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

  • Matthew J Hollocks (a1), Jian Wei Lerh (a2), Iliana Magiati (a2), Richard Meiser-Stedman (a1) and Traolach S Brugha (a3)...
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.

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Corresponding author
Author for correspondence: Matthew J Hollocks, E-mail: M.Hollocks@uea.ac.uk.
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These authors contributed equally to this work.

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References
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Armijo-Olivo, S, Stiles, CR, Hagen, NA, Biondo, PD and Cummings, GG (2012) Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: Methodological research. Journal of Evaluation in Clinical Practice 18, 1218.
Ashwood, KL, Gillan, N, Horder, J, Hayward, H, Woodhouse, E, McEwen, FS, Findon, J, Eklund, H, Spain, D, Wilson, CE, Cadman, T, Young, S, Stoencheva, V, Murphy, CM, Robertson, D, Charman, T, Bolton, P, Glaser, K, Asherson, P, Simonoff, E and Murphy, DG (2016) Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychological Medicine 46, 110.
Barendregt, JJ, Doi, SA, Lee, YY, Norman, RE and Vos, T (2013) Meta-analysis of prevalence. Journal of Epidemiology and Community Health 67, 974978.
Baxter, AJ, Brugha, TS, Erskine, HE, Scheurer, RW, Vos, T and Scott, JG (2015) The epidemiology and global burden of autism spectrum disorders. Psychological Medicine 45, 601613.
Bearss, K, Taylor, CA, Aman, MG, Whittemore, R, Lecavalier, L, Miller, J, Pritchett, J, Green, B and Scahill, L (2016) Using qualitative methods to guide scale development for anxiety in youth with autism spectrum disorder. Autism 20, 663672.
Beck, AT (1978) Beck depression inventory. Depression 2006, 24.
Bejerot, S, Eriksson, JM and Mortberg, E (2014) Social anxiety in adult autism spectrum disorder. Psychiatry Research 220, 705707.
Berthoz, S, Lalanne, C, Crane, L and Hill, EL (2013) Investigating emotional impairments in adults with autism spectrum disorders and the broader autism phenotype. Psychiatry Research 208, 257264.
Bird, G, Press, C and Richardson, DC (2011) The role of alexithymia in reduced eye-fixation in Autism Spectrum Conditions. Journal of Autism and Developmental Disorders 41, 15561564.
Bögels, SM, Knappe, S and Clark, LA (2013) Adult separation anxiety disorder in DSM-5. Clinical Psychology Review 33, 663674.
Brugha, TS, Doos, L, Tempier, A, Einfeld, S and Howlin, P (2015) Outcome measures in intervention trials for adults with autism spectrum disorders; a systematic review of assessments of core autism features and associated emotional and behavioural problems. International Journal of Methods in Psychiatric Research 24, 99115.
Buck, TR, Viskochil, J, Farley, M, Coon, H, McMahon, WM, Morgan, J and Bilder, DA (2014) Psychiatric comorbidity and medication use in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 44, 30633071.
Capriola, NN, Maddox, BB and White, SW (2016) No offense intended: fear of negative evaluation in adolescents and adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 47, 38033813.
Carlisi, CO, Norman, L, Murphy, CM, Christakou, A, Chantiluke, K, Giampietro, V, Simmons, A, Brammer, M, Murphy, DG, Mataix-Cols, D, Rubia, K and Rubia, K (2017) Comparison of neural substrates of temporal discounting between youth with autism spectrum disorder and with obsessive-compulsive disorder. Psychological Medicine 47, 115.
Cederlund, M, Hagberg, B and Gillberg, C (2010) Asperger syndrome in adolescent and young adult males. Interview, self- and parent assessment of social, emotional, and cognitive problems. Research in Developmental Disabilities 31, 287298.
Chandrasekhar, T and Sikich, L (2015) Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience 17, 219227.
Charlot, L, Deutsch, CK, Albert, A, Hunt, A, Connor, DF and McIlvane, WJJ (2008) Mood and anxiety symptoms in psychiatric inpatients with autism spectrum disorder and depression. Journal of Mental Health Research in Intellectual Disabilities 1, 238253.
