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Cited by 93Autism Spectrum Disorder ResearchDown syndrome and intellectual disability researchFamily and Disability Support Research

Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood

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Rai, Dheeraj, Heuvelman, Hein, Dalman, Christina, Culpin, Iryna, Lundberg, Michael, Carpenter, Peter, Magnusson, Cecilia·2018·JAMA Network Open
DOI 10.1001/jamanetworkopen.2018.1465PMC PMC6324523
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Abstract

Importance: Depression is a frequently occurring mental disorder and may be common in adults with autism spectrum disorders (ASD), but there is a lack of longitudinal population-based studies examining this association. Whether any increased risk of depression in ASD has a shared familial basis and whether it differs by co-occurring intellectual disability is not well known. Objectives: To examine whether individuals with ASD are more likely to be diagnosed as having depression in adulthood than the general population and their nonautistic siblings and to investigate whether these risks differ by the presence or absence of intellectual disability. Design, Setting, and Participants: Population-based cohort study with a nested sibling comparison. The Stockholm Youth Cohort is a total population record linkage study that includes all children and young people (age range, 0-17 years) who were ever resident in Stockholm County, Sweden, between January 2001 and December 2011 (n = 735 096). Data analysis was conducted between January 5 and November 30, 2017, in Stockholm County, Sweden. Main Outcomes and Measures: Clinical diagnosis of depressive disorders was identified using the Stockholm County Adult Psychiatric Outpatient Register and the Swedish National Patient Register. Results: Participants were 223 842 individuals followed up to age 27 years by 2011, of whom 4073 had diagnosed ASD (mean [SD] age, 21.5 [2.7] years; 65.9% male; 2927 without intellectual disability and 1146 with intellectual disability) and 219 769 had no ASD (mean [SD] age, 22.1 [2.8] years; 50.9% male). By age 27 years, 19.8% (n = 808) of individuals diagnosed having ASD had a diagnosis of depression compared with 6.0% (n = 13 114) of the general population (adjusted relative risk [RR], 3.64; 95% CI, 3.41-3.88). The risk of a depression diagnosis was higher in ASD without intellectual disability (adjusted RR, 4.28; 95% CI, 4.00-4.58) than in ASD with intellectual disability (adjusted RR, 1.81; 95% CI, 1.51-2.17). Nonautistic full-siblings (adjusted RR, 1.37; 95% CI, 1.23-1.53) and half-siblings (adjusted RR, 1.42; 95% CI, 1.23-1.64) of individuals with ASD also had a higher risk of depression than the general population. Compared with their nonautistic full-siblings, individuals with ASD had more than a 2-fold risk of a depression diagnosis (adjusted odds ratio, 2.50; 95% CI, 1.91-3.27) in young adulthood. Conclusions and Relevance: According to this study's results, ASD, particularly ASD without intellectual disability, is associated with depression by young adulthood compared with the general population. It appears that this association is unlikely to be explained by shared familial liability. Future research to identify modifiable pathways between ASD and depression may assist in the development of preventive interventions.

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  • In a total population study of 223,842 individuals in Stockholm County, 19.8% of the 4073 with ASD had a diagnosis of depression by age 27, compared with 6% of the general population sample (adjusted risk ratio 3.6, 95% CI 3.4 to 3.9).

    “a recent total population study 11 of 223,842 individuals in Stockholm County, Sweden, reported that, of the 4073 who had a diagnosis of ASD, 19.8% also had a diagnosis of depression by the age of 27 years, compared with 6% of the general population sample [adjusted risk ratio 3.6, 95% confidence interval (CI) 3.4 to 3.9].”

    From Guided self-help for depression in autistic adults: The ADEPT feasibility RCT (2019) · cites this paper as [11]

  • The prevalence of depression may be significantly higher in autistic adults than in the general population.

    “There is increasing evidence, however, that the prevalence of depression may be significantly higher in autistic adults than in the general population.”

    From Guided self-help for depression in autistic adults: The ADEPT feasibility RCT (2019) · cites this paper as [11]

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Authors
Rai, D., Heuvelman, H., Dalman, C., Culpin, I., Lundberg, M., Carpenter, P., & Magnusson, C.
Affiliations
  • National Health Service (GB)
  • Karolinska Institutet (SE)
  • University of Bristol (GB)
Corresponding author
Rai, Dheeraj
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2018-08-31
Volume
1
Issue
4
Pages
e181465
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2018.1465
PMC
PMC6324523
OpenAlex
W2892187963
Cited by
93
References
42
Citations by year
2026: 7 · 2025: 15 · 2024: 8 · 2023: 10 · 2022: 16 · 2021: 12 · 2020: 12 · 2019: 13
FWCI
5.65
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (acceptedVersion, cc-by)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Funders
  • NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
  • University of Bristol
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
autism spectrum disorder, depression, intellectual disability, early adulthood, familial risk, sibling comparison, depressive disorders, psychiatric comorbidity, population-based cohort, data linkage, Swedish National Patient Register, Stockholm County
MeSH terms
Autism Spectrum Disorder, Adult, Depression, Female, Humans, Male, Intellectual Disability, Sweden, Cohort Studies, Young Adult

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