Association of Activity Engagement with Severity of Depressive Symptoms in Adults with ASD

Background: Adults with Autism Spectrum Disorder (ASD) are at a higher risk for having comorbid mental health conditions, such as depression and anxiety. The patient health questionnaire-9 (PHQ-9) is a widely used self-administered questionnaire used to screen for depression and measure severity of depressive symptoms, identifying mild to severe depressive symptoms. Community participation has been associated with reduced risk of depressive symptoms in certain subpopulations (e.g., in older women in the general population (Ahern and Hendryx, 2008) or post-stroke (White et al., 2014)). In individuals with ASD, community participation has been found to decrease significantly during the transition from adolescence into adulthood (Myers et al., 2015).

Objectives: Our goal was to determine which factors are associated with severity of depressive symptoms in adults with ASD.

Methods: Using retrospective medical record chart review study design, we abstracted data for adults with prior clinically established ASD diagnosis, who presented for initial evaluation at the UW Medicine Adult Autism Clinic between January and August 2015, and had completed a PHQ-9 at the initial visit (n=32). ANOVAs were conducted using PHQ-9 as the dependent variable, and each of the following binary categorical variables as independent variables: sex, family history of anxiety and/or depression, engagement in community/recreational/educational activities, current employment/school status, change in living arrangement (over the preceding year) or current psychotherapy.

Results: Engagement in community/recreational/educational activities was associated with severity of depressive symptoms: PHQ-9 scores were lower (less depression) in patients engaged in one or more activities (M=9.5 SD=5.7) compared to patients not involved in activities (M=15.5 SD=5.8) (F=6.6, p<0.05). Individuals who were currently receiving psychotherapy had significantly higher depression scores (M=14.3 SD=5.4) compared to those who were not (M=8.4 SD=5.7) (F=8.7, p<0.01). Adults with family history of depression and/or anxiety had higher depression scores (M=13.0 SD=6.2) as compared to individuals without reported family history of depression and/or anxiety (M=8.4 SD=5.4) (F=4.8, p<0.05).

Conclusions: Our finding of association between current psychotherapy and severity of depressive symptoms likely reflects that patients with higher depression scores have an indication to receive psychotherapy (e.g., ongoing depressive episode). The association between depressive symptoms and involvement in activities (community participation, recreational and/or educational activities) suggests an important relationship between co-morbid depression symptoms in adults with ASD and ability to engage in activities of adulthood. While a causative relationship cannot be determined through our current methods, our results suggest that access to community participation, recreational, and/or educational activities is related to lower depressive symptom severity. It will be important to understand the direction of this finding as promotion of community-based, educational and recreational activities for adults with ASD may be an important component of treatment plans for depression in ASD.