Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: A Meta-Analysis
Abstract
Substantial uncertainty exists about the prevalence of depressive disorders in individuals with autism spectrum disorder (ASD). This meta-analysis quantitatively summarized studies that assessed the lifetime and current prevalence of unipolar depressive disorders in children, adolescents, and adults with ASD. We also examined demographic, methodological, and study moderators. This meta-analysis adhered to PRISMA guidelines. A total of 7857 articles were identified through 5 databases (PubMed, Web of Science, PYSCInfo, CINAHL, ProQuest Dissertations and Theses), forward searches, and backward searches. Two reviewers independently screened articles and extracted data. Sixty-six articles met inclusion criteria. Results indicated that the pooled lifetime and current prevalence was 14.4% (95% CI 10.3-19.8) and 12.3% (95% CI 9.7-15.5), respectively. Rates of depressive disorders were highest among studies that used a standardized interview to assess depressive disorders (lifetime = 28.5%, 95% CI 20.1-38.8; current = 15.3%, 95% CI 11.0-20.9) and required participants to report on their own depressive symptoms (lifetime = 48.6%, 95% CI 33.3-64.2; current = 25.9%, 95% CI 17.0-37.3). Rates were also higher in studies that included participants with higher intelligence. Lifetime, but not current, prevalence was positively associated with age and the proportion of the sample that was White. In conclusion, we found that the rates of depressive disorders are high among individuals with ASD. Compared to typically developing individuals, individuals with ASD are 4-times more likely to experience depression in their lifetime. These results suggest that individuals with ASD should be regularly screened and offered treatment for depression.
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Compared to their typically developing peers, individuals with ASD are four times more likely to experience depression in their lifetime.
“Compared to their typically developing peers, individuals with ASD are four times more likely to experience depression in their lifetime [109].”
From Pharmacological treatment in autism: a proposal for guidelines on common co-occurring psychiatric symptoms (2025) · cites this paper as [109]
Autistic youth experience depression at rates nearly twice that of their non-autistic peers.
“particularly among autistic youth who experience depression at rates nearly twice that of their non-autistic peers (Hudson et al., 2019; Schwartzman & Corbett, 2020).”
From Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy (2024) · cites this paper as Hudson et al., 2019
Individuals with ASD have a four-times-higher chance of developing depression compared to typically developed peers.
“Moreover, individuals with Autism Spectrum Disorder (ASD) have a four-times-higher chance of developing depression when compared to typically developed peers [3]”
From Cognitive Coping Strategies among Inpatient Adolescents with Depression and Psychiatric Comorbidity (2023) · cites this paper as [3]
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“Furthermore, the female preponderance in the general population regarding internalizing problems such as depression and anxiety disorders (Rutter et al., 2003; Van Oort et al., 2009) is not consistently found among autistic people (Hudson et al., 2019; Kirkovski et al., 2013).”
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Klein, C. B., McQuaid, G. A., Charlton, R. A., Klinger, L. G., & Wallace, G. L. (2022) · Autism Research · doi:10.1002/aur.2877 · Cited by 37 · see citing works
“Given the high prevalence of depression in autistic adults (Hudson et al., 2019), and associated cascading effects of psychomotor slowing in thinking, memory, and judgment; future research should examine the effects of depression on cognitive aging in autistic adults.”
Hedley, D., Hayward, S. M., Denney, K., Uljarević, M., Bury, S., Sahin, E., Brown, C. M., Clapperton, A., Dissanayake, C., Robinson, J., et al. (2021) · Autism Research · doi:10.1002/aur.2614 · Cited by 38 · see citing works
Béopoulos, A., Géa, M., Fasano, A., & Iris, F. (2021) · Nutrients · doi:10.3390/nu14010065 · Cited by 36 · see citing works
“In addition, a person with ASD is four times more likely to experience a depression disorder than a neurotypical individual [21].”
BackgroundLooking Back at the Next 40 Years of ASD Neuroscience Research
McPartland, J. C., Lerner, M. D., Bhat, A. N., Clarkson, T., Jack, A., Koohsari, S., Matuskey, D., McQuaid, G. A., Su, W.-C., & Trevisan, D. A. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05095-5 · Cited by 34 · see citing works
“Depression is one of the most common co-occurring disorders in ASD (Hudson et al. 2019; Mandell, 2008), and there is potential for rTMS to treat co-occurring depression.”
