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Prevalence of Co-Occurring Mental Health Diagnoses in the Autism Population: A Systematic Review and Meta-Analysis

125 Pages Posted: 10 Jan 2019

See all articles by Meng-Chuan Lai

Meng-Chuan Lai

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health; University of Toronto - Campbell Family Mental Health Research Institute; University of Toronto - Centre for Brain and Mental Health; University of Toronto - Department of Psychiatry; University of Cambridge - Department of Psychiatry; National Taiwan University - Department of Psychiatry

Caroline Kassee

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Richard Besney

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Sarah Bonato

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Laura Hull

University College London - Research Department of Clinical, Educational and Health Psychology

William Mandy

University College London - Research Department of Clinical, Educational and Health Psychology

Peter Szatmari

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Stephanie H. Ameis

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

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Abstract

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

Suggested Citation

Lai, Meng-Chuan and Kassee, Caroline and Besney, Richard and Bonato, Sarah and Hull, Laura and Mandy, William and Szatmari, Peter and Ameis, Stephanie H., Prevalence of Co-Occurring Mental Health Diagnoses in the Autism Population: A Systematic Review and Meta-Analysis (April 1, 2019). Available at SSRN: https://ssrn.com/abstract=3310628

Meng-Chuan Lai (Contact Author)

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health ( email )

Toronto, Ontario
Canada

University of Toronto - Campbell Family Mental Health Research Institute ( email )

Toronto, Ontario
Canada

University of Toronto - Centre for Brain and Mental Health ( email )

Toronto
Canada

University of Toronto - Department of Psychiatry ( email )

Toronto, Ontario M5G 1X8
Canada

University of Cambridge - Department of Psychiatry

Herchel Smith Bldg
Robinson Way
Cambridge, CB2 0SZ
United Kingdom

National Taiwan University - Department of Psychiatry

Taipei
Taiwan

Caroline Kassee

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Toronto, Ontario
Canada

Richard Besney

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Toronto, Ontario
Canada

Sarah Bonato

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Toronto, Ontario
Canada

Laura Hull

University College London - Research Department of Clinical, Educational and Health Psychology

17 Queen Square
London WC1N 3AR
United Kingdom

William Mandy

University College London - Research Department of Clinical, Educational and Health Psychology

17 Queen Square
London WC1N 3AR
United Kingdom

Peter Szatmari

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health

Toronto, Ontario
Canada

Stephanie H. Ameis

University of Toronto - The Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health ( email )

Toronto, Ontario
Canada

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