021; Lai et al., 2019; Uljarevi c et al., 2020) and therefore may be particularly vulnerable to the impact of COVID-19 (Baweja et al., 2021; Oomen et al., 2021).”
BackgroundAnxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Foley, K., Magiati, I., Cai, R. Y., Dissanayake, C., Richdale, A. L., & Trollor, J. N. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-04084-z · Cited by 164 · see citing works
Hedley, D., Uljarević, M., Wilmot, M., Richdale, A., & Dissanayake, C. (2018) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2017.11.003 · Cited by 154 · see citing works
Hedley, D., Uljarević, M., Wilmot, M., Richdale, A. L., & Dissanayake, C. (2017) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-017-3274-2 · Cited by 139 · cited 1× · see citing works
“…pre-existing heightened risk of suicide (Cassidy et al., 2018; Hedley & Uljarevi c, 2018), or broad risk factors such as reduced social support which is typically associated with suicide risk (Hedley et al., 2017; Hedley, Uljarevi c, Foley, et al., 2018; Hedley, Uljarevi c, Wilmot, et al., 2018).”
BackgroundOomen, D., Nijhof, A. D., & Wiersema, J. R. (2021) · Molecular Autism · doi:10.1186/s13229-021-00424-y · Cited by 136 · cited 3× · see citing works
“…Autism spectrum disorder (ASD; henceforth ‘autism’) have a heightened vulnerability to mental ill-health (JokirantaOlkoniemi et al., 2021; Lai et al., 2019; Uljarevi c et al., 2020) and therefore may be particularly vulnerable to the impact of COVID-19 (Baweja et al., 2021; Oomen et al., 2021).”
BackgroundA longitudinal study of mental health before and during COVID-19 lockdown in the French population
Ramiz, L., Contrand, B., Castro, M. Y. R., Dupuy, M., Lu, L., Sztal-Kutas, C., & Lagarde, E. (2021) · Globalization and Health · doi:10.1186/s12992-021-00682-8 · Cited by 121 · cited 4× · see citing works
“The COVID-19 viral pandemic has dramatically impacted the world’s population (Moynihan et al., 2021; Salari et al., 2020; Viner et al., 2020), including significant negative impacts on mental health (Brooks et al., 2020; Cooke et al., 2020; O’Connor et al., 2021; Ramiz et al., 2021).”
BackgroundInfluentialTeismann, T., Forkmann, T., Brailovskaia, J., Siegmann, P., Glaesmer, H., & Margraf, J. (2018) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2017.08.001 · Cited by 120 · see citing works
Lugo‐Marín, J., Gisbert, L., Setién-Ramos, I., Español‐Martín, G., Ibañez-Jiménez, P., Forner-Puntonet, M., Arteaga-Henríquez, G., Soriano-Día, A., Duque-Yemail, J. D., & Ramos‐Quiroga, J. A. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101757 · Cited by 114 · cited 1× · see citing works
“…increased worry (e.g., about access to health services, medication and food, safety and security, work, and pets) and stress (often associated with a loss of routines and social supports) (Corbett et al., 2021; Eshraghi et al., 2020; Lugo-Marín et al., 2021; Oomen et al., 2021) have been reported.”
BackgroundArnold, S. R. C., Uljarević, M., Hwang, Y. I., Richdale, A. L., Trollor, J. N., & Lawson, L. P. (2019) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-019-03947-9 · Cited by 101 · see citing works
Corbett, B., Muscatello, R. A., Klemenčić, M., & Schwartzman, J. M. (2021) · Autism Research · doi:10.1002/aur.2521 · Cited by 101 · cited 2× · see citing works
“Thus, with regards to potential risk factors for increased mental health difficulties (e.g., stress) (Cooke et al., 2020; Corbett et al., 2021; Salari et al., 2020) and suicide (e.g., reduced social support) (Holmes et al., 2020; O’Connor et al., 2021), the potential for impact on mental health and…”
BackgroundThe Coronavirus Impact Scale: Construction, Validation, and Comparisons in Diverse Clinical Samples
Stoddard, J., Reynolds, E. K., Paris, R., Haller, S. P., Johnson, S. B., Zik, J. B., Elliotte, E., Maru, M., Jaffe, A., Mallidi, A., et al. (2023) · JAACAP Open · doi:10.1016/j.jaacop.2023.03.003 · Cited by 87 · cited 16× · see citing works
“Nonetheless, the nature of ‘impact’ as measured by the CIS scale emphasizes the social and familial impact of COVID-19 (e.g., mental health treatment access, social supports, stress).”