BackgroundFucà, E., Guerrera, S., Valeri, G., Casula, L., Novello, R. L., Menghini, D., & Vicari, S. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12020677 · Cited by 36 · see citing works
“In addition, the socioeconomic conditions and the cultural context could differ among the groups considered for the studies [57,58], influencing prevalence estimates.”
BackgroundPsychiatric Comorbidities in Children With ASD: Autism Centre Experience
Ivanović, I. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.673169 · Cited by 34 · see citing works
Francis, G. A., Deniz, E., Torgerson, C. J., & Toseeb, U. (2022) · Autism & Developmental Language Impairments · doi:10.1177/23969415211073118 · Cited by 33 · see citing works
Chiu, H. T., Ip, I. N., Ching, F. N. Y., Wong, B. P.-H., Lui, W.-H., Tse, C.-S., & Wong, S. W. H. (2024) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05847-x · Cited by 32 · see citing works
“ASD individuals also experience high rates of mental health comorbidities, with anxiety and depression as particularly prevalent co-occurring conditions (Croen et al., 2015; Greenlee et al., 2016; Hudson et al., 2019 ; Lugnegård et al., 2011; Mazzone et al., 2012).”
McQuaid, G. A., Gendy, J., Lee, N., & Wallace, G. L. (2022) · Autism in Adulthood · doi:10.1089/aut.2021.0088 · Cited by 32 · see citing works
The Mental Well-Being of Informal Carers of Adults on the Autism Spectrum: a Systematic Review
Sonido, M., Hwang, Y., Trollor, J., & Arnold, S. R. C. (2019) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-019-00177-8
Masi, G., Scullin, S., Narzisi, A., Muratori, P., Paciello, M., Fabiani, D., Lenzi, F., Mucci, M., & D’Acunto, G. (2020) · Brain Sciences · doi:10.3390/brainsci10100750 · Cited by 30 · see citing works
“8) (current and lifetime prevalence, respectively) [30].”
Maslahati, T., Bachmann, C., Höfer, J., Küpper, C. S., Stroth, S., Wolff, N., Poustka, L., Roessner, V., Kamp‐Becker, I., Hoffmann, F., et al. (2021) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-021-05008-6 · Cited by 31 · see citing works
“Adults with ASD show high rates of comorbid psychiatric disorders (Howlin & Magiati, 2017; Hudson et al., 2019), co-occurring intellectual disability (ID; Postorino et al.”
BackgroundMuscatello, R. A., Andujar, J. D., Taylor, J. L., & Corbett, B. A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04516-1 · Cited by 30 · see citing works
Differentiation of autism spectrum disorder and mood or anxiety disorder
Wittkopf, S., Stroth, S., Langmann, A., Wolff, N., Roessner, V., Roepke, S., Poustka, L., & Kamp‐Becker, I. (2021) · Autism · doi:10.1177/13623613211039673 · Cited by 31 · see citing works
“3% for depressive disorders in ASD patients (Hudson et al., 2019).”
InfluentialTaylor, J. L., Adams, R. E., Pezzimenti, F., Zheng, S., & Bishop, S. L. (2021) · Autism Research · doi:10.1002/aur.2621 · Cited by 29 · see citing works
Ferenc, K., Płatos, M., Byrka, K., & Król, M. E. (2022) · Autism · doi:10.1177/13623613221135818 · Cited by 31 · see citing works
“Nearly half of the sample reported a diagnosis of depression, which reflects the statistics on co-occurring depression in the autistic population (Hudson et al., 2019).”
BackgroundCurrie, G., Finlay, B., Seth, A., Roth, C. G., Elsabbagh, M., Hudon, A., Hunt, M. R., Jodoin, S., Lach, L., Lencucha, R., et al. (2022) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2022.2136090 · Cited by 27 · see citing works
“, 2011) and a four times higher incidence of depression (Hudson et al., 2019).”
BackgroundInvestigating the structure of trait rumination in autistic adults: A network analysis
Williams, Z. J., McKenney, E. E., & Gotham, K. O. (2021) · Autism · doi:10.1177/13623613211012855 · Cited by 27 · see citing works
“Email: Zachary.j.williams@vanderbilt.edu Depression is among the most clinically significant outcomes for autistic1 adults, with a lifetime prevalence in this population nearly 4 times that of the general population (Hollocks et al., 2019; Hudson et al., 2019).”
