Abstract
Depression is the most commonly experienced mental health condition in adults with autism spectrum conditions (ASC). However, it is unclear what tools are currently being used to assess depression in ASC, or whether tools need to be adapted for this group. This systematic review therefore aimed to identify tools used to assess depression in adults with and without ASC, and then evaluate these tools for their appropriateness and measurement properties. Medline, PsychINFO and Web of Knowledge were searched for studies of depression in: (a) adults with ASC, without co‐morbid intellectual disability; and (b) adults from the general population without co‐morbid conditions. Articles examining the measurement properties of these tools were then searched for using a methodological filter in PubMed, and the quality of the evidence was evaluated using the COSMIN checklist. Twelve articles were identified which utilized three tools to assess depression in adults with ASC, but only one article which assessed the measurement properties of one of these tools was identified and thus evaluated. Sixty‐four articles were identified which utilized five tools to assess depression in general population adults, and fourteen articles had assessed the measurement properties of these tools. Overall, two tools were found to be robust in their measurement properties in the general population—the Beck Depression Inventory (BDI‐II), and the patient health questionnaire (PHQ‐9). Crucially only one study was identified from the COSMIN search, which showed weak evidence in support of the measurement properties of the BDI‐II in an ASC sample. Implications for effective measurement of depression in ASC are discussed. Autism Res 2018, 11: 738–754. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.Lay SummaryDepression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.
Highlights
Recent research has shown that a majority of adults with an autism spectrum condition (ASC) meet diagnostic criteria for at least one psychiatric condition (79%), with depression being the most common [Lever & Geurts, 2016]
The PubMed search for studies assessing the measurement properties of depression tools used in adults with ASC, without co-morbid intellectual disability, identified 17 articles which were screened, one of which was retained for analysis (Fig. 2)
Research has used a smaller range of validated tools to assess depression in those with ASC compared to the general population
Summary
Recent research has shown that a majority of adults with an autism spectrum condition (ASC) meet diagnostic criteria for at least one psychiatric condition (79%), with depression being the most common [Lever & Geurts, 2016]. Studies have highlighted high rates of depression in adults with ASC [e.g., Cassidy et al, 2014; Hofvander et al, 2009]. Depression has been shown to increase risk of adults with ASC contemplating, planning [Cassidy et al, 2014], or dying by suicide [Hirvikoski et al, 2016]. It is crucial to effectively identify depression in this group. It is unclear if there are valid tools available to assess depression in those with ASC
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