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Cited by 186Autism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional DevelopmentChild Nutrition and Feeding Issues

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Association of Autistic Traits With Depression From Childhood to Age 18 Years

Open access
Rai, Dheeraj, Culpin, Iryna, Heuvelman, Hein, Magnusson, Cecilia M. K., Carpenter, Peter, Jones, Hannah J., Emond, Alan M., Zammit, Stanley, Golding, Jean, Pearson, Rebecca M.·2018·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2018.1323PMC PMC6143081
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Abstract

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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Figure 1. Trajectories of Depressive Symptoms in Individuals With Autism Spectrum Disorders (ASD) and ASD Traits and the Comparison Population Shown are confounder-adjusted mean Short Mood and Feelings Questionnaire (SMFQ) scores between ages 10 and 18 years among those with or without ASD and ASD traits. Fitted means were calculated using xtmixed (Stata/MP, version 14; StataCorp) multilevel regression models with linear, quadratic, and cubic terms for time. Trajectories were adjusted for child sex, parity, maternal occupational class, mother’s highest educational attainment, financial problems, maternal age at delivery, maternal Crown-Crisp anxiety score at 18 weeks’ gestation and 8 weeks after delivery, maternal antenatal (18 and 32 weeks’ gestation) and postnatal (8 weeks and 8 months) depression measured with the Edinburgh Postnatal Depression Scale, and accommodation type. Error bars indicate 95% CIs. A, ASD estimates based on 6091 observations with complete data on autism diagnosis and covariates. B, Social communication estimates based on 5209 observations with complete data on the Social Communication Disorders Checklist scores and covariates. C, Coherence estimates based on 5204 observations with complete data on coherence scores and covariates. D, Repetitive behavior estimates based on 5299 observations with complete data on repetitive behavior scores and covariates. E, Sociability estimates based on 5677 observations with complete data on sociability scores and covariates.
Figure 1. Trajectories of Depressive Symptoms in Individuals With Autism Spectrum Disorders (ASD) and ASD Traits and the Comparison Population Shown are confounder-adjusted mean Short Mood and Feelings Questionnaire (SMFQ) scores between ages 10 and 18 years among those with or without ASD and ASD traits. Fitted means were calculated using xtmixed (Stata/MP, version 14; StataCorp) multilevel regression models with linear, quadratic, and cubic terms for time. Trajectories were adjusted for child sex, parity, maternal occupational class, mother’s highest educational attainment, financial problems, maternal age at delivery, maternal Crown-Crisp anxiety score at 18 weeks’ gestation and 8 weeks after delivery, maternal antenatal (18 and 32 weeks’ gestation) and postnatal (8 weeks and 8 months) depression measured with the Edinburgh Postnatal Depression Scale, and accommodation type. Error bars indicate 95% CIs. A, ASD estimates based on 6091 observations with complete data on autism diagnosis and covariates. B, Social communication estimates based on 5209 observations with complete data on the Social Communication Disorders Checklist scores and covariates. C, Coherence estimates based on 5204 observations with complete data on coherence scores and covariates. D, Repetitive behavior estimates based on 5299 observations with complete data on repetitive behavior scores and covariates. E, Sociability estimates based on 5677 observations with complete data on sociability scores and covariates.CC BY · PubMed Central
Figure 2. Trajectories of Depressive Symptoms in Children With or Without Autism Spectrum Disorders (ASD) and ASD Traits Within and Outside the Context of Bullying Shown are confounder-adjusted mean Short Mood and Feelings Questionnaire (SMFQ) scores among children with or without ASD and ASD traits and exposed or unexposed to bullying. Fitted means were calculated using xtmixed (Stata/MP, version 14; StataCorp) multilevel regression models with linear, quadratic, and cubic terms for time. Trajectories were adjusted for the same variables as those listed above for Figure 1. Error bars indicate 95% CIs. A, ASD estimates based on 4516 observations with complete data on autism diagnosis, bullying variables, and covariates. B, Social communication estimates based on 4041 observations with complete data on the Social Communication Disorders Checklist scores, bullying variables, and covariates. C, Coherence estimates based on 4070 observations with complete data on coherence scores, bullying variables, and covariates. D, Repetitive behavior estimates based on 4051 observations with complete data on repetitive behavior scores, bullying variables, and covariates. E, Sociability estimates based on 4268 observations with complete data on sociability scores, bullying variables, and covariates.
Figure 2. Trajectories of Depressive Symptoms in Children With or Without Autism Spectrum Disorders (ASD) and ASD Traits Within and Outside the Context of Bullying Shown are confounder-adjusted mean Short Mood and Feelings Questionnaire (SMFQ) scores among children with or without ASD and ASD traits and exposed or unexposed to bullying. Fitted means were calculated using xtmixed (Stata/MP, version 14; StataCorp) multilevel regression models with linear, quadratic, and cubic terms for time. Trajectories were adjusted for the same variables as those listed above for Figure 1. Error bars indicate 95% CIs. A, ASD estimates based on 4516 observations with complete data on autism diagnosis, bullying variables, and covariates. B, Social communication estimates based on 4041 observations with complete data on the Social Communication Disorders Checklist scores, bullying variables, and covariates. C, Coherence estimates based on 4070 observations with complete data on coherence scores, bullying variables, and covariates. D, Repetitive behavior estimates based on 4051 observations with complete data on repetitive behavior scores, bullying variables, and covariates. E, Sociability estimates based on 4268 observations with complete data on sociability scores, bullying variables, and covariates.CC BY · PubMed Central

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Metadata

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)
DOI
10.1001/jamapsychiatry.2018.1323
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
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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