Depression among adults in the United States is on the rise – partly due to the COVID-19 pandemic – with some estimates putting the rate of depression at 1 in every 3 people. Adults with autism spectrum disorder (ASD) are at higher risk for depression than the general population, and research into risk factors for depression in autism is ongoing.
Research into depression risk and resilience factors for adults with ASD is also critical to guide proper screening and intervention efforts, said Vanderbilt Kennedy Center (VKC) member Jessica Schwartzman, Ph.D., author on a Frontiers in Psychiatry paper that examined the connection between repetitive behaviors and depression in autistic adults.
“We were really interested in trying to understand if certain traits found more commonly in autism might place people at elevated risk for depression,” Schwartzman said.
In collaboration with the Katherine Gotham Social, Emotional and Affective Health Lab, Schwartzman and Zachary Williams, data scientist and Medical Scientist Training Program student, investigated relationships between aspects of autism – such as insistence on sameness (IS) and repetitive sensorimotor (RSM) behaviors – and depression risk in 762 autistic adults. Specifically, Schwartzman and team sought to understand if IS and RSM were direct risk factors for depression, or if something else may explain observed relationships between IS, RSM and depression in autistic adults.
The research team found that IS does place adults at higher risk for depression symptoms, highlighting the importance of collecting data on patients’ levels of IS during routine diagnostic evaluations for ASD.
However, the researchers also found that adults with ASD who reported higher rates of neuroticism – the disposition to experience negative affects including anger, anxiety, self-consciousness, irritability and emotional instability – were much more likely to experience depression and suicidal thoughts.
“The current findings lead us to believe that it is neuroticism that drives the observed relationship between IS and depression symptoms, rather than IS or RSM alone,” Schwartzman said. “As researchers and clinicians, we need to be screening for neurotic traits as a risk factor for depression in autism. We need to consider and characterize neurotic traits in understanding mental health in autism and in building patients’ treatment plans.”
In addition, the team found that female and gender nonbinary autistic adults were at greater risk for depression than autistic males, with significantly higher risk in gender nonbinary adults. Gender diverse adults are historically underrepresented in ASD research, but these findings reiterate the need for continued investigations of risk factors and interventions for depression in this population. It is also likely that socioeconomic factors may contribute to risk of depression in autistic adults, Schwartzman says.
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