The prevalence and correlates of depression vary across countries. Contextual factors such as country-level income or income inequalities have been hypothesised to contribute to these differences.
To ...investigate associations of depression with socioeconomic factors at the country level (income inequality, gross national income) and individual (education, employment, assets and spending) level, and to investigate their relative contribution in explaining the cross-national variation in the prevalence of depression.
Multilevel study using interview data of 187 496 individuals from 53 countries participating in the World Health Organization World Health Surveys.
Depression prevalence varied between 0.4 and 15.7% across countries. Individual-level factors were responsible for 86.5% of this variance but there was also reasonable variation at the country level (13.5%), which appeared to increase with decreasing economic development of countries. Gross national income or country-level income inequality had no association with depression. At the individual level, fewer material assets, lower education, female gender, economic inactivity and being divorced or widowed were associated with increased odds of depression. Greater household spending, unlike material assets, was associated with increasing odds of depression (adjusted analysis).
The variance of depression prevalence attributable to country-level factors seemed to increase with decreasing economic development of countries. However, country-level income inequality or gross national income explained little of this variation, and individual-level factors appeared more important than contextual factors as determinants of depression. The divergent relationship of assets and spending with depression emphasise that different socioeconomic measures are not interchangeable in their associations with depression.
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
To quantify the prevalence of ...depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23-26%) compared with a pre-pandemic level of 13% (95% CI 12-14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
Anxiety is common in children with ASD; however, the burden of specific anxiety disorders for adults with ASD is under-researched. Using the Stockholm Youth Cohort, we compared anxiety disorder ...diagnoses among autistic adults (n = 4049), with or without intellectual disability, and population controls (n = 217,645). We conducted additional sibling analyses. Anxiety disorders were diagnosed in 20.1% of adults with ASD compared with 8.7% of controls (RR = 2.62 95% CI 2.47–2.79), with greatest risk for autistic people without intellectual disability. Rates of almost all individual anxiety disorders were raised, notably obsessive–compulsive disorder and phobic anxiety disorders. Anxiety disorders were more common in full siblings and half-siblings of people with ASD. The implications of this are explored.
Epidemiological studies in the United States consistently find autism spectrum disorders (ASD) to be overrepresented in high socioeconomic status (SES) families. These findings starkly contrast with ...SES gradients of many health conditions, and may result from SES inequalities in access to services. We hypothesized that prenatal measures of low, not high, parental SES would be associated with an increased risk of offspring ASD, once biases in case ascertainment are minimized.
We tested this hypothesis in a population-based study in Sweden, a country that has free universal healthcare, routine screening for developmental problems, and thorough protocols for diagnoses of ASD. In a case-control study nested in a total population cohort of children aged 0 to 17 years living in Stockholm County between 2001 and 2007 (N = 589,114), we matched ASD cases (n = 4,709) by age and sex to 10 randomly selected controls. We retrieved parental SES measures collected at time of birth by record linkage.
Children of families with lower income, and of parents with manual occupations (OR = 1.4, 95% CI = 1.3-1.6) were at higher risk of ASD. No important relationships with parental education were observed. These associations were present after accounting for parental ages, migration status, parity, psychiatric service use, maternal smoking during pregnancy, and birth characteristics; and regardless of comorbid intellectual disability.
Lower, not higher, socioeconomic status was associated with an increased risk of ASD. Studies finding the opposite may be underestimating the burden of ASD in lower SES groups.
Studies report overlap between autism spectrum disorders and psychosis. This may indicate a relationship between the 2 disorders or an artificial overlap due to similarity of symptoms. The aim of ...this study was to investigate whether autism spectrum disorder and autistic traits predict psychotic experiences in early adolescence.
This study analyzes prospective data from a cohort. A dataset was analyzed of 5,359 cohort members who had provided data on autistic traits and/or a diagnosis of an autism spectrum disorder and psychotic experiences at age 12 years.
A diagnosis of an autism spectrum disorder (odds ratio = 2.81, 95% confidence interval = 1.07, 7.34 p = .035) and childhood autistic traits (odds ratio = 1.15, 95% confidence interval = 1.05, 1.26 p = .0018) were associated with psychotic experiences after adjustment for confounders.
These findings suggest a shared neurodevelopmental origin for autism and psychosis.
