Prevalence of Co-Occurring Mental Health Diagnoses in the Autism Population: A Systematic Review and Meta-Analysis
125 Pages Posted: 10 Jan 2019More...
Background: Co-occurring mental health/psychiatric conditions (CMHCs) are common in autism, impeding quality of life. Reported prevalence rates range widely. Accurate prevalence estimates and identification of moderators are needed to enhance recognition and care and guide future research.
Methods: We conducted a systematic review and meta-analysis according to PRISMA and MOOSE standards (pre-registered protocol: PROSPERO CRD42018103176). We searched publications from January 1st, 1993 to November 27th, 2018 using Medline, Embase, PsycINFO, Scopus, Web of Science and from the grey literature. Included articles: (1) were published in English/French, (2) reported the prevalence of CMHCs in autistic individuals and (3) reported confirmed clinical diagnoses of CMHCs and autism using DSM- or ICD-based criteria. Risk of bias was assessed. Overall pooled estimates of prevalence for different CMHCs in autism were determined using random-effects models. Heterogeneity was investigated using random-effects meta-regression models.
Findings: Out of 9,515 unique studies, 420 were selected for full-text review. Meta-analyses from 83 studies showed overall pooled estimates of: ADHD 33% (95%CI 29-37%), anxiety disorders 23% (19-27%), sleep-wake disorders 13% (7-20%), depressive disorders 12% (9-14%), obsessive-compulsive disorder 10% (8-13%), disruptive/impulse-control/conduct disorders 10% (8-13%), schizophrenia spectrum disorders 5% (4-7%), and bipolar disorders 5% (3-7%). Estimates in clinical sample-based studies were higher than population/registry-based studies for most CMHCs. Age, gender, intellectual functioning and country of study were associated with heterogeneity.
Interpretation: A variety of CMHCs are more prevalent in the autism population than in the general population. Careful assessment of mental health concerns is an essential component of care for all autistic people.
Funding Statement: This work was supported by two Academic Scholars Awards from the Department of Psychiatry, University of Toronto (to M-CL and SHA), and by the O’Brien Scholars Program, Slaight Family Child and Youth Mental Health Innovation Fund and The Catherine and Maxwell Meighen Foundation via the CAMH Foundation (to M-CL and SHA).
Declaration of Interests: "None reported."
Ethics Approval Statement: We conducted a systematic review and meta-analysis according to PRISMA and MOOSE standards (pre-registered protocol: PROSPERO CRD42018103176).
Keywords: autism, mental health, comorbidity, psychiatric disorder, prevalence, meta-analysis
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