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Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis

Hudson, Chloe C., Hall, Layla, Harkness, Kate L.·2019·Journal of Abnormal Child Psychology

DOI 10.1007/s10802-018-0402-1

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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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“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.”
Background
Exploring Key Physiological System Profiles at Rest and the Association with Depressive Symptoms in Autism Spectrum Disorder
Muscatello, 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
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
“3% for depressive disorders in ASD patients (Hudson et al., 2019).”
Influential
Job loss predicts worsening depressive symptoms for young adults with autism: A COVID ‐19 natural experiment
Taylor, J. L., Adams, R. E., Pezzimenti, F., Zheng, S., & Bishop, S. L. (2021) · Autism Research · doi:10.1002/aur.2621 · Cited by 29
Looking through rainbow-rimmed glasses: Taking neurodiversity perspective is related to subjective well-being of autistic adults
Ferenc, K., Płatos, M., Byrka, K., & Król, M. E. (2022) · Autism · doi:10.1177/13623613221135818 · Cited by 41
“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).”
Background
Mental health challenges during COVID-19: perspectives from parents with children with neurodevelopmental disabilities
Currie, 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 31
“, 2011) and a four times higher incidence of depression (Hudson et al., 2019).”
Background
Investigating 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
“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).”
Background
Marital 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
Health and wellbeing outcomes and social prescribing pathways in community‐based support for autistic adults: A systematic mapping review of reviews
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 28
“…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).”
Background
Parent-Reported Rates and Clinical Correlates of Suicidality in Children with Autism Spectrum Disorder: A Longitudinal Study
Hunsche, 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
“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).”
Result
Strain 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
“Both individuals with autism (Hudson et al., 2019), and the elderly (Djernes, 2006) are known to display elevated levels of depression.”
Background
Depression in independent young adults on the autism spectrum: Demographic characteristics, service use, and barriers
Zheng, S., Adams, R. E., Taylor, J. L., Pezzimenti, F., & Bishop, S. L. (2021) · Autism · doi:10.1177/13623613211008276 · Cited by 29
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 25
“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).”
Influential
Validity 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 27
“Background Depression is a common comorbid psychopathology in autism spectrum disorders (ASD) [1, 2].”
Background
Autistic adults’ experiences of financial wellbeing: Part II
Pellicano, E., Hall, G., & Ying Cai, R. (2024) · Autism · doi:10.1177/13623613231191594 · Cited by 24
“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).”
Background
“This cage that I’m stuck inside”: Autistic adults’ perceptions of weight management, body weight, and body image
Healy, S., Pacanowski, C. R., Kennedy, L., & Obrusníková, I. (2021) · Autism · doi:10.1177/13623613211006989 · Cited by 23
“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.”
Background
Autistic 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
Evaluating the Impact of Voice Activity Detection on Speech Emotion Recognition for Autistic Children
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
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 26
Leveling Up Dialectical Behavior Therapy for Autistic Individuals with Emotion Dysregulation: Clinical and Personal Insights
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 29
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 27
“, 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.”
Background
Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy
Schwartzman, J. M., Roth, M. C., Paterson, A. V., Jacobs, A. X., & Williams, Z. J. (2024) · Autism · doi:10.1177/13623613231213543 · Cited by 24
“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).”
Background
The role of emotion dysregulation and intolerance of uncertainty in autism: Transdiagnostic factors influencing co-occurring conditions
Conner, 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
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 27
“ASD children are four-fold more likely to suffer depression [277].”
Background
A School-Based Approach to Building Resilience and Mental Health Among Adolescents on the Autism Spectrum: A Longitudinal Mixed Methods Study
Shochet, 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
Affective problems, gastrointestinal symptoms, sleep problems, and challenging behaviour in children and adolescents with autism spectrum disorder
Leader, G., Browne, H., Whelan, S., Cummins, H., & Mannion, A. (2022) · Research in Autism · doi:10.1016/j.rasd.2022.101915 · Cited by 25
Distinct and shared therapeutic neural mechanisms of mindfulness-based and social support stress reduction groups in adults with autism spectrum disorder
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
Heterogeneity and convergence across seven neuroimaging modalities: A review of the autism spectrum disorder literature
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
“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.”
Background
Depression 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 22
Development and Parasympathetic Regulation in Male and Female Adolescents with Autism Spectrum Disorder: A Two-Timepoint Longitudinal Study
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 22
“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.”
Background
The 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
An Examination of Perceived Stress and Emotion Regulation Challenges as Mediators of Associations Between Camouflaging and Internalizing Symptomatology
McQuaid, G. A., Sadowski, L. Y., Lee, N., & Wallace, G. L. (2023) · Autism in Adulthood · doi:10.1089/aut.2022.0121 · Cited by 25
Applying the Vulnerability Stress Adaptation Model of Marriage to Couples Raising an Autistic Child: A Call for Research on Adaptive Processes
Schiltz, H. K., & Hecke, A. V. V. (2020) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-020-00332-2 · Cited by 26
Repetitive Negative Thinking As a Transdiagnostic Prospective Predictor of Depression and Anxiety Symptoms in Neurodiverse First-Semester College Students
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
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
Multimorbidity patterns and subgroups among autistic adults with intellectual disability: Results from the EFAAR study
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
“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).”
Background
Emotional problems in preschool and school-aged children with neurodevelopmental disorders in Spain: EPINED epidemiological project
Morales‐Hidalgo, P., Voltas, N., Hernández‐Martínez, C., & Canals, J. (2023) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2023.104454 · Cited by 23
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
“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).”
Background
Anxiety and Depression from Adolescence to Old Age in Autism Spectrum Disorder
Uljarević, M., Hedley, D., Cai, R. Y., Hardan, A. Y., & South, M. (2020) · Springer eBooks · doi:10.1007/978-1-4614-6435-8_102432-1 · Cited by 17
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
“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 18
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
“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.
ORCID: Hudson, Chloe C.
Harkness, Kate L.
Venue: Journal of Abnormal Child Psychology
Publisher: Springer Science and Business Media LLC
Published: 2018-03-01
Volume: 47
Issue: 1
Pages: 165-175
ISSN: 0091-0627 (ISSN-L)
1573-2835
DOI: 10.1007/s10802-018-0402-1
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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Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis

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