Individuals with autism spectrum disorder might be at significantly higher risk of bipolar disorder, anxiety, and depression, a new study suggests.
and associates. The report was published in JAMA Pediatrics.
Dr. Kirsch and associates reported the outcomes of a population-based cohort study involving 1,014 individuals with autism spectrum disorder and 2,028 age-and sex-matched controls without autism spectrum disorder. They found that individuals with autism spectrum disorder were more than nine times more likely to be diagnosed with bipolar disorder, 2.81 times more likely to be diagnosed with depression, and 3.45 times more likely to be diagnosed with anxiety, compared with controls.
“Significant psychosocial sequelae associated with having ASD, including difficulties developing and maintaining relationships, challenges succeeding academically and vocationally, and behaviors that can be problematic to manage, particularly increase risk for mood and anxiety symptoms in individuals with ASD,” wrote Dr. Kirsch of the department of psychiatry and psychology at the Mayo Clinic, Rochester, Minn., and associates. “Individuals with ASD also experience greater rates of other mental health challenges, including attention-deficit/hyperactivity disorder and substance abuse.”
Individuals with autism spectrum disorder who received a diagnosis of depression, anxiety, or bipolar disorder also were more likely to be diagnosed at a younger age than were those without autism. In the case of depression, the median age of diagnosis was 15.7 years, compared with 18.1 years among controls. For anxiety, the median age of diagnosis among individuals with autism spectrum disorder was 15.2 years, compared with 20.3 years for controls. For bipolar disorder, it was 20.3 years, compared with 27 years although the small number of individuals meant this was not statistically significant.
The authors suggested that the earlier age at diagnosis might reflect that individuals with autism spectrum disorder generally are monitored more closely, and are more likely to be connected to screening and diagnostic resources because of their original diagnosis.
The researchers also found that the increased risk of depression and anxiety was even higher among men with autism spectrum disorder, even though the cumulative incidence of these conditions was greater in women both with and without autism. In addition, the researchers noted that individuals with autism spectrum disorder were more likely to be diagnosed with multiple psychiatric conditions than were those without autism.
Dr. Kirsch and associates cited several limitations. One is that the population studied came from Olmsted County, Minn., which is wealthier and less diverse than the general population. Nevertheless, the results could help guide treatments for patients with ASD.
“Given the high rates of comorbidity, researchers and practitioners should develop tools that are specific to the unique needs of this population and effective medications and treatments for mood and anxiety concerns, which remain limited in this population,” they wrote.
The study was funded by grants from the National Institutes of Health and the U.S. Public Health Service. No conflicts of interest were disclosed.
SOURCE: Kirsch A et al. JAMA Pediatr. 2019 Dec 2. doi: 10.1001/jamapediatrics.2019.4368.