Association of autistic traits with depression from childhood to age 18 years
Open accessAbstract
Importance: Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear. Objectives: To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying. Design, Setting, and Participants: Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017. Main Outcomes and Measures: Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule-Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years. Results: The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results. Conclusions and Relevance: Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.
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The onset of depressive symptoms in autism appears to be early.
“The onset of depressive symptoms in autism appears to be early.”
From Guided self-help for depression in autistic adults: The ADEPT feasibility RCT (2019) · cites this paper as [10]
Autistic children and children with higher autism traits have higher depressive symptoms at age 10 years and these remain elevated with an upwards trajectory until age 18 years.
“A UK-based cohort study 10 reported that autistic children and children with higher autism traits have higher depressive symptoms at the age of 10 years and that these remain elevated with an upwards trajectory until the age of 18 years.”
From Guided self-help for depression in autistic adults: The ADEPT feasibility RCT (2019) · cites this paper as [10]
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- Authors
- Rai, D., Culpin, I., Heuvelman, H., Magnusson, C. M. K., Carpenter, P., Jones, H. J., Emond, A. M., Zammit, S., Golding, J., & Pearson, R. M.
- Affiliations
- National Health Service (GB)
- University of Bristol (GB)
- Karolinska Institutet (SE)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Rai, Dheeraj
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-08-01
- Volume
- 75
- Issue
- 8
- Pages
- 835
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6143081
- OpenAlex
- W2808175745
- Cited by
- 185
- References
- 44
- Citations by year
- 2026: 17 · 2025: 25 · 2024: 36 · 2023: 30 · 2022: 17 · 2021: 27 · 2020: 16 · 2019: 13 · 2018: 4
- FWCI
- 8.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Explore Bristol Research (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Bristol Research (University of Bristol) (submittedVersion, cc-by)
- Funders
- Wellcome Trust (08426812/Z/07/Z)
- National Institute for Health and Care Research
- Cardiff University
- University of Bristol
- Karolinska Institutet
- Medical Research Council (MR/L010305/1, MC_PC_15018)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- autism spectrum disorder, autistic traits, depression, depressive symptoms, bullying, genetic confounding, polygenic risk score, social communication, repetitive behavior, sociability, coherence, adolescence, early adulthood, Avon Longitudinal Study of Parents and Children, mental health trajectories, birth cohort follow-up, environmental risk factors, genetic risk factors
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Child, Depression, Female, United Kingdom, Humans, Interview, Psychological, Longitudinal Studies, Male, Risk, Psychological Distance, Social Environment, Multifactorial Inheritance, International Classification of Diseases, Genome-Wide Association Study, Bullying
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