Association of Comorbid Mood and Anxiety Disorders With Autism Spectrum Disorder

Abstract

IMPORTANCEIt is critical to evaluate the risk of comorbid psychiatric diagnoses to meet the needs of individuals with autism spectrum disorder (ASD).OBJECTIVE To examine whether individuals with ASD are at greater risk for comorbid diagnoses of depression, anxiety, or bipolar disorder. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used data from a population-based birth cohort of 31 220 individuals born in Olmsted County, Minnesota, from January 1, 1976, to December 31, 2000. Patients with research-identified ASD were previously identified using a multistep process that evaluated signs and symptoms abstracted from medical and educational records. For each of the 1014 patients with ASD, 2 age-and sex-matched referents who did not meet criteria for ASD were randomly selected from the birth cohort (n = 2028). Diagnosis codes for anxiety, depression, and bipolar disorders were electronically obtained using the Rochester Epidemiological Project records-linkage system. Data analysis was performed from July 1, 2018, to April 1, 2019. MAIN OUTCOMES AND MEASURESCumulative incidence of clinically diagnosed depression, anxiety, and bipolar disorder through early adulthood in individuals with ASD compared with referents. RESULTS A total of 1014 patients with ASD (median age at last follow-up, 22.8 years [interquartile range, 18.4-28.0 years]; 747 [73.7%] male; 902 [89.0%] white) and 2028 referents (median age at last follow-up, 22.4 years [interquartile range, 18.8-26.2 years]; 1494 [73.7%] male; 1780 [87.8%] white) participated in the study. Patients with ASD were significantly more likely to have clinically diagnosed bipolar disorder (hazard ratio [HR], 9.34; 95% CI, 4.57-19.06), depression (HR, 2.81; 95% CI,, and anxiety (HR, 3.45; 95% CI, 2.96-4.01) compared with referents. Among individuals with ASD, the estimates of cumulative incidence by 30 years of age were 7.3% (95% CI, 4.8%-9.7%) for bipolar disorder, 54.1% (95% CI, 49.8%-58.0%) for depression, and 50.0% (95% CI, 46.0%-53.7%) for anxiety. Among referents, cumulative incidence estimates by 30 years of age were 0.9% (95% CI, 0.1%-1.7%) for bipolar disorder, 28.9% (95% CI, 25.7%-32.0%) for depression, and 22.2% (95% CI, 19.3%-25.0%) for anxiety. CONCLUSIONS AND RELEVANCEThe findings suggest that individuals with ASD may be at increased risk for clinically diagnosed depression, anxiety, and bipolar disorder compared with age-and sex-matched referents. This study supports the importance of early, ongoing surveillance and targeted treatments to address the psychiatric needs of individuals with ASD.

The Psychological Impact of the COVID-19 Pandemic on Adults With Autism: A Survey Study Across Three Countries

“…Moreover, an overstretched healthcare system paired with social distancing rules meant that many adults with autism lost some, if not all of the support they received before the pandemic, as evident from both our quantitative and qualitative results. These results are particularly worrisome considering that adults with autism ordinarily have higher rates of anxiety and depression than neurotypicals (18,19), as was also reported by participants in our sample, and struggle to access mental health services (37,38). These results are in line with a recent report from the National Autism Society (39), where 9 out of 10 people with autism indicated to worry about their mental health during lockdown.…”

“…It is important to note that although the groups did not differ on common matched-for variables such as age, gender ratio, and years of education (taken as a rough proxy for SES (46)), there were differences between groups on other variables such as preexisting mental health difficulties and employment status, with adults reporting more mental health difficulties and lower employment status. However, these differences are representative of what is generally found in the autism population (18,19,40). Moreover, this makes the greater pandemic related increase in mental health problems as found for adults with autism even more worrisome.…”

“…This gives reason to believe that individuals with autism may experience the pandemic in a unique way. Given the fact that adults with autism are reported to have more difficulty coping with stressful events than neurotypicals do (20,21), and especially because levels of anxiety and depression are known to be generally high in the autism population (18,19), there is a need for research to ascertain the impact of the pandemic on the mental health of individuals with autism. This need is also evident from the emerging articles that emphasize the concerns for individuals with autism during the COVID-19 pandemic (22,23).…”

Social Visual Perception Under the Eye of Bayesian Theories in Autism Spectrum Disorder Using Advanced Modeling of Spatial and Temporal Parameters

“…Particularly it is reported that around 70% of individuals with autism spectrum disorder might also fulfill the criteria for another co-morbid mental disorder and approximately 40% can have two or more co-morbid mental disorders (1). Common comorbid conditions include anxiety disorders, epilepsy, depression, gastrointestinal symptoms, challenging behavior, sleep problems, toileting, and feeding issues (31)(32)(33)(34)(35)(36), as well as Attention-Deficit/Hyperactivity Disorder (ADHD) (37). Interestingly, even before DSM-V, studies have reported ADHD traits in populations with autism spectrum disorder in the areas of attention and social cognition (38).…”

Role of FMRP in rapid antidepressant effects and synapse regulation

“…Notably, people who are FMR1 premutation carriers exhibit higher rates of MDD and depressed mood compared to the general population [17][18][19] . Additionally, people with ASD have an increased risk of developing MDD by the time they are 30 years old compared to people without ASD 20 . Moreover, caretakers of people with FXS identify mood and depression as a priority for treatment development 21 .…”