Beyond symptoms: socioeconomic and behavioral determinants of quality of life in adults with autism spectrum disorder.

Abstract

Quality of life (QoL) is a central outcome in autism spectrum disorder (ASD) research, particularly in adulthood, when social participation, employment, and health behaviors substantially shape long-term well-being. We aimed to examine global and domain-specific QoL among Brazilian adults with ASD and to investigate sociodemographic and behavioral determinants of poorer QoL. A cross-sectional web-based survey was conducted with 439 adults diagnosed with ASD in Brazil. QoL was assessed using the EUROHIS-QOL 8-item index, covering global QoL and its domains, using the cutoff <4 to classify poor QoL. Sociodemographic, clinical, and behavioral variables were self-reported. 60.4% of participants reported low QoL. In the multiple logistic regression, physical activity and higher household income were independently associated with lower odds of poor QoL. In contrast, unemployment and being divorced were associated with poorer QoL. A longer time since diagnosis was associated with better QoL in multiple QoL domains. Physical activity emerged as a significant associated factor with better QoL across nearly all QoL dimensions. QoL among adults with ASD is associated with behavioral and social determinants rather than clinical characteristics alone. Higher levels of physical activity, employment, and socioeconomic stability were associated with better multidimensional QoL in this population.