BackgroundMarital Satisfaction, Parenting Styles, and Child Outcomes in Families of Autistic Children
Greenlee, J. L., Piro-Gambetti, B., Putney, J., Papp, L. M., & Hartley, S. (2021) · Family Process · doi:10.1111/famp.12708 · Cited by 26 · see citing works
Featherstone, C., Sharpe, R. A., Axford, N., Asthana, S., & Husk, K. (2021) · Health & Social Care in the Community · doi:10.1111/hsc.13635 · Cited by 26 · see citing works
“…autistic people experience health disparities including higher mortality and shorter life expectancy than the general population, and a high prevalence of preventable physical and mental health concerns (Hirvikoski et al., 2016; Woolfenden et al., 2012; Hudson et al., 2019; Kinnear et al., 2019).”
BackgroundHunsche, M. C., Saqui, S., Mirenda, P., Zaidman‐Zait, A., Bennett, T. A., Duku, E., Elsabbagh, M., Georgiades, S., Smith, I. M., Szatmári, P., et al. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04373-y · Cited by 25 · see citing works
“These null results may also reflect the age range of the current study, given that rates of mood and anxiety disorders increase in early adolescence (Hudson et al. 2019; van Steensel et al. 2011).”
ResultStrain differences in behaviour and immunity in aged mice: Relevance to Autism
O’Connor, R., van de Wouw, M., Moloney, G. M., Ventura‐Silva, A. P., O’Riordan, K. J., Golubeva, A. V., Dinan, T. G., Schellekens, H., & Cryan, J. F. (2020) · Behavioural Brain Research · doi:10.1016/j.bbr.2020.113020 · Cited by 25 · see citing works
“Both individuals with autism (Hudson et al., 2019), and the elderly (Djernes, 2006) are known to display elevated levels of depression.”
BackgroundZheng, S., Adams, R. E., Taylor, J. L., Pezzimenti, F., & Bishop, S. L. (2021) · Autism · doi:10.1177/13623613211008276 · Cited by 28 · see citing works
Depression and Employment Outcomes in Autistic Adults: A Systematic Review
Schwartzman, J. M., & Corbett, B. A. (2022) · Review Journal of Autism and Developmental Disorders · doi:10.1007/s40489-022-00331-9 · Cited by 24 · see citing works
“Specifically, lifetime prevalence rates of depression in autistic adults range from 37 to 48.6%, per self-report (Hollocks et al., 2019; Hudson et al., 2019).”
InfluentialValidity of the patient health questionnaire 9-item in autistic youths: a pilot study
Pilunthanakul, T., Goh, T. J., Fung, D. S. S., Sultana, R., Allen, J. C., & Sung, M. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03556-w · Cited by 26 · see citing works
“Background Depression is a common comorbid psychopathology in autism spectrum disorders (ASD) [1, 2].”
BackgroundAutistic adults’ experiences of financial wellbeing: Part II
Pellicano, E., Hall, G., & Ying Cai, R. (2024) · Autism · doi:10.1177/13623613231191594 · Cited by 24 · see citing works
“Also, autistic people have a substantially elevated risk of experiencing mental health problems, especially anxiety, depression (Hollocks et al., 2019; Hudson et al., 2019) and physical health issues (Rydzewska et al., 2021).”
BackgroundHealy, S., Pacanowski, C. R., Kennedy, L., & Obrusníková, I. (2021) · Autism · doi:10.1177/13623613211006989 · Cited by 23 · see citing works
“As nearly half of autistic adults experience clinical depression (Hudson et al., 2019) and one in five have an anxiety diagnosis (Nimmo-Smith et al.”
