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Cited by 139Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesChild and Adolescent Psychosocial and Emotional Development

Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder

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Kirsch, Alexandra C., Huebner, Andrea R. S., Mehta, Sunil Q., Howie, Flora R., Weaver, Amy L., Myers, Scott M., Voigt, Robert G., Katusic, Slavica K.·2020·JAMA Pediatrics
DOI 10.1001/jamapediatrics.2019.4368PMC PMC6902186
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Abstract

Importance: It is critical to evaluate the risk of comorbid psychiatric diagnoses to meet the needs of individuals with autism spectrum disorder (ASD). Objective: To examine whether individuals with ASD are at greater risk for comorbid diagnoses of depression, anxiety, or bipolar disorder. Design, Setting, and Participants: This cohort study used data from a population-based birth cohort of 31 220 individuals born in Olmsted County, Minnesota, from January 1, 1976, to December 31, 2000. Patients with research-identified ASD were previously identified using a multistep process that evaluated signs and symptoms abstracted from medical and educational records. For each of the 1014 patients with ASD, 2 age- and sex-matched referents who did not meet criteria for ASD were randomly selected from the birth cohort (n = 2028). Diagnosis codes for anxiety, depression, and bipolar disorders were electronically obtained using the Rochester Epidemiological Project records-linkage system. Data analysis was performed from July 1, 2018, to April 1, 2019. Main Outcomes and Measures: Cumulative incidence of clinically diagnosed depression, anxiety, and bipolar disorder through early adulthood in individuals with ASD compared with referents. Results: A total of 1014 patients with ASD (median age at last follow-up, 22.8 years [interquartile range, 18.4-28.0 years]; 747 [73.7%] male; 902 [89.0%] white) and 2028 referents (median age at last follow-up, 22.4 years [interquartile range, 18.8-26.2 years]; 1494 [73.7%] male; 1780 [87.8%] white) participated in the study. Patients with ASD were significantly more likely to have clinically diagnosed bipolar disorder (hazard ratio [HR], 9.34; 95% CI, 4.57-19.06), depression (HR, 2.81; 95% CI, 2.45-3.22), and anxiety (HR, 3.45; 95% CI, 2.96-4.01) compared with referents. Among individuals with ASD, the estimates of cumulative incidence by 30 years of age were 7.3% (95% CI, 4.8%-9.7%) for bipolar disorder, 54.1% (95% CI, 49.8%-58.0%) for depression, and 50.0% (95% CI, 46.0%-53.7%) for anxiety. Among referents, cumulative incidence estimates by 30 years of age were 0.9% (95% CI, 0.1%-1.7%) for bipolar disorder, 28.9% (95% CI, 25.7%-32.0%) for depression, and 22.2% (95% CI, 19.3%-25.0%) for anxiety. Conclusions and Relevance: The findings suggest that individuals with ASD may be at increased risk for clinically diagnosed depression, anxiety, and bipolar disorder compared with age- and sex-matched referents. This study supports the importance of early, ongoing surveillance and targeted treatments to address the psychiatric needs of individuals with ASD.

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  • Psychosocial factors that lead to challenges in relationship development and academic and vocational success may play a role in anxiety disorders among individuals with ASD.

    “Psychosocial factors that lead to challenges in relationship development and academic and vocational success may play a role in anxiety disorders among individuals with ASD [93].”

    From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [93]

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Authors
Kirsch, A. C., Huebner, A. R. S., Mehta, S. Q., Howie, F. R., Weaver, A. L., Myers, S. M., Voigt, R. G., & Katusic, S. K.
Affiliations
  • Mayo Clinic (US)
  • Autism & Developmental Medicine Institute (US)
  • Baylor College of Medicine (US)
Corresponding author
Kirsch, Alexandra C.
ORCID
Venue
JAMA Pediatrics
Publisher
American Medical Association (AMA)
Published
2020-01-01
Volume
174
Issue
1
Pages
63
ISSN
  • 1072-4710 (ISSN-L)
  • 2168-6203
DOI
10.1001/jamapediatrics.2019.4368
PMC
PMC6902186
OpenAlex
W2991063110
Cited by
139
References
35
Citations by year
2026: 23 · 2025: 22 · 2024: 24 · 2023: 20 · 2022: 23 · 2021: 19 · 2020: 8
FWCI
7.27
Type
journal article
Language
en
Open access
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute on Aging (R01AG034676, R33AG058738)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
autism spectrum disorder, comorbidities, mood disorders, anxiety disorders, depression, bipolar disorder, cumulative incidence, early adulthood, psychiatric diagnosis, birth cohort, Olmsted County, Minnesota, risk factors, sex differences, parental employment, parental depression, parental anxiety, parental alcohol use
MeSH terms
Autism Spectrum Disorder, Adolescent, Adult, Anxiety Disorders, Female, Follow-Up Studies, Forecasting, Humans, Male, Minnesota, Retrospective Studies, Risk Factors, Comorbidity, Incidence, Mood Disorders, Young Adult

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