Examining psychological protective mechanisms as moderators of the association between autistic traits and psychosis expression in a general population twin sample

Background: Psychological protective factors, such as coping styles, extraversion, and optimal parenting, may reduce the risk of psychosis. However, their role in moderating the association between autistic traits (ATs) and psychosis expression (PE) remains understudied. Methods: This study analyzed the first-wave data from the TwinssCan Project (n = 792 twins and siblings, 60.2 % female, mean age = 17.4 ± 3.6). ATs and PE were assessed using the Autism-Spectrum Quotient and the Community Assessment of Psychic Experiences (CAPE), respectively. Multilevel linear regression models were used to evaluate the moderating effects of seven coping styles (active coping, avoidance, reassuring thoughts, expressing emotions, seeking social support, palliative-reacting, and passive-reacting coping), extraversion, and optimal parenting. Results: Seeking social support (B[95 %CI]:-0.005[−0.009,−0.001]), reassuring thoughts (B[95 %CI]:−0.005[−0.009,−0.001]), extraversion (B[95 %CI]: −0.03[−0.04,−0.01]) and optimal parenting (B[95 %CI]: −0.02[−0.03,0]) weakened the associations between ATs and CAPE total frequency scores, suggestive of protective mechanisms, whereas passive-reacting coping (B[95 %CI]:0.007[0.004,0.010]) strengthened this, suggestive of a risk factor. Additionally, avoidance(B[95 %CI]:0.09[0.02,0.16]) emerged as a risk factor in confirmatory analyses by significantly interacting with ATs in predicting CAPE total severity scores. Conclusions: Engagement coping, extraversion, and optimal parenting may mitigate psychosis vulnerability in individuals with higher ATs, while passive-reactive coping and avoidance may heighten psychosis vulnerability. Although further research is needed, our findings provide a rationale for developing and testing targeted preventive strategies aimed at enhancing resilience in individuals with ATs.