BackgroundAutistic Adult Health and Professional Perceptions of It: Evidence From the ASDEU Project
Micai, M., Ciaramella, A., Salvitti, T., Fulceri, F., Fatta, L. M., Poustka, L., Diehm, R., Iskrov, G. G., Stefanov, R. S., Guillon, Q., et al. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.614102 · Cited by 24 · see citing works
Milling, M., Baird, A., Bartl-Pokorny, K. D., Liu, S., Alcorn, A. M., Shen, J., Tavassoli, T., Ainger, E., Pellicano, E., Pantić, M., et al. (2022) · Frontiers in Computer Science · doi:10.3389/fcomp.2022.837269 · Cited by 22 · see citing works
Anxiety in Autism Spectrum Disorder: Clinical Characteristics and the Role of the Family
Guerrera, S., Pontillo, M., Tata, M. C., Vincenzo, C. D., Bellantoni, D., Napoli, E., Valeri, G., & Vicari, S. (2022) · Brain Sciences · doi:10.3390/brainsci12121597 · Cited by 25 · see citing works
Keenan, E. G., Gurba, A. N., Mahaffey, B., Kappenberg, C. F., & Lerner, M. D. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0011 · Cited by 22 · see citing works
Social Knowledge & Performance in Autism: A Critical Review & Recommendations
Gates, J. A., McNair, M. L., Richards, J. K., & Lerner, M. D. (2023) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-023-00449-0 · Cited by 22 · see citing works
“, 2017) and mood disorders such as depression (Hudson et al., 2019) all may interfere with deployment of known social behaviors above and beyond the autism-related performance factors mentioned.”
BackgroundSchwartzman, J. M., Roth, M. C., Paterson, A. V., Jacobs, A. X., & Williams, Z. J. (2024) · Autism · doi:10.1177/13623613231213543 · Cited by 24 · see citing works
“Adolescent depression is a prevalent public health problem in the United States (Avenevoli et al., 2015), particularly among autistic youth who experience depression at rates nearly twice that of their non-autistic peers (Hudson et al., 2019; Schwartzman & Corbett, 2020).”
BackgroundConner, C. M., Kim, P. S., White, S. W., & Mazefsky, C. A. (2022) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2022.104332 · Cited by 22 · see citing works
Autism and associated disorders: cannabis as a potential therapy
Babayeva, M., Assefa, H., Basu, P., & Loewy, Z. G. (2022) · Frontiers in Bioscience-Elite · doi:10.31083/j.fbe1401001 · Cited by 21 · see citing works
“ASD children are four-fold more likely to suffer depression [277].”
BackgroundShochet, I. M., Saggers, B. R., Carrington, S. B., Orr, J. A., Wurfl, A. M., Kelly, R. L., & Duncan, B. M. (2022) · School Mental Health · doi:10.1007/s12310-022-09501-w · Cited by 23 · see citing works
Leader, G., Browne, H., Whelan, S., Cummins, H., & Mannion, A. (2022) · Research in Autism Spectrum Disorders · doi:10.1016/j.rasd.2022.101915 · Cited by 23 · see citing works
Pagni, B. A., Hill, E., Walsh, M. J. M., Delaney, S., Ogbeama, D., Monahan, L., Cook, J. R., Guerithault, N., Dixon, M. V., Ballard, L., et al. (2023) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.220159 · Cited by 20 · see citing works
Halliday, A. R., Vucic, S. N., Georges, B., LaRoche, M., Mendoza Pardo, M. A., Swiggard, L. O., McDonald, K., Olofsson, M., Menon, S. N., Francis, S. M., et al. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1474003 · Cited by 20 · see citing works
“Autistic youth are at higher risk for internalizing psychopathology (267, 268), sleep problems (269), and attention problems (270) than their neurotypical peers; co-occurring psychopathology in autistic participants could contribute to the heterogeneity of fi ndings.”
BackgroundDepression in young autistic people: A scoping review
Kim, S. Y., & Lecavalier, L. (2021) · Research in Autism · doi:10.1016/j.rasd.2021.101841 · Cited by 20 · see citing works
Muscatello, R. A., Pachol, A., Romines, A., Smith, I., & Corbett, B. A. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05664-2 · Cited by 21 · see citing works
“Concerningly, an estimated 40% of adults with ASD will be diagnosed with a depressive disorder in their lifetime (Hollocks et al., 2019; Hudson et al., 2019), well-above the global population average (Mayes et al.”
