Prevalence and correlates of depressive disorders among adolescents with autism spectrum disorder in Hong Kong West Cluster.

OBJECTIVES

To determine the prevalence and correlates of depressive disorders among adolescents with autism spectrum disorder (ASD) in the Hong Kong West Cluster.

METHODS

Chinese adolescents aged 13 to 17 years with a clinical diagnosis of ASD who had been followed up within the preceding 18 months in the Hong Kong West Cluster were identified. Eligible patients and their parents were invited to complete a questionnaire for data collection. Diagnosis of depressive disorders was determined using the parent-reported Diagnostic Interview Schedule for Children Version IV. Depressive symptom severity was measured using the 21-item self-report Beck Depression Inventory-II. ASD symptoms were assessed using the parent-administered Developmental, Dimensional and Diagnostic Interview. Broader behavioural and emotional difficulties were assessed using the parent-reported Strengths and Difficulties Questionnaire. Parental mental health was assessed using the Patient Health Questionnaire-9 for depressive symptoms and the Generalised Anxiety Disorder-7 for anxiety symptoms.

RESULTS

Of 140 adolescents with ASD, 82 boys and 14 girls (mean age, 15.7 years) and their parents completed the questionnaires and interviews and were included in the analysis. Of these adolescents, 12 (12.5%) met the criteria for major depressive disorder (MDD). Only 58.3% of the 12 patients were receiving drug or psychological treatment. The most commonly reported depressive symptoms were biological and cognitive; sadness was reported by only two (18.2%) participants. Predictors of MDD among adolescents with ASD were maternal educational attainment of a bachelor's degree or above relative to secondary education (odds ratio [OR] = 36.73, p = 0.015), a paternal history of mental disorder (OR = 9.90, p = 0.041), and higher maternal depressive score (OR = 1.24 per unit increase, p = 0.027). Additionally, female sex (OR = 7.25, p = 0.065) and higher paternal anxiety score (OR = 1.24, p = 0.098) showed trends towards an increased likelihood of MDD.

CONCLUSIONS

The prevalence of MDD among adolescents with ASD in Hong Kong was 12.5%. Symptoms of MDD were predominantly biological and cognitive, whereas sadness was underreported. Predictors of MDD were maternal educational attainment of a bachelor's degree or above, a paternal history of mental disorder, and higher maternal depressive scores. Clinicians assessing adolescents with ASD should be aware of these atypical presentations and avoid relying solely on self-reported sadness when making a diagnosis. Parental mental health intervention may be a clinical priority and a potential preventive strategy.