Decreased Satisfaction in Peer Relationships Is Strongly Associated with Depression in Children with High ASD Traits: A Population-Based Cross-Sectional Study in Japan

Background: High rates of depression have been reported among children with autism spectrum disorder (ASD); however the relationship between depression and ASD traits observed in a community-based children sample has not yet been studied. In addition, the association between health-related quality of life (HRQOL) and depression in children with high ASD traits in a general population has not been evaluated, although that between HRQOL and depression has been reported in children with ASD in a clinical setting.

Objectives: This study aimed to examine how ASD traits are associated with depression in children using a population-based community sample. Moreover, we investigated how HRQOL is associated with depression in children with high ASD traits.

Methods: We conducted a survey among all children above grade 4 who attended national and public primary or junior high schools and their primary caregivers in September 2016. Of 8518 questionnaires, we received 7147 valid responses (83.9%). We evaluated ASD traits in children using a parental reported questionnaire, Autism Spectrum Screening Questionnaire (ASSQ). The Depression Self-Rating Scale for Children (DSRS-C) and Pediatric Quality of Life Inventory^™ (PedsQL^™), both self-reported questionnaires, were used for evaluating depression and HRQOL, respectively.

Results: The results of multiple regression analysis for all children revealed that ASSQ score and all subscale scores of PedsQL^™ and other demographic factors were significantly associated with DSRS-C score, indicating that high ASD traits were associated with more severe depression even in a community sample of children. Moreover, we conducted multiple regression analyses by categorizing children into two groups based on ASSQ scores (score ≥ 19 or not) in order to examine how ASD traits influence on the relationship HRQOL and depression. Consequently, only emotional and social functioning were significantly associated with depression in the high ASD trait group, although all four PedsQL^™ subscale scores were significantly associated with depression in the low ASD trait group. However, the relationship between social functioning score and depression was stronger in the high ASD trait group (β = −0.324, p < 0.001) than in the low ASD trait group (β = −0.177, p < 0.001). The association between emotional functioning and depression was comparable between the high and low ASD trait groups (β = −0.347, p < 0.001 vs. β = −0.391, p < 0.001). These results indicated that decreased satisfaction in peer relationships was more strongly associated with depression in children with high ASD traits than in those with low ASD traits. Furthermore, Analysis of variance for the PedsQL^™ subscale scores revealed that all subscale scores were higher in the high ASD trait group than in the low ASD trait group, and the largest effect size was observed in the difference of the social functioning score between groups (d = 0.82).

Conclusions: Decreased satisfaction in peer relationships is more strongly associated with more severe depression in children with high ASD traits than in those with low ASD traits. This result suggests that intervention in the quality of peer relationships among children with high ASD traits is essential to prevent depression.