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Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis
Open accessAbstract
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.
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“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
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“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
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“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]
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“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
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“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
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“Autistic adults are at greater risk of co-occurring psychiatric disorders, self-harm and suicidal behaviors compared to the general population (Hollocks et al., 2019; Licence et al., 2019; Cassidy et al., 2020; Moseley et al., 2020).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Hollocks et al., 2019
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“Anxiety disorders commonly occur in autism.”
From Examining a model of anxiety in autistic adults (2024) · cites this paper as Hollocks et al., 2019
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“and that lifetime prevalence of anxiety (42%) and depression (37%) are remarkably high (Hollocks et al., 2019).”
From A mixed methods study of autistic adults' mental health therapy experiences (2023) · cites this paper as Hollocks et al., 2019
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“which is a major problem for a lot of autistic people”
From Autistic Cognition: Charting Routes to Anxiety (2021) · cites this paper as [14]
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In the citing paper
“Recent systematic reviews and meta-analyses have found that among autistic adults, the prevalence for current and lifetime co-occurrence of anxiety ranges between 27% and 42% (Hollocks et al., 2019)”
From Differences in anxieties and social networks in a group-matched sample of autistic and typically developing students transitioning to university (2020) · cites this paper as Hollocks et al., 2019
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“CI has been linked to flexible problem solving and transition between activities in autistic individuals (Uddin, 2021) and associated with anxiety and depression in autistic youth (Hollocks et al., 2019) and adult general population samples (Gabrys et al., 2018; Wang et al., 2019).”
From Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. (2025) · cites this paper as Hollocks et al., 2019
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“Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Hollocks et al., 2019
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Metadata
- 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
- Publisher
- Cambridge University Press (CUP)
- 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
- bronze
- doi.org
- 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
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