The Purported Association Between Depression, Aggression, and Self-Injury in People With Intellectual Disability: A Critical Review of the Literature

Abstract

The prevalence of depression in individuals with an intellectual disability is estimated to lie between 3% and 6%. It has been suggested that symptoms of depression in this population might be atypical and include unusual features such as challenging behavior. However, there is significant disagreement regarding the use of challenging behavior as "depressive equivalent" symptomatology. The aim of this review is to evaluate published research reporting on the association between challenging behavior, specifically aggression and self-injury, and depression in people with an intellectual disability as a first step toward evaluating whether challenging behaviors might be considered as depressive equivalent symptoms. The results of the studies identified indicated that the association between depression and aggression, and depression and self-injury are equivocal and the interpretations of the results limited by threats to validity. Based on this analysis, there is insufficient evidence to support the use of challenging behavior as a depressive equivalent symptom. Further research to examine potentially confounding variables and the association between challenging behaviour and depression using methodologically robust designs and measures is clearly warranted.

Persistence and predictors of self-injurious behaviour in autism: a ten-year prospective cohort study

“…It is well-documented that painful health conditions are more common in individuals with autism, elevated for those presenting with self-injury [56]. It could be argued that lower mood occurs as a result of pain associated with the complex behavioural profile for individuals presenting with self-restraint [57]. The identification of self-restraint behaviours within the current study was limited to behavioural presence, with no record of duration or severity for individual topographies and how this may relate to mood.…”

Practitioner Review: Self‐injurious behaviour in children with developmental delay

“…(), d Oliver et al. (), e Davies and Oliver (), f Richards, Davies & Oliver (In prep), g Lundqvist (), h Richman et al. (), i Cooper et al., .…”

“…In the literature on adults with intellectual disabilities it has been suggested that self‐injury might be a ‘depressive equivalent’. Evidence is, at best, tenuous and contested (McBrien, ; Tsiouris, Mann, Patti, & Sturmey, ; Davies and Oliver, ). The suggestion is of concern as there might be other important interpretations of an association between pervasive low mood and self‐injury.…”

The Impact of COVID-19 Restrictions on Psychological Distress in Family Caregivers of Children with Neurodevelopmental Disability in the UK

“…Challenging behaviours indicate levels of severe mental stress and distress reactions in those with intellectual disabilities (Courtney & Perera, 2020 ). These behaviours are exacerbated by disruption to day-to-day routines (adaptive functioning), or restrictions on enjoyed activities (Borthwick-Duffy, 1994 ; NICE guidelines – NG11; published May, 2015) and are conditional on the level of disability (Davies & Oliver, 2016 ), depression (Davies & Oliver, 2014 ) and anxiety (Koritsas, & Iacono, 2015; Rzepecka, et al, 2011). It could be hypothesised that the COVID-19 pandemic and related limitations to routine and lockdown arrangements (Anderson et al, 2020 ) are likely to trigger or exacerbate these factors.…”