Association Between Autism Spectrum Disorders With or Without Intellectual Disability and Depression in Young Adulthood

Dheeraj Rai, Hein Heuvelman, C Dalman, Iryna Culpin, M Lundberg, Peter Carpenter, Cecilia Magnusson

Research output: Contribution to journalArticle (Academic Journal)peer-review

19 Citations (Scopus)
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Importance: Depression is a common mental disorder and may be common in adults with autism spectrum disorder (ASD) but there is a lack of longitudinal population-based studies examining this relationship. Whether any increased risk of depression in ASD have a shared familial basis and whether they differ by cooccurring intellectual disability is not well known.
Objectives: To examine whether individuals with ASD are more likely to be diagnosed with depression in adulthood than the general population, and their non-autistic siblings, and whether these risks differ by the presence or absence of intellectual disability.
Design: Population-based cohort study with a nested sibling comparison. Data analysis was conducted between January and November 2017
Setting: Stockholm County, Sweden.
Participants: 223,842 individuals followed up to age 27 years by 2011, of whom 4,073 had a diagnosed ASD [mean age 21.5 years, SD 2.7; 65.9% male; 1,146 with and 2,972 without intellectual disability) and 219,769 had no ASD (mean age 22.1 years, SD 2.8; 50.9% male)
Main outcome: Clinical diagnosis of depressive disorders was identified using the Stockholm adult psychiatric register and the National patient register.
Results: One in five (n=808, 19.8%) individuals diagnosed with ASD had a diagnosis of depression as compared to 6% (n=13,114) of the general population by age 27 years [adjusted RR 3.6 (95% CI 3.4-3.9)]. The risk of a depression diagnosis was higher in ASD without intellectual disability [adjusted RR 4.3 (CI 4.0-4.6)] than ASD with intellectual disability [adjusted RR 1.8 (CI 1.5-2.2)]. Non-autistic full [adjusted RR 1.4 (CI 1.2-1.5)] and half-siblings [adjusted RR 1.4 (CI 1.2-1.6)] of individuals with ASD also had a higher risk of depression than the general population. Compared to their non-autistic full siblings, individuals with ASD had an over a two-fold risk of a depression diagnosis [adjusted OR 2.5 (1.9-3.3)] in young adulthood.
Conclusions and relevance: Individuals with ASD, particularly ASD without intellectual disability have a substantial burden of depression by young adulthood compared to the general population. This association is unlikely to be explained by shared familial liability. Future research to identify modifiable pathways between ASD and depression may help development of preventative interventions.
Original languageEnglish
Article numbere181465
Number of pages11
JournalJAMA Network Open
Issue number4
Early online date31 Aug 2018
Publication statusPublished - Aug 2018

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