Young Adults With Autism at Significant Risk for Depression

Megan Brooks

September 04, 2018

Young adults with autism spectrum disorder (ASD), particularly those who are relatively high functioning, have a greater risk for depression than their siblings without ASD and than the general population, new research suggests.

The study assessed data from almost 224,000 individuals in Sweden, including more than 4000 with ASD.

"To our knowledge, no previous population-based study has highlighted the stark differences in risk depression among individuals with ASD by the presence or absence of intellectual disability or has used sibling comparisons to demonstrate increased risk of depression among individuals with ASD over and beyond any influence of shared genetics and environmental factors," note investigators led by Dheeeraj Rai, MRCPsych, PhD, Bristol Medical School at the University of Bristol, United Kingdom.

Given the high burden of depression among individuals with ASD, "a greater focus on timely identification and management of depression is important considering that it is a potentially treatable cause of distress, disability, and suicidal behaviors," they write.

The study was published online August 31 in JAMA Network Open.

1 in 5 Depressed by Age 27

The researchers analyzed data on 223,842 individuals who were followed up to age 27 years as part of the Stockholm Youth Cohort study. A total of 4073 had ASD — 2927 without intellectual disability, and 1146 with intellectual disability.

Depression diagnoses were obtained from the Stockholm County Adult Psychiatric Outpatient Register and the Swedish National Patient Register.

Between the ages of 18 and 27 years, 19.8% of individuals with ASD were diagnosed with depression. This rate was three times higher than population control persons (6.0%; adjusted relative risk [aRR], 3.64; 95% confidence interval [CI], 3.41 - 3.88).

Among those with ASD, depression was more common in higher-functioning individuals without intellectual disability than in their peers with intellectual disability (24.1% vs 9.1%; aRR, 4.28; 95% CI, 4.00 - 4.58).

"This resonates with results of smaller studies and case reports suggesting that those with greater cognitive ability and thus insights into being different may be more prone to depression," Rai and colleagues note.

Nonautistic full siblings (aRR, 1.37; 95% CI, 1.23 - 1.53) and half siblings (aRR, 1.42; 95% CI, 1.23 - 1.64) of individuals with ASD also had a higher risk for depression compared with population control persons. This finding is consistent with a recent study that found a greater burden of affective disorders in siblings of individuals with ASD compared with siblings of a control group of nonautistic children, the researchers report.

Individuals with ASD had more than a twofold risk for depression in young adulthood relative to their nonautistic full siblings (adjusted odds ratio, 2.50; 95% CI, 1.91 - 3.27), suggesting a mechanism other than shared familial characteristics, the investigators write.

Delayed Diagnosis Common

The researchers also note the importance of their finding that roughly half of the individuals with ASD and depression were diagnosed with ASD after receiving a diagnosis of depression.

This finding "underscores the importance of acknowledging that, despite the increased awareness and recognition, many individuals with ASD, especially those without cognitive impairments, receive a delayed diagnosis, often after experiencing other psychiatric problems," they write.

People who are diagnosed with ASD later in life often report long-standing stress in relation to social isolation and bullying. They often know they are different but lack the explanatory framework of ASD to help them contextualize their difficulties, Rai and colleagues point out.

"Although more research will be required to gain a fuller understanding, our results may suggest that receiving a diagnosis of ASD could partially buffer against an even greater risk of depression by helping individuals understand their difficulties and seek relevant support from educational, health, or social services," they write.

Support for the study was provided by the Baily Thomas Charitable Foundation; the Swedish Research Council for Health, Working Life, and Welfare; the National Institute for Health Research Biomedical Research Center at the University Hospitals Bristol National Health Service Foundation Trust; and the University of Bristol. The authors have disclosed no relevant financial relationships.

JAMA Network Open. Published online August 31, 2018. Full text

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