Department of Clinical Psychology,University of East Anglia,Norwich,UK.
Department of Psychology,National University of Singapore,Singapore.
Psychol Med. 2019 Mar;49(4):559-572. doi: 10.1017/S0033291718002283. Epub 2018 Sep 4.
Adults with autism spectrum disorder (ASD) are thought to be at disproportionate risk of developing mental health comorbidities, with anxiety and depression being considered most prominent amongst these. Yet, no systematic review has been carried out to date to examine rates of both anxiety and depression focusing specifically on adults with ASD. This systematic review and meta-analysis examined the rates of anxiety and depression in adults with ASD and the impact of factors such as assessment methods and presence of comorbid intellectual disability (ID) diagnosis on estimated prevalence rates. Electronic database searches for studies published between January 2000 and September 2017 identified a total of 35 studies, including 30 studies measuring anxiety (n = 26 070; mean age = 30.9, s.d. = 6.2 years) and 29 studies measuring depression (n = 26 117; mean age = 31.1, s.d. = 6.8 years). The pooled estimation of current and lifetime prevalence for adults with ASD were 27% and 42% for any anxiety disorder, and 23% and 37% for depressive disorder. Further analyses revealed that the use of questionnaire measures and the presence of ID may significantly influence estimates of prevalence. The current literature suffers from a high degree of heterogeneity in study method and an overreliance on clinical samples. These results highlight the importance of community-based studies and the identification and inclusion of well-characterized samples to reduce heterogeneity and bias in estimates of prevalence for comorbidity in adults with ASD and other populations with complex psychiatric presentations.
成人自闭症谱系障碍（ASD）被认为存在不成比例的心理健康共病风险，其中焦虑和抑郁被认为最为突出。然而，迄今为止，尚无系统综述专门针对 ASD 成人来检查焦虑和抑郁的发病率，以及评估方法和共患智力障碍（ID）诊断的存在等因素对估计患病率的影响。电子数据库检索了 2000 年 1 月至 2017 年 9 月期间发表的研究，共确定了 35 项研究，其中 30 项研究测量了焦虑（n = 26070；平均年龄 = 30.9，s.d. = 6.2 岁），29 项研究测量了抑郁（n = 26117；平均年龄 = 31.1，s.d. = 6.8 岁）。ASD 成人当前和终生任何焦虑障碍的患病率估计值为 27%和 42%，抑郁障碍的患病率估计值为 23%和 37%。进一步的分析表明，使用问卷测量和存在 ID 可能会显著影响患病率的估计。当前的文献在研究方法上存在高度异质性，并且过度依赖临床样本。这些结果强调了基于社区的研究以及识别和纳入特征明确的样本的重要性，以减少 ASD 成人和其他具有复杂精神表现的人群中合并症患病率估计的异质性和偏倚。
