Monday, 2 April 2018

World Autism Awareness Day: "individuals with ASD are 4-times more likely to experience depression in their lifetime"

Autistica: number 1 research priority
Today - 2 April - is World Autism Awareness Day.

According to the United Nations, today is a day to "highlight the need to help improve the quality of life of those with autism so they can lead full and meaningful lives as an integral part of society."

I'm sure everyone - those diagnosed with autism, their parents and other family members and those who've devoted their professional lives to autism - will have a different interpretation of how to accomplish that message. I assume however, that all strive for a better life for ALL those on the autism spectrum and perhaps moving the message from 'awareness' to something more like 'actions'.

Quite a big part of 'improving quality of life' means acknowledging that a diagnosis of autism brings about an elevated frequency of certain quality-of-life-draining issues. I've talked quite extensively about some of them on this blog (see here and see here for example) covering both physiological and psychiatric issues / labels / diagnoses. Of all the 'comorbidities' (if I can still call them that) mentioned, one diagnosis and/or constellation of symptoms seems to be particularly frequent and life-changing in the context of autism: depression (see here) in its many forms (see here).

Depression covers a lot of clinical ground and, in some cases, has some important links to some potentially life-limiting outcomes (see here) that have also been mentioned in the context of autism (see here). It's something that needs both screening for and management of (yes, depression is manageable) and can be literally life-transforming when tackled / managed successfully. I might add that alongside pharmacotherapy / talking therapy being indicated, there are various other options to potentially consider when it comes to the management of depression in various contexts (see here and see here and see here and see here) (minus any medical or clinical advice given or intended).

A recent paper by Chloe Hudson and colleagues [1] summarises the collected peer-reviewed literature on the topic of depression and autism, concluding that: "rates of depressive disorders are high among individuals with ASD [autism spectrum disorder]." Also, as per the title of this post, "individuals with ASD are 4-times more likely to experience depression in their lifetime" when compared with the non-autistic population. The authors have also very helpfully written a lay-person summary of their meta-analysis (yet another meta-analysis covering something to do with autism).

I don't think anyone is or should be particularly surprised by the Hudson findings but it does cement the autism-depression link based on the top of the methodological tree hierarchy of peer-reviewed science. I might add that another finding reported by Hudson et al - "Rates [of depression] were also higher in studies that included participants with higher intelligence" - is also worthy of comment (see here). Not least, when it comes to targeted screening for something like depression in the context of autism (and possibly beyond), but also because such a finding seems to add to the idea that being intelligent / cognitively more able does not always mean that life is just fine and dandy (see here). I might also mention that greater research and clinical efforts also need to be focused on screening for something like depression in some of the more 'under-studied' peoples of the autism spectrum too (see here). Y'know, just to ensure that depression being associated with higher intelligence is not simply because those who aren't more cognitively able are being excluded from such investigations...

There is another question that needs comment when it comes to the autism-depression link: why? Some authors have speculated that issues such as 'autism acceptance' could be part-and-parcel of any link (see here). Yes, the social environment probably does play a role for some people, but I'm slightly reluctant to suggest that acceptance plays a solitary role in the development of something like depression. I say that on the basis of some growing interest in how issues such as loneliness begets low self-esteem which *might* then lead into something like an enhanced risk of depression (see here). One also needs to consider that autism rarely appears in some sort of diagnostic or social vacuum (see here) so other labels and/or diagnoses could also elevate the risk of depressive symptoms appearing (see here for example). And then there is biology to also consider (see here). Factors related to the aetiology of depression are likely to be complex and quite individual across different people. Sweeping generalisations are not required.

The take-home message once again, is that the risk of depression is elevated when it comes to a diagnosis of autism, and screening and appropriate management are very much indicated [2]. To move on from just talking about improving quality of life to actually improving quality of life could well be achieved (at least in part) by recognising and tackling depression when it appears in the context of autism. Real quality of life changing stuff...

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[1] Hudson CC. et al. Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis. J Abnorm Child Psychol. 2018 Mar 1.

[2] Sapmaz D. et al. The Clinical Features of Comorbid Pediatric Bipolar Disorder in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2018 Mar 21.

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