Crane, L, Goddard, L and Pring, L (2013) Autobiographical memory in adults with autism spectrum disorder: the role of depressed mood, rumination, working memory and theory of mind. Autism: the International Journal of Research and Practice 17, 205219.
Croen, LA, Zerbo, O, Qian, Y, Massolo, ML, Rich, S, Sidney, S and Kripke, C (2015) The health status of adults on the autism spectrum. Autism: the International Journal of Research and Practice 19, 814823.
Ghaziuddin, M and Zafar, S (2008) Psychiatric comorbidity of adults with autism spectrum disorders. Clinical Neuropsychiatry: Journal of Treatment Evaluation 5, 912.
Gillberg, IC, Helles, A, Billstedt, E and Gillberg, C (2016) Boys with asperger syndrome grow up: psychiatric and neurodevelopmental disorders 20 years after initial diagnosis. Journal of Autism and Developmental Disorders 46, 7482.
Gotham, K, Unruh, K and Lord, C (2015) Depression and its measurement in verbal adolescents and adults with autism spectrum disorder. Autism: the International Journal of Research and Practice 19, 491504.
Hassiotis, A and Turk, J (2012) Mental health needs in adolescents with intellectual disabilities: cross-sectional survey of a service sample. Journal of Applied Research in Intellectual Disabilities 25, 252261.
Hedley, D, Uljarevic, M, Wilmot, M, Richdale, A and Dissanayake, C (2017) Brief report: social support, depression and suicidal ideation in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 47:36693677.
Helverschou, SB, Bakken, TL and Martinsen, H (2008) Identifying symptoms of psychiatric disorders in people with autism and intellectual disability: an empirical conceptual analysis. Mental Health Aspects of Developmental Disabilities 11, 107115.
Helverschou, SB, Bakken, TL and Martinsen, H (2009) The psychopathology in autism checklist (PAC): a pilot study. Research in Autism Spectrum Disorders 3, 179195.
Hermans, H, van der Pas, FH and Evenhuis, HM (2011) Instruments assessing anxiety in adults with intellectual disabilities: a systematic review. Research in Developmental Disabilities 32, 861870.
Hermans, H, Jelluma, N, van der Pas, FH and Evenhuis, HM (2012) Feasibility, reliability and validity of the Dutch translation of the anxiety, depression and mood scale in older adults with intellectual disabilities. Research in Developmental Disabilities 33, 315323.
Higgins, JPT and Thompson, SG (2002) Quantifying heterogeneity in a meta-analysis. Statistics in Medicine 21, 15391558.
Hill, E, Berthoz, S and Frith, U (2004) Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders 34, 229235.
Hofvander, B, Delorme, R, Chaste, P, Nydén, A, Wentz, E, Ståhlberg, O, Herbrecht, E, Stopin, A, Anckarsäter, H, Gillberg, C, Råstam, M and Leboyer, M (2009) Psychiatric and psychosocial problems in adults with normal-intelligence autism spectrum disorders. BMC Psychiatry 9, 35.
Houghton, R, Ong, RC and Bolognani, F (2017) Psychiatric comorbidities and use of psychotropic medications in people with autism spectrum disorder in the United States. Autism Research, 10, 20372047.
Howlin, P (2013) Social disadvantage and exclusion: adults with autism lag far behind in employment prospects. Journal of the American Academy of Child & Adolescent Psychiatry 52, 897899.
Jones, L, Goddard, L, Hill, EL, Henry, LA and Crane, L (2014) Experiences of receiving a diagnosis of autism spectrum disorder: a survey of adults in the United Kingdom. United States Journal of Autism and Developmental Disorders 44, 30333044.
Joshi, G, Wozniak, J, Petty, C, Martelon, MK, Fried, R, Bolfek, A, Kotte, A, Stevens, J, Furtak, SL, Bourgeois, M, Caruso, J, Caron, A and Biederman, J (2013) Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. Journal of Autism and Developmental Disorders 43, 13141325.
Kerns, CM, Kendall, PC, Berry, L, Souders, MC, Franklin, ME, Schultz, RT, Miller, J and Herrington, J (2014) Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders. 44, 28512861.
Kessler, RC, Berglund, P, Demler, O, Jin, R, Koretz, D, Merikangas, KR, Rush, AJ, Walters, EE and Wang, PS (2003) The epidemiology of major depressive disorder. JAMA 289, 3095.