BackgroundMethodInfluentialCassidy, S., Bradley, L., Cogger-Ward, H., & Rodgers, J. (2021) · Molecular Autism · doi:10.1186/s13229-021-00449-3 · Cited by 84 · cited 1× · see citing works
“Although a version of this instrument has now been validated for use in autistic adults (Cassidy et al., 2021), it was not available when the present study was conceived.”
MethodImproving health care for disabled people in COVID-19 and beyond: Lessons from Australia and England
Kavanagh, A. M., Dickinson, H., Carey, G. E., Llewellyn, G. M., Emerson, E., Disney, G., & Hatton, C. (2020) · Disability and health journal · doi:10.1016/j.dhjo.2020.101050 · Cited by 81 · cited 1× · see citing works
“Among the most vulnerable to these impacts are those with pre-existing mental health conditions (Newby et al., 2020; O’Connor et al., 2021; Tan et al., 2020) and disability (Kavanagh et al., 2021).”
BackgroundHedley, D., Uljarević, M., Bury, S. M., & Dissanayake, C. (2019) · Autism Research · doi:10.1002/aur.2064 · Cited by 76 · see citing works
Pediatric emergency department utilization during the COVID-19 pandemic in New York City
Sokoloff, W. C., Krief, W. I., Giusto, K. A., Mohaimin, T., Murphy-Hockett, C., Rocker, J. A., & Williamson, K. A. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.02.029 · Cited by 75 · cited 3× · see citing works
“There is some evidence that the pandemic has brought upon an increase in suicidal thoughts (O’Connor et al., 2021; Sokoloff et al., 2021), which are strong predictors of suicide attempt (Klonsky et al., 2017; Mars et al., 2019; Nock et al., 2009; Nock et al., 2013).”
BackgroundRisk for Premature Mortality and Intentional Self-harm in Autism Spectrum Disorders
Jokiranta‐Olkoniemi, E., Gyllenberg, D., Sucksdorff, D., Suominen, A., Kronström, K., Chudal, R., & Sourander, A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04768-x · Cited by 73 · see citing works
Early Pandemic Experiences of Autistic Adults: Predictors of Psychological Distress
Bal, V. H., Wilkinson, E. H., White, L. C., Law, J. K., Feliciano, P., & Chung, W. K. (2021) · Autism Research · doi:10.1002/aur.2480 · Cited by 64 · cited 4× · see citing works
“Based on the literature from both general and autistic populations, summarized above (e.g., Bal et al., 2021; Hedley et al., 2019; Hedley, Uljarevi c, Foley, et al., 2018; O’Connor et al., 2021; Teismann, Forkmann, et al., 2018), we hypothesized that: (a) wellbeing would be a protective factor and…”
BackgroundInfluentialWhat has been the effect of covid-19 on suicide rates?
Appleby, L. (2021) · BMJ · doi:10.1136/bmj.n834 · Cited by 60 · cited 1× · see citing works
“This finding may be due to data being collected during the early stages of the pandemic, thereby concealing longer-term effects (Appleby, 2021; Pirkis et al., 2021).”
BackgroundCohort profile: the Australian Longitudinal Study of Adults with Autism (ALSAA)
Arnold, S. R. C., Foley, K., Hwang, Y. I., Richdale, A. L., Uljarević, M., Lawson, L. P., Cai, R. Y., Falkmer, T., Falkmer, M., Lennox, N., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030798 · Cited by 58 · cited 3× · see citing works
“Although similar in age and gender distribution to the longitudinal sample (Arnold et al., 2019), the study sample is not reflective of the male-to-female ratio of autism, which is about 3:1 (Loomes et al., 2017).”
