Risk and protective factors underlying depression and suicidal ideation in Autism Spectrum Disorder

Abstract

Background People with Autism Spectrum Disorder (ASD) are at significantly increased risk of suicidal thoughts and behavior. Given that social difficulties in ASD often lead to social isolation, which can in turn increase the risk for depression, this study examined loneliness and social support as potential risk and protective factors associated with depression and suicidal ideation. Method The sample comprised 185 people (92 females) with ASD aged 14 to 80 years who were participating in a national survey. Results Forty‐nine percent of participants returned scores in the clinical range for depression and 36% reported recent suicidal ideation. Females, comprising almost 50% of the sample, returned higher depression scores than males, however no differences were identified between males and females in terms of suicidal ideation. Regression analyses revealed that loneliness, satisfaction with social support, and ASD traits predicted depression scores. Satisfaction with social support predicted suicidal ideation, however, it was no longer a significant predictor after the effects of depression were taken into account. Path analysis showed that ASD trait severity was independently related to depression, that the effect of number of social supports on depression was mediated by loneliness and satisfaction with social support, and that effects of loneliness and satisfaction with social support on suicidal ideation were mediated by depression. The pattern of relationships was nearly identical for males and females. Conclusions This study supports a model whereby loneliness and social support operate respectively as protective and risk factors for depression and suicidal ideation in ASD.

Predictors of mental health and well‐being in employed adults with autism spectrum disorder at 12‐month follow‐up

“…Although our baseline finding for ASD traits is consistent with previous studies that have failed to identify a relationship between ASD traits and depression [Hedley, Uljarević, & Hedley, ; Hedley, Uljarević, Wilmot, Richdale, & Dissanayake, ], or anxiety [Uljarević et al, ], it is important to note that a number of cross‐sectional studies have identified significant relationships between these factors amongst ASD [Hedley, Uljarević, Foley, et al, ; Uljarević et al, ] and non‐ASD [Lamport & Zlomke, ; Salehzadeh et al, ] populations. Findings from our study and those of others suggests the relationship between ASD traits and psychopathology is complex and likely non‐linear, and highlights the importance of longitudinal study designs to fully characterize the role of ASD trait severity in the development and maintenance of psychopathology [Tebartz van Elst, Pick, Biscaldi, Fangmeier, & Riedel, ].…”

“…However, regression results failed to identify social support as a significant predictor of positive well‐being at follow‐up when controlling for baseline (well‐being) scores. While the association between social support and well‐being in the typical population is well replicated [Turner, ; Wilhelm et al, ], and there is growing evidence that social support may be an important protective factor against poor negative mental health outcomes (e.g., depression, suicidal ideation) in people with ASD [Hedley, Uljarević, Foley, et al, ; Hedley, Uljarević, & Hedley, ; Hedley, Uljarević, Wilmot, et al, ], our results do not strongly support this interpretation in the present sample. More research into the role of social support in improving mental health and well‐being in people with ASD is therefore needed.…”

“…Nevertheless, the availability of data from two time‐points, which allowed us to identify potential predictors of mental health and well‐being, is a significant strength of the study. Second, although we have selected measures that have a strong evidence base in clinical and general populations, or which have been shown to perform well psychometrically in adults with ASD [Hedley, Uljarević, Foley, et al, ], it is generally acknowledged that there is a lack of validated instruments to assess mental health difficulties in ASD [Uljarević et al, ; Wigham, Barton, Parr, & Rodgers, ]. Third, we did not include a comparative sample of adults with ASD engaged in open (i.e., unsupported) employment.…”

“…Furthermore, children with ASD who fared worse in terms of positive well‐being had more behavioral, communication, and social problems, suggesting symptom severity may have impacted well‐being. Furthermore, ASD trait severity has been found to predict elements of negative mental health in adults with ASD, including anxiety and depression [Hedley, Uljarević, Foley, et al, ; Uljarević et al, ; cf. Uljarević et al, ].…”

“…Another key predictor of mental health and well‐being is social support. In adults with ASD, social support has been identified as a protective factor against depression and suicidal ideation [Hedley, Uljarević, Foley, et al, ; Hedley, Uljarević, Wilmot, Richdale, & Dissanayake, ], and is a significant predictor of state and trait anxiety [Harkry, ]. In non‐ASD populations, social support has been shown to predict life satisfaction [Strizović & Mratinković, ] and positive well‐being [Wilhelm et al, ], improves long‐term depression trajectories [Heinz et al, ], and provides a protective effect during crisis [Henderson, ].…”