Kessler, RC, Chiu, WT, Jin, R, Ruscio, AM, Shear, K and Walters, EE (2006) The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Archives of General Psychiatry 63, 415424.
Kessler, RC, Petukhova, M, Sampson, NA, Zaslavsky, AM and Wittchen, HU (2012) Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International Journal of Methods in Psychiatric Research 21, 169184.
Ketelaars, C, Horwitz, E, Sytema, S, Bos, J, Wiersma, D, Minderaa, R and Hartman, CA (2008) Brief report: adults with mild autism spectrum disorders (ASD): scores on the autism spectrum quotient (AQ) and comorbid psychopathology. Journal of Autism and Developmental Disorders 38, 176180.
Kim, YS, Leventhal, BL, Koh, Y-J, Fombonne, E, Laska, E, Lim, E-C, Cheon, K-A, Kim, S-J, Kim, Y-K, Lee, H, Song, D-H and Grinker, RR (2011) Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry 168, 904912.
Lai, MC, Lombardo, M V., Pasco, G, Ruigrok, AN V, Wheelwright, SJ, Sadek, SA, Chakrabarti, B and Baron-Cohen, S (2011) A behavioral comparison of male and female adults with high functioning autism spectrum conditions. PLoS ONE 6, p.e20835.
Lever, AG and Geurts, HM (2016) Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 46, 19161930.
Lugnegard, T, Hallerback, MU and Gillberg, C (2011) Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities 32, 19101917.
Maddox, BB and White, SW (2015) Comorbid social anxiety disorder in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 45, 39493960.
Magiati, I, Lerh, JW, Hollocks, MJ, Uljarevic, M, Rodgers, J, Mcconachie, H, Ozsivadjian, A, South, M, Van Hecke, A, Hardan, A, Libove, R, Leekam, S and Simonoff, E (2017) The measurement properties of the spence children's anxiety scale-parent version in a large international pooled sample of young people with autism spectrum disorder, 10 1–24.
Mazefsky, CA, Folstein, SE and Lainhart, JE (2008) Overrepresentation of mood and anxiety disorders in adults with autism and their first-degree relatives: what does it mean? Autism Research 1, 193197.
McDermott, S, Moran, R, Platt, T, Issac, T, Wood, H and Dasari, S (2005) Depression in adults with disabilities, in primary care. Disability and Rehabilitation 27, 117123.
McLean, CP, Asnaani, A, Litz, BT and Hofmann, SG (2011) Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research 45, 10271035.
Morgan, CN, Roy, M and Chance, P (2003) Psychiatric comorbidity and medication use in autism: a community survey. Psychiatric Bulletin 27, 378381.
Moss, P, Howlin, P, Savage, S, Bolton, P and Rutter, M (2015) Self and informant reports of mental health difficulties among adults with autism findings from a long-term follow-up study. Autism: the International Journal of Research and Practice 19, 832841.
Moss, P, Mandy, W and Howlin, P (2017) Child and adult factors related to quality of life in adults with autism. Journal of Autism and Developmental Disorders 47, 18.
Nylander, L, Holmqvist, M, Gustafson, L and Gillberg, C (2013) Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study. Nordic Journal of Psychiatry 67, 344350.
Ozsivadjian, A, Knott, F and Magiati, I (2012) Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: a focus group study. Autism: the International Journal of Research and Practice 16, 107121.
Rodgers, J, Herrema, R, Honey, E and Freeston, M (2018) Towards a treatment for intolerance of uncertainty for autistic adults: a single case experimental design study. Journal of autism and developmental disorders, pp. 114.
Rodgers, J, Wigham, S, McConachie, H, Freeston, M, Honey, E and Parr, JR (2016) Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Research 9, 12051215.
Roy, M, Prox-Vagedes, V, Ohlmeier, MD and Dillo, W (2015) Beyond childhood: psychiatric comorbidities and social background of adults with asperger syndrome. Psychiatria Danubina 27, 5059.
Russell, A, Cooper, K, Barton, S, Ensum, I, Gaunt, D, Horwood, J, Ingham, B, Kessler, D, Metcalfe, C, Parr, J and Rai, D (2017) Protocol for a feasibility study and randomised pilot trial of a low-intensity psychological intervention for depression in adults with autism: the Autism Depression Trial (ADEPT). BMJ open 7, p. e019545.