BackgroundTeismann, T., Brailovskaia, J., Siegmann, P., Nyhuis, P. W., Wolter, M., & Willutzki, U. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.11.085 · Cited by 52 · see citing works
Considerations for assessing the impact of the COVID-19 pandemic on mental health in Australia
Tan, E. J., Meyer, D., Neill, E., Phillipou, A., Toh, W. L., Rheenen, T. E. V., & Rossell, S. L. (2020) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867420947815 · Cited by 48 · cited 2× · see citing works
“Among the most vulnerable to these impacts are those with pre-existing mental health conditions (Newby et al., 2020; O’Connor et al., 2021; Tan et al., 2020) and disability (Kavanagh et al., 2021).”
BackgroundThe Coronavirus Impact Scale: Construction, Validation, and Comparisons in Diverse Clinical SamplesPreprint
Stoddard, J., Reynolds, E. K., Paris, R., et al. (2021) · doi:10.31234/osf.io/kz4pg · Cited by 43 · see citing works
Hedley, D., Uljarević, M., Cai, R. Y., Bury, S. M., Stokes, M. A., & Evans, D. W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0245562 · Cited by 40 · see citing works
Byrne, S. J., Bailey, E., Lamblin, M., McKay, S., Pirkis, J., Mihalopoulos, C., Spittal, M. J., Rice, S., Hetrick, S., Hamilton, M., et al. (2022) · Trials · doi:10.1186/s13063-022-06072-8 · Cited by 26 · see citing works
Self-citationAutism-related traits and suicide risk among active duty U.S. military service members.
Stanley, I. H., Day, T. N., Gallyer, A. J., Shelef, L., Kalla, C., Gutierrez, P. M., & Joiner, T. E. (2020) · Psychological Services · doi:10.1037/ser0000418 · Cited by 22 · cited 1× · see citing works
“There is emerging evidence that autistic traits or phenotype contribute to heightened suicide risk (Cassidy et al., 2018; Hedley et al., 2021; Stanley et al., 2021).”
BackgroundByrne, S. J., Bailey, E., Lamblin, M., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-518233/v1 · Cited by 6 · see citing works
Haschek, A., Richdale, A. L., Lawson, L. P., Abdullahi, I., Flower, R. L., Unwin, K. L., Hedley, D., & Bury, S. M. (2021) · Figshare · doi:10.26181/5f890479948c5 · Cited by 1 · see citing works
Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Cai, R., Hardan, A., & South, M. (2020) · Encyclopedia of Autism Spectrum Disorders · doi:10.1007/978-1-4614-6435-8_102432-1 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- International Wellbeing Group. (2013). Personal wellbeing index (5th ed.). Deakin University. https://www.acqol.com.au/instruments#measures
- Thorpe, K. G. (2018). The subjective wellbeing of Australians with an Autism Spectrum condition [Master's dissertation, Deakin University, Melbourne, Australia. http://hdl.handle.net/10536/DRO/DU:30112386
Cited by
Sorted by citations
Updated Systematic Review of Suicide in Autism: 2018–2024
Brown, C. M., Newell, V., Sahin, E., & Hedley, D. (2024) · Current Developmental Disorders Reports · doi:10.1007/s40474-024-00308-9 · Cited by 130 · see citing works
“Mood disorders, particularly depression and anxiety, were associated with increased STB risk across multiple studies [57, 74, 75].”
Suicide and COVID-19: a rapid scoping review
Barlattani, T., D’Amelio, C., Capelli, F., Mantenuto, S., Rossi, R., Socci, V., Stratta, P., Stefano, R. D., Rossi, A., & Pacitti, F. (2023) · Annals of General Psychiatry · doi:10.1186/s12991-023-00441-6 · Cited by 54 · see citing works
Mournet, A. M., Wilkinson, E. H., Bal, V. H., & Kleiman, E. M. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102235 · Cited by 49 · see citing works
Santomauro, D. F., Hedley, D., Sahin, E., Brugha, T. S., Naghavi, M., Vos, T., Whiteford, H. A., Ferrari, A. J., & Stokes, M. A. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116150 · Cited by 41 · see citing works
“Prior work with autistic persons also found no evidence of an association between reported pandemic impact and suicidal ideation (Hedley et al., 2021), suggesting the risk profile for autistic persons may not have been significantly impacted by the COVID-19 pandemic.”
