Substantial uncertainty exists about the prevalence of depressive disorders in individuals with autism spectrum disorder (ASD). This meta-analysis quantitatively summarized studies that assessed the lifetime and current prevalence of unipolar depressive disorders in children, adolescents, and adults with ASD. We also examined demographic, methodological, and study moderators. This meta-analysis adhered to PRISMA guidelines. A total of 7857 articles were identified through 5 databases (PubMed, Web of Science, PYSCInfo, CINAHL, ProQuest Dissertations and Theses), forward searches, and backward searches. Two reviewers independently screened articles and extracted data. Sixty-six articles met inclusion criteria. Results indicated that the pooled lifetime and current prevalence was 14.4% (95% CI 10.3–19.8) and 12.3% (95% CI 9.7–15.5), respectively. Rates of depressive disorders were highest among studies that used a standardized interview to assess depressive disorders (lifetime = 28.5%, 95% CI 20.1–38.8; current = 15.3%, 95% CI 11.0–20.9) and required participants to report on their own depressive symptoms (lifetime = 48.6%, 95% CI 33.3–64.2; current = 25.9%, 95% CI 17.0–37.3). Rates were also higher in studies that included participants with higher intelligence. Lifetime, but not current, prevalence was positively associated with age and the proportion of the sample that was White. In conclusion, we found that the rates of depressive disorders are high among individuals with ASD. Compared to typically developing individuals, individuals with ASD are 4-times more likely to experience depression in their lifetime. These results suggest that individuals with ASD should be regularly screened and offered treatment for depression.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101(2), 213–232. https://doi.org/10.1037/0033-2909.101.2.213
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.
Angold, A., & Costello, E. J. (2001). The epidemiology of depression in children and adolescents. In I. M. Goodyer (Ed.), The depressed child and adolescent (2nd ed., pp. 143–178). New York: Cambridge University Press.
Begg, C. B., & Mazumdar, M. (1994). Operating characteristics of a rank correlation test for publication bias. Biometrics, 50, 1088–1101.
Billstedt, E., Gillberg, C., & Gillberg, C. (2005). Autism after adolescence: Population-based 13- to 22-year follow-up study of 120 individuals with autism diagnosed in childhood. Journal of Autism and Developmental Disorders, 35, 351–360. https://doi.org/10.1007/s10803-005-3302-5
Borenstein, M., Rothstein, D., & Cohen, J. (2005). Comprehensive meta-analysis: A computer program for research synthesis [computer software]. Englewood: Biostat.
Breslau, J., Javaras, K. N., Blacker, D., Murphy, J. M., & Normand, S. L. T. (2008). Differential item functioning between ethnic groups in the epidemiological assessment of depression. The Journal of Nervous and Mental Disease, 196(4), 297. https://doi.org/10.1097/NMD.0b013e31816a490e
Cassidy, S., & Rodgers, J. (2017). Understanding and prevention of suicide in autism. The Lancet Psychiatry, 4(6), e11. https://doi.org/10.1016/S2215-0366(17)30162-1
Chandrasekhar, T., & Sikich, L. (2015). Challenges in the diagnosis and treatment of depression in autism spectrum disorders across the lifespan. Dialogues in Clinical Neuroscience., 17(2), 219–227.
Costello, E. J., Costello, A. J., Edelbrock, C., Burns, B. J., Dulcan, M. K., Brent, D., & Janiszewski, S. (1988). Psychiatric disorders in pediatric primary care: Prevalence and risk factors. Archives of General Psychiatry, 45(12), 1107–1116.29.
Duval, S. (2005). The trim and fill method. In H. R. Rothstein, A. J. Sutton, & M. Borenstein (Eds.), Publication bias in meta-analysis: Prevention, assessment and adjustments (pp. 127–144). Hoboken: Wiley.
Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnelplot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x
Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal, 315, 629–634.
Fernell, E., Eriksson, M. A., & Gillberg, C. (2013). Early diagnosis of autism and impact on prognosis: A narrative review. Clinical Epidemiology, 5, 33–43. https://doi.org/10.2147/CLEP.S41714
Gotham, K., Brunwasser, S. M., & Lord, C. (2015). Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 369–376. https://doi.org/10.1016/j.jaac.2015.02.005
Hoy, D., Brooks, P., Woolf, A., Blyth, F., March, L., Bain, C., et al. (2012). Assessing risk of bias in prevalence studies: Modification of an existing tool and evidence of interrater agreement. Journal of Clinical Epidemiology, 65(9), 934–939. https://doi.org/10.1016/j.jclinepi.2011.11.014
Johnson, S. A., Filliter, J. H., & Murphy, R. R. (2009). Discrepancies between self-and parent-perceptions of autistic traits and empathy in high functioning children and adolescents on the autism spectrum. Journal of Autism and Developmental Disorders, 39(12), 1706–1714. https://doi.org/10.1007/s10803-009-0809-1
Joshi, G., Wozniak, J., Petty, C., Martelon, M. K., Fried, R., Bolfek, A., et al. (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(6), 1314–1325. https://doi.org/10.1007/s10803-012-1679-5
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). The epidemiology of major depressive disorder: Results from the National Comorbidity Survey Replication (NCS-R). The Journal of the American Medical Association, 289(23), 3095–3105. https://doi.org/10.1001/jama.289.23.3095
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593
Kessler, R. C., Birnbaum, H., Bromet, E., Hwang, I., Sampson, N., & Shahly, V. (2010). Age differences in major depression: Results from the National Comorbidity Survey Replication (NCS-R). Psychological Medicine, 40(2), 225–237. https://doi.org/10.1017/S0033291709990213
Kessler, R. C., McGonagle, K. A., Swartz, M., Blazer, D. G., & Nelson, C. B. (1993). Sex and depression in the National Comorbidity Survey I: Lifetime prevalence, chronicity and recurrence. Journal of Affective Disorders, 29(2), 85–96.