Russell, AJ, Murphy, CM, Wilson, E, Gillan, N, Brown, C, Robertson, DM, Craig, MC, Deeley, Q, Zinkstok, J, Johnston, K, McAlonan, GM, Spain, D and Murphy, DG (2016) The mental health of individuals referred for assessment of autism spectrum disorder in adulthood: a clinic report. Autism: the International Journal of Research and Practice 20, 623627.
Salazar, F, Baird, G, Chandler, S, Tseng, E, O'sullivan, T, Howlin, P, Pickles, A and Simonoff, E (2015) Co-occurring psychiatric disorders in preschool and elementary school-aged children with autism spectrum disorder. Journal of Autism and Developmental Disorders 45:22832294.
Simonoff, E, Pickles, A, Charman, T, Chandler, S, Loucas, T and Baird, G (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry 47, 921929.
Spain, D, Happe, F, Johnston, P, Campbell, M, Sin, J, Daly, E, Ecker, C, Anson, M, Chaplin, E, Glaser, K, Mendez, A, Lovell, K and Murphy, D (2016) Social anxiety in adult males with autism spectrum disorders. Research in Autism Spectrum Disorders 32, 1323.
Sterling, L, Dawson, G, Estes, A and Greenson, J (2008) Characteristics associated with presence of depressive symptoms in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders 38, 10111018.
Stewart, ME, Barnard, L, Pearson, J, Hasan, R and O'Brien, G (2006) Presentation of depression in autism and Asperger syndrome a review. Autism 10, 103116.
Taylor, JL and Seltzer, MM (2011) Employment and post-secondary educational activities for young adults with autism spectrum disorders during the transition to adulthood. Journal of Autism and Developmental Disorders 41, 566574.
Tsakanikos, E, Costello, H, Holt, G, Bouras, N, Sturmey, P and Newton, T (2006) Psychopathology in adults with autism and intellectual disability. United States Journal of Autism and Developmental Disorders 36, 11231129.
Tsakanikos, E, Sturmey, P, Costello, H, Holt, G and Bouras, N (2007) Referral trends in mental health services for adults with intellectual disability and autism spectrum disorders. England Autism: the International Journal of Research and Practice 11, 917.
Tsakanikos, E, Underwood, L, Kravariti, E, Bouras, N and McCarthy, J (2011) Gender differences in co-morbid psychopathology and clinical management in adults with autism spectrum disorders. Research in Autism Spectrum Disorders 5, 803808.
Uljarevic, M, Richdale, AL, McConachie, H, Hedley, D, Cai, RY, Merrick, H, Parr, JR and Le Couteur, A (2018) The hospital anxiety and depression scale: factor structure and psychometric properties in older adolescents and young adults with autism spectrum disorder. Autism Research 11:258269.
Vannucchi, G, Masi, G, Toni, C, Dell'Osso, L, Erfurth, A and Perugi, G (2014) Bipolar disorder in adults with Asperger's Syndrome: a systematic review. Journal of Affective Disorders 168, 151160.
van Steensel, FJA and Heeman, EJ (2017) Anxiety levels in children with autism spectrum disorder: a meta-analysis. Journal of Child and Family Studies 26, 17531767.
van Steensel, FJA, Bögels, SM and Perrin, S (2011) Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review 14, 302317.
Viechtbauer, W (2010) Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36, 148.
Wallace, BC, Dahabreh, IJ, Trikalinos, T a, Lau, J, Trow, P and Schmid, CH (2012) Closing the gap between methodologists and end-users: r as a computational back-End. Journal of Statistical Software 49, 115.
Wigham, S, Barton, S, Parr, JR and Rodgers, J (2017) A systematic review of the rates of depression in children and adults With high-functioning autism spectrum disorder. Journal of Mental Health Research in Intellectual Disabilities 10, 267287.
Wood, JJ and Gadow, KD (2010) Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Science and Practice 17, 281292.
Zainal, H, Magiati, I, Tan, JWL, Sung, M, Fung, DSS and Howlin, P (2014) A preliminary investigation of the Spence children's anxiety parent scale as a screening tool for anxiety in young people with autism spectrum disorders. Journal of Autism and Developmental Disorders 44, 19821994.
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