BackgroundNajeeb, P., & Quadt, L. (2024) · Neurodiversity · doi:10.1177/27546330241233088 · Cited by 40 · see citing works
“Furthermore, some studies ( N = 3) (Asbury & Toseeb, 2023; Hedley et al., 2021; Ozsivadjian et al., 2022) focused on the impact of the COVID-19 pandemic and found that some pandemic-asso-ciated adaptations increased autistic individuals ’ well-being.”
InfluentialFridell, A., Norrman, H. N., Girke, L., & Bölte, S. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031268 · Cited by 31 · see citing works
Autistic patients' experiences of the hospital setting: A scoping review
Greenwood, E., Cooklin, A., Barbaro, J., & Miller, C. (2023) · Journal of Advanced Nursing · doi:10.1111/jan.15880 · Cited by 30 · see citing works
Hedley, D., Batterham, P. J., Bury, S. M., Clapperton, A., Denney, K. E., Dissanayake, C., Fox, P., Frazier, T. W., Gallagher, E., Hayward, S. M., et al. (2022) · Autism · doi:10.1177/13623613221131234 · Cited by 28 · see citing works
“…of suicidal thoughts, aligned with rumination and repetitive thinking, as well as suicide risk in autistic and non-autistic populations (Hedley et al., 2021b; Kerkhof & van Spijker, 2011; Morrison & O’Connor, 2008), (b) closeness to attempt, which can be indicative of the emergence of…”
BackgroundMethodResultCoping‐resilience profiles and experiences of stress in autistic adults
Muniandy, M., Richdale, A. L., & Lawson, L. P. (2022) · Autism Research · doi:10.1002/aur.2817 · Cited by 17 · see citing works
“While there is emerging evidence to suggest its deleterious effects on stress and well-being in autistic individuals (e.g., Ameis et al., 2020; Corbett et al., 2021), the impact of the pandemic will inevitably vary between individuals (Hedley et al., 2021).”
BackgroundRealpe, A. X., Mills, N., Beasant, L., Douglas, S., Kenny, L., & Rai, D. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0027 · Cited by 13 · see citing works
Wolff, B., Franco, V. R., Magiati, I., Pestell, C., & Glasson, E. J. (2023) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2023.104566 · Cited by 15 · see citing works
Soto, E. F., Orantes, D., Russo, N. N., & Antshel, K. M. (2024) · Autism · doi:10.1177/13623613241236228 · Cited by 14 · see citing works
“The SBQ-R has been used to assess suicidal behaviors in autistic adult populations (Cassidy et al., 2021; Hedley et al., 2021) and SGM populations (Chu et al., 2019).”
MethodFeatherstone, C., Sharpe, R. A., Axford, N., Asthana, S., Ball, S., & Husk, K. (2022) · Primary Health Care Research & Development · doi:10.1017/s1463423622000755 · Cited by 15 · see citing works
“Emerging research with this population has found that lockdown had a negative effect on mental well-being for autistic adults, including increasing anxiety and stress (Bal et al. , 2021; Pais and Knapp, 2021; Hedley et al. , 2021; Bundy et al. , 2022).”
BackgroundLew‐Koralewicz, A. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19159468 · Cited by 12 · see citing works
Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders
Shakeshaft, A., Blakey, R., Kwong, A. S. F., Riglin, L., Smith, G. D., Stergiakouli, E., Tilling, K. M., & Thapar, A. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.01.029 · Cited by 12 · see citing works
“Additionally, some autistic individuals reported that the relief of day-to-day social demands was appreciated during the early lockdown (Hedley et al., 2021), with less demands to camouflage or mask behavior (Bundy et al., 2022).”
Friedman, S., Noble, R., Archer, S., Gibson, J. L., & Hughes, C. H. (2023) · Autism · doi:10.1177/13623613231166462 · Cited by 11 · see citing works
“Despite these silver linings, for many, increased social isolation (Hedley et al., 2021; Pellicano et al., 2021) and disruptions to routine (Bundy et al., 2022; Davidson et al., 2021) were linked to poorer well-being.”