Kiep, M., Spek, A. A., & Hoeben, L. (2015). Mindfulness-based therapy in adults with an autism spectrum disorder: Do treatment effects last? Mindfulness, 6, 637–644. https://doi.org/10.1007/s12671-014-0299-x
Koenen, K. C., Moffitt, T. E., Roberts, A. L., Martin, L. T., Kubzansky, L., Harrington, H., et al. (2009). Childhood IQ and adult mental disorders: A test of the cognitive reserve hypothesis. American Journal of Psychiatry, 166(1), 50–57. https://doi.org/10.1176/appi.ajp.2008.08030343
Kraper, C. K., Kenworthy, L., Popal, H., Martin, A., & Wallace, G. L. (2017). The gap between adaptive behavior and intelligence in autism persists into young adulthood and is linked to psychiatric co-morbidities. Journal of Autism and Developmental Disorders, 47(10), 3007–3017. https://doi.org/10.1007/s10803-017-3213-2
Magnuson, K. M., & Constantino, J. N. (2011). Characterization of depression in children with autism spectrum disorders. Journal of Developmental and Behavioral Pediatrics, 32(4), 332–340. https://doi.org/10.1097/DBP.0b013e318213f56c
Matson, J. L., & Cervantes, P. E. (2014). Commonly studies comorbid psychopathologies among persons with autism spectrum disorder. Research in Developmental Disabilities, 35, 952–962. https://doi.org/10.1016/j.ridd.2014.02.012
Mazzone, L., Ruta, L., & Reale, L. (2012). Psychiatric comorbidities in asperger syndrome and high functioning autism: Diagnostic challenging. Annuals of General Psychiatry, 11(16), 1–13. https://doi.org/10.1186/1744-859X-11-16
McGillivray, J. A., & Evert, H. T. (2014). Group cognitive behavioural therapy program shows potential in reducing symptoms of depression and stress among young people with ASD. Journal of Developmental Disorders, 44, 2041–2051. https://doi.org/10.1007/s10803-014-2087-9
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., et al. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017
Miller, P. R., Dasher, R., Collins, R., Griffiths, P., & Brown, F. (2001). Inpatient diagnostic assessments: 1. Accuracy of structured vs. unstructured interviews. Psychiatry Research, 105, 255–264.
Moretti, M. M., Fine, S., Haley, G., & Marriage, K. (1985). Childhood and adolescent depression: Child-report versus parent-report information. Journal of the American Academy of Child Psychiatry, 24(3), 298–302. https://doi.org/10.1016/S0002-7138(09)61090-6
Regier, D. A., Boyd, J. H., Burke, J. D., Rae, D. S., Myers, J. K., Kramer, M., et al. (1988). One-month prevalence of mental disorders in the United States: Based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45(11), 977–986.
Richa, S., Fahed, M., Khoury, E., & Mishara, B. (2014). Suicide in autism spectrum disorders. Archives of Suicide Research, 18, 327–339. https://doi.org/10.1080/13811118.2013.82483
Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and nutrition examination survey III. American Journal of Public Health, 95(6), 998–1000. https://doi.org/10.2105/AJPH.2004.047225
Ustün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C., & Murray, C. J. (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry, 184, 386–392.
van Steensel, F. J., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302. https://doi.org/10.1007/s10567-011-0097-0
Wingate, M., Kirby, R. S., Pettygrove, S., Cunniff, C., Schulz, E., Ghosh, T., et al. (2014). Prevalence of autism spectrum disorders among children aged 8 years: Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Surveillance Summaries, 63, 1–22.
World Health Organization. (2017). Autism spectrum disorders: Fact sheet. Retrieved from: http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en.
Conflict of Interest
The authors declare that they have no conflict of interest.
Meta-analyses are exempt from research ethics board review because the data is collected from publically available information.
Because the study did not involve interaction with participants, informed consent was not required.
Electronic supplementary material
About this article
Cite this article
Hudson, C.C., Hall, L. & Harkness, K.L. Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis. J Abnorm Child Psychol 47, 165–175 (2019). https://doi.org/10.1007/s10802-018-0402-1
- Autism spectrum disorder
- Depressive disorders