Cited by 988Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesFamily and Disability Support Research

Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis

Open access
Hollocks, Matthew J, Lerh, Jian Wei, Magiati, Iliana, Meiser-Stedman, Richard, Brugha, Traolach S·2019·Psychological Medicine

Abstract

Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. Yet, no systematic review has been carried out to date to examine rates of both anxiety and depression focusing specifically on adults with ASD. This systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD and the impact of factors such as assessment methods and presence of comorbid intellectual disability (ID) diagnosis on estimated prevalence rates. Electronic database searches for studies published between January 2000 and September 2017 identified a total of 35 studies, including 30 studies measuring anxiety ( n = 26 070; mean age = 30.9, s.d. = 6.2 years) and 29 studies measuring depression ( n = 26 117; mean age = 31.1, s.d. = 6.8 years). The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder. Further analyses revealed that the use of questionnaire measures and the presence of ID may significantly influence estimates of prevalence. The current literature suffers from a high degree of heterogeneity in study method and an overreliance on clinical samples. These results highlight the importance of community-based studies and the identification and inclusion of well-characterized samples to reduce heterogeneity and bias in estimates of prevalence for comorbidity in adults with ASD and other populations with complex psychiatric presentations.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1017/s0033291718002283

Cites

78 of 78 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Anxiety is common for autistic people, with a prevalence rate of 42% for autistic adults.

    “Anxiety is common for autistic people, with a prevalence rate of 42% for autistic adults (Hollocks et al., 2019).”

    From A Pilot Randomised Control Trial Exploring the Feasibility and Acceptability of Delivering a Personalised Modular Psychological Intervention for Anxiety Experienced by Autistic Adults: Personalised Anxiety Treatment-Autism (PAT-A) (2024) · cites this paper as Hollocks et al., 2019

    The Summary of main findings and Table 4 report a 42% pooled lifetime prevalence of any anxiety disorder in autistic adults. The claim omits the lifetime qualifier; the paper’s estimate for current anxiety is 27%. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Clinically significant anxiety and depression symptoms were found in 25-40% of autistic individuals aged from late adolescence to old age.

    “while clinically significant anxiety and depression symptoms were found in a 25 -40% of autistic individuals aged from late adolescence to old age (Hollocks et al ., 2019; Uljarevi´ c et al ., 2019).”

    From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Hollocks et al., 2019

    The Summary of main findings reports substantial anxiety and depression prevalence in autistic adults, and the Study sample includes some participants aged 16 or older. But the claimed 25–40% range blurs current and lifetime estimates: current anxiety and depression were 27% and 23%, respectively, while lifetime rates were 42% and 37%. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • The most common mental health challenge for autistic individuals is anxiety.

    “The most common mental health challenge for autistic individuals is anxiety [14-16]”

    From Autistic Cognition: Charting Routes to Anxiety (2021) · cites this paper as [14]

    The Summary of main findings (page not available) reports slightly higher pooled rates of anxiety than depression among autistic adults: 27% versus 23% for current disorders and 42% versus 37% for lifetime disorders. The review does not establish that anxiety is the most common mental health challenge across all autistic individuals or compared with every other mental health condition; its pooled estimates concern adults and anxiety and depression. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Autistic individuals experience high rates of depression and other co-occurring mental health conditions.

    “In addition, autistic individuals experience high rates of depression and other co-occurring mental health conditions (e.g. Hollocks et al., 2019).”

    From Listening to the autistic voice: Mental health priorities to guide research and practice in autism from a stakeholder-driven project (2020) · cites this paper as Hollocks et al., 2019

    The Conclusion and clinical implications reports high rates of co-occurring depression and anxiety in adults with ASD. The claim extends that finding to autistic individuals generally, while the Rates/prevalence section contrasts the adult finding with relatively low reported rates of depression in children and adolescents with ASD. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Autism often co-occurs with psychological comorbidities, including suicidality, anxiety disorders, and mood disorders like depression.

    “As previously mentioned, autism often co-occurs with several additional psychological comorbidities, including suicidality, anxiety disorders, and mood disorders like depression (Cassidy et al., 2018;Hollocks et al., 2019).”

    From Rethinking psychological interventions in autism: Toward a neurodiversity‐affirming approach. (2025) · cites this paper as Hollocks et al., 2019

    The Introduction and Conclusion report that anxiety and depression are common co-occurring conditions in adults with ASD. The paper does not establish suicidality as a common co-occurring condition; it appears in the title of a cited work in the References. Its findings also concern adults, whereas the citing sentence refers to autism generally. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

4 of the 82 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Ghaziuddin M and Zafar S (2008) Psychiatric comorbidity of adults with aut- ism spectrum disorders. Clinical Neuropsychiatry: Journal of Treatment Evaluation 5, 9-12.
  2. Matthew J Hollocks et al. https://doi.org/10.1017/S0033291718002283 Published online by Cambridge University Press
  3. Viechtbauer W (2010) Conducting meta-analyses in R with the metafor pack- age. Journal of Statistical Software 36, 1-48.

Cited by

Sorted by citations

Authors
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S.
Affiliations
  • University of East Anglia (GB)
  • National University of Singapore (SG)
  • University of Leicester (GB)
Corresponding author
Hollocks, Matthew J
Venue
Psychological Medicine
Published
2018-09-04
Volume
49
Issue
4
Pages
559-572
ISSN
  • 0033-2917 (ISSN-L)
  • 1469-8978
OpenAlex
W2889987209
Cited by
988
References
82
Citations by year
2026: 138 · 2025: 158 · 2024: 155 · 2023: 150 · 2022: 141 · 2021: 131 · 2020: 88 · 2019: 24 · 2018: 2
FWCI
8.21
Type
journal article
Language
en
Open access
Locations
  • Psychological Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion)
Funders
National Institute for Health and Care Research
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 › Family and Disability Support Research
Keywords
autism spectrum disorder, anxiety disorders, depression, comorbidities, prevalence, autistic adults, intellectual disability, psychiatric comorbidity, questionnaire measures, community-based study
MeSH terms
Autism Spectrum Disorder, Adult, Anxiety, Depression, Humans, Risk Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review