BackgroundBal, V., Mournet, A. M., Glascock, T., Shinall, J., Gunin, G., Jadav, N., Zhang, H., Brennan, E., Istvan, E., & Kleiman, E. M. (2023) · Autism · doi:10.1177/13623613231186035 · Cited by 10 · see citing works
“Reports highlighting the impact of the pandemic on mental health and well-being of autistic adults (Adams et al., 2021; Bal et al., 2021; Hedley et al., 2021) underscore the need for brief, problem-focused interventions to support autistic adults through periods of uncertainty and constant change.”
BackgroundHedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., Robinson, J., Trollor, J. N., Uljarević, M., & Stokes, M. A. (2024) · Autism · doi:10.1177/13623613241289493 · Cited by 10 · see citing works
“Clinician determined suicide risk level was based on the study risk protocol (see Hedley, Batterham, et al., 2023; Hedley et al., 2021) and involved discussion with a registered psychologist on the team (authors S.M.”
InfluentialHomeworking experiences of neuro-divergent workers: systematic review
Brooks, S. K., Hall, C. E., Rogers, M. B., & Greenberg, N. (2024) · Occupational Medicine · doi:10.1093/occmed/kqae095 · Cited by 9 · see citing works
The relationship between alexithymia and self-esteem in autistic adolescents
Strang, M., Macmillan, C. M., Brown, C. M., Hooley, M., & Stokes, M. A. (2024) · Research in Autism · doi:10.1016/j.rasd.2024.102334 · Cited by 11 · see citing works
Jeyagurunathan, A., Koh, Y. S., Sambasivam, R., Abdin, E., Samari, E., Chow, W. L., Ma, S., Chong, S. A., & Subramaniam, M. (2025) · Journal of Happiness Studies · doi:10.1007/s10902-025-00889-1 · Cited by 4 · see citing works
“Studies have shown a significant association of the pandemic with poor PWI and high depressive and anxiety symptoms (Hedley et al., 2021; Salari et al., 2020).”
Guo, C., Wong, K. F., Xu, Y., Hung, K. K. C., & Ho, H. C. (2024) · Applied Research in Quality of Life · doi:10.1007/s11482-024-10395-w · Cited by 4 · see citing works
“For instance, the lockdown associated with pandemics such as COVID-19 is believed to cause a wellbeing crisis, with detrimental effects on an individual’s physical and mental wellbeing, especially for vulnerable populations (Dinsuhaimi et al., 2022; Hedley et al., 2021; Owens et al., 2022).”
Kassee, C., Jachyra, P., Mahalingam, V., Tint, A., Lin, H., Ameis, S. H., Martino, A. D., Lunsky, Y., & Lai, M. (2024) · Journal of Applied Research in Intellectual Disabilities · doi:10.1111/jar.13300 · Cited by 3 · see citing works
Saavedra, C. S. F., Sáez, C. P. G., Guillén, V., Andana, M. V., Cid, C. O. L., Collin, S. H., & Riquelme, V. A. R. (2023) · Revista Chilena de Fonoaudiología · doi:10.5354/0719-4692.2023.69295 · Cited by 2 · see citing works
Predictors of Change in Wellbeing and Mental Health of Parents of Autistic Pre-Schoolers
Green, C. C., Smith, J., Bent, C. A., Chetcuti, L., Uljarević, M., Benson, P. R., & Hudry, K. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-024-06471-7 · Cited by 2 · see citing works
“Some data collection occurred following onset of the COVID-19 world-wide pandemic, during which the local region experienced multiple, protracted periods of lockdown (i.e., stay-at-home order) which have been have been linked to poorer wellbeing and increased depression (Hedley et al., 2021).”
Lowe, J., Jones, S. C., & Mizzi, S. (2024) · Disability & Society · doi:10.1080/09687599.2024.2439973 · Cited by 2 · see citing works
“Although both autistic women and men reported experiencing greater difficulties during the COVID-19 pandemic, the associations between personal wellbeing, depression and suicide risk were stronger among autistic women (Hedley et al. 2021).”