BackgroundThe combination of autism and exceptional cognitive ability increases risk for suicidal ideation
Casten, L. G., Thomas, T., Doobay, A. F., Foley‐Nicpon, M., Kramer, S., Nickl‐Jockschat, T., Abel, T. G., Assouline, S. G., & Michaelson, J. J. (2022) · Neurobiology of Learning and Memory · doi:10.1016/j.nlm.2022.107698 · Cited by 22 · see citing works
McQuaid, G. A., Sadowski, L. Y., Lee, N., & Wallace, G. L. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0121 · Cited by 22 · see citing works
Schiltz, H. K., & Hecke, A. V. V. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00332-2 · Cited by 20 · see citing works
McKenney, E. E., Brunwasser, S. M., Richards, J. K., Day, T. C., Kofner, B., McDonald, R. G., Williams, Z. J., Gillespie‐Lynch, K., Kang, E., Lerner, M. D., et al. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0078 · Cited by 19 · see citing works
Utility of the ADOS-2 in children with psychiatric disorders
Colombi, C., Fish, A. M., & Ghaziuddin, M. (2019) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-019-01411-8 · Cited by 18 · see citing works
Miot, S., Chancel, R., Périés, M., Crepiat, S., Couderc, S., Pernon, É., Picot, M., Gonnier, V., Jeandel, C., Blain, H., et al. (2022) · Autism · doi:10.1177/13623613221121623 · Cited by 18 · see citing works
“Co-occurring psychiatric disorders are also frequent in ASD, such as hyperactivity, anxiety, sleep disturbances and depression (Hollocks et al., 2019; Hudson et al., 2019; Lai et al., 2019).”
BackgroundMorales‐Hidalgo, P., Voltas, N., Hernández‐Martínez, C., & Canals, J. (2023) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2023.104454 · Cited by 18 · see citing works
Pregnancy in autistic women and social medical considerations: scoping review and meta- synthesis
Ferrara, R., Ricci, P., Damato, F. M., Iovino, L., Ricci, L., Cicinelli, G., Simeoli, R., & Keller, R. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1222127 · Cited by 19 · see citing works
“It is also known that, in adulthood, autism is often accompanied by other psychopathologies such as anxiety and depression (25) or also personality disorder or psychosis (26).”
BackgroundAnxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Cai, R., Hardan, A., & South, M. (2020) · Encyclopedia of Autism Spectrum Disorders · doi:10.1007/978-1-4614-6435-8_102432-1 · Cited by 1 · see citing works
Toward a better understanding of T cell dysregulation in autism: An integrative review
Moreno, R. J., Amara, R. A., & Ashwood, P. (2024) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2024.10.009 · Cited by 18 · see citing works
“The ASD population is more prone to anxiety, depression, sleep disorders, and gastrointestinal (GI) issues (Chaidez et al., 2014; Solomon, 2012; Hudson et al., 2019).”
Chronic bryostatin-1 rescues autistic and cognitive phenotypes in the fragile X mice
Cogram, P., Alkon, D. L., Crockford, D., Deacon, R. M. J., Hurley, M. J., Altimiras, F. J., Sun, M., & Tranfaglia, M. R. (2020) · Scientific Reports · doi:10.1038/s41598-020-74848-6 · Cited by 17 · see citing works
Self-reported social impairments predict depressive disorder in adults with autism spectrum disorder
Day, T. C., McNaughton, K. A., Naples, A. J., & McPartland, J. C. (2020) · Autism · doi:10.1177/1362361319857375 · Cited by 17 · see citing works
“Email: james.mcpartland@yale.edu some studies suggesting increased depressive symptoms in females (Gotham, Brunwasser, & Lord, 2015) and others indicating similarities among males and females (De-laIglesia & Olivar, 2015; Hudson et al., 2018).”
BackgroundResultInfluential
- Authors
- Hudson, C. C., Hall, L., & Harkness, K. L.
- Affiliations
- Queen's University (CA)
- Corresponding author
- Hudson, Chloe C.
- Venue
- Journal of Abnormal Child Psychology
- Published
- 2018-03-01
- Volume
- 47
- Issue
- 1
- Pages
- 165-175
- ISSN
- 0091-0627 (ISSN-L)
- 1573-2835
- OpenAlex
- W2792899115
- Cited by
- 411
- References
- 40
- Citations by year
- 2026: 50 · 2025: 65 · 2024: 80 · 2023: 58 · 2022: 51 · 2021: 56 · 2020: 30 · 2019: 19 · 2018: 2
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Research on Child and Adolescent Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- 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, depressive disorders, depression prevalence, lifetime prevalence, current prevalence, major depressive disorder, children and adolescents, adults, intelligence, age differences, racial differences, depression screening
- MeSH terms
- Autism Spectrum Disorder, Adolescent, Adult, Child, Child, Preschool, Depressive Disorder, Humans, Comorbidity, Prevalence, Young Adult
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