Redquest, B. K., Andreasen, S., Turner, K., & McMorris, C. A. (2023) · Developments in neuroethics and bioethics · doi:10.1016/bs.dnb.2023.05.007 · Cited by 2 · see citing works
Grieve, C. M., Roest, A. M., White, S. W., Ganzevoort, C. O. W., Smit, R. W. H., Bekius, J., van Balkom, I. D. C., & Greaves‐Lord, K. (2026) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-026-00580-y · Cited by 1 · see citing works
Jodra, M., & García-Villamisar, D. A. (2024) · Scientific Reports · doi:10.1038/s41598-024-55049-x · Cited by 1 · see citing works
“This coincides with previous results of several studies 7,8 that proved the existence of this relationship.”
ResultCullen, J. A., Leslie, A., & Haney, J. L. (2024) · Social Work in Mental Health · doi:10.1080/15332985.2024.2357704 · Cited by 1 · see citing works
“Our findings support research indicating that were both positive and negative impacts of COVID-19 on the autistic community (Hedley et al., 2021; Oomen et al., 2021).”
Hedley, D., Williams, Z. J., Deady, M., Batterham, P. J., Bury, S. M., Brown, C. M., Robinson, J., Trollor, J. N., Uljarević, M., & Stokes, M. A. (2024) · doi:10.31219/osf.io/xqd9b · Cited by 1 · see citing works
New Perspectives about the COVID-19 Pandemic for Autistics
Bennett, M., & Goodall, E. (2022) · Emerald Group Publishing Limited eBooks · doi:10.1108/978-1-80455-033-520221004
Spanyol, S., Leung, C., Bennett‐Weston, A., & Silva, A. C. S. E. (2025) · Research in Autism · doi:10.1016/j.reia.2025.202534
In Times of Need: Psychiatric Emergency Department Presentations in Autistic Adults
Courchesne, V., Frayne, M., Castelino, C., Luk, V., Man, L. L. Y., Lee, C.-H. J., Baharikhoob, P., Pace-Tonna, C., Jachyra, P., Ameis, S. H., et al. (2026) · Autism in Adulthood · doi:10.1177/25739581251415125
Double Disadvantage? Wellbeing Among Vietnamese Migrant Parents of Autistic Children
Nguyen, K. P., Pecora, L. A., Hooley, M., & Stokes, M. A. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-026-07453-7
Neurodiversidade na administração pública brasileira: experiências vividas por servidores públicos
Motta, A. C. D. G. D., da Motta, D. L., & Bouzada, M. A. C. (2026) · Cadernos EBAPE BR · doi:10.1590/1679-395120260009x
Neurodiversity in Brazilian public administration: lived experiences of civil servants
Motta, A. C. D. G. D., da Motta, D. L., & Bouzada, M. A. C. (2026) · Cadernos EBAPE BR · doi:10.1590/1679-395120260009
- Authors
- Hedley, D., Hayward, S. M., Denney, K., Uljarević, M., Bury, S., Sahin, E., Brown, C. M., Clapperton, A., Dissanayake, C., Robinson, J., Trollor, J., & Stokes, M. A.
- Affiliations
- La Trobe University (AU)
- Deakin University (AU)
- The University of Melbourne (AU)
- UNSW Sydney (AU)
- Corresponding author
- Hedley, Darren
- ORCID
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2021-09-21
- Volume
- 14
- Issue
- 12
- Pages
- 2663-2676
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- PMC
- PMC8646719
- OpenAlex
- W3200644286
- Cited by
- 38
- References
- 75
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 14 · 2023: 9 · 2022: 7 · 2021: 1
- FWCI
- 5.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Autism Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- La Trobe University (cc-by)
- Funders
- Australian Research Council (Discovery Early Career Researcher Award / DE180100)
- National Health and Medical Research Council (Career Development Fellowship / APP1142348)
- Suicide Prevention Australia (National Suicide Prevention Research Fellowship)
- University of Melbourne (Dame Kate Campbell Fellowship)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- COVID-19 pandemic, autism spectrum disorder, autistic adults, depression, suicide risk, personal well-being, mental health, gender differences, age differences
- MeSH terms
- Autism Spectrum Disorder, COVID-19, SARS-CoV-2, Adult, Australia, Autistic Disorder, Depression, Female, Humans, Male, Risk Factors, Suicide, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