In a record-linkage study in Stockholm, Sweden, the year 2011 prevalence of diagnosed autism spectrum disorders (ASD) was found to be 0.40, 1.74, 2.46, and 1.76 % among 0–5, 6–12, 13–17, and ...18–27 year olds, respectively. The corresponding proportion of cases with a recorded diagnosis of intellectual disability was 17.4, 22.1, 26.1 and 29.4 %. Between 2001 and 2011, ASD prevalence increased almost 3.5 fold among children aged 2–17 years. The increase was mainly accounted for by an eightfold increase of ASD without intellectual disability (from 0.14 to 1.10 %), while the prevalence of ASD with intellectual disability increased only slightly (from 0.28 to 0.34 %). The increase in ASD prevalence is likely contributed to by extrinsic factors such as increased awareness and diagnostics.
Gender-typical play is observed throughout childhood for non-autistic children. However, there has been limited research into the gender typicality of autistic children’s play compared to that of ...non-autistic children. In a longitudinal population-based cohort, we compared gendered play behaviours in autistic and non-autistic children using standardised parent-report (30, 42 and 57 months) and child-report (8 years) data (N = 11,251). We observed no difference in gendered play behaviours between girls with or without autism at any time point. Autistic and non-autistic boys did not differ in the gender typicality of their play when aged 30 months, but the play of autistic boys appeared less masculine than that of non-autistic boys (β = −1.1, 95% confidence interval = −2.1 to −0.2; and β = −2.6, 95% confidence interval = −4.7 to −0.5) at 42 and 57 months. Autistic boys also self-reported less masculine play behaviours than non-autistic boys at 8 years of age (β = −3.4, 95% confidence interval = −6.6 to −0.2). We found that autistic boys’ play was less gender typical than that of non-autistic boys in middle and later childhood. Our findings highlight the importance of examining gendered play behaviours in a developmental context and have relevance for understanding the development of gender identity in autism.
Lay abstract
Non-autistic children tend to show gendered patterns of play behaviours – boys are more likely to play with ‘masculine’ toys, and girls are more likely to play with ‘feminine’ toys. However, little is known about whether autistic children follow these patterns as well. We looked at the masculinity and femininity of autistic and non-autistic children’s play behaviours at multiple time points. Parents reported their children’s play behaviours at ages 30, 42 and 57 months, and children reported their own play behaviours at 8 years old. We found no difference between autistic and non-autistic girls, who both showed more feminine play behaviours as they got older. Autistic boys’ play behaviours were reported as less masculine than non-autistic boys at 42 and 57 months, and at 8 years old. We also found that non-autistic boys’ play tended to become more masculine as they got older, but this was not the case for autistic boys. Our findings suggest that differences in autistic and non-autistic boys’ play behaviours may develop at around 42 months old.
Summary
Purpose: In a nationally representative population‐based study in England, we estimated the burden of psychiatric and neurodevelopmental comorbidities in people with epilepsy. We ...investigated whether any overrepresentation of comorbidities could be explained by epilepsy being a chronic medical or neurologic condition, or by the confounding effect of demographic and socioeconomic factors or other health conditions.
Methods: The Adult Psychiatric Morbidity Survey 2007 comprised detailed interviews with 7,403 individuals living in private households in England. Doctor‐diagnosed epilepsy (and asthma, diabetes, and migraine, chronic conditions for comparison) was ascertained by self‐report, and extensive diagnostic and screening interviews were used to assess psychiatric and neurodevelopmental conditions.
Key Findings: The estimated lifetime prevalence of epilepsy in the adult (≥16 years old) population of England was 1.2% (95% confidence interval CI 1.0–1.5). Almost one‐third of the people with epilepsy had an International Classification of Diseases, Tenth Revision (ICD‐10) anxiety or depressive disorder (compared with one in six people without epilepsy). Among these, social phobia and agoraphobia, generalized anxiety disorder, depression, and measures of suicidality had strong associations with epilepsy, which remained robust after accounting for potential confounders. These associations were consistently stronger than those in people with asthma or diabetes, and similar to those in people reporting migraine or chronic headaches. Epilepsy was also strongly associated with autism spectrum disorders (odds ratio OR 7.4, 95% CI 1.5–35.5) and possible eating disorders, and these associations were not evident in people with asthma, diabetes, or migraine.
Significance: Psychiatric and neurodevelopmental conditions were overrepresented in people with epilepsy. These associations were stronger than with other nonneurologic chronic conditions, and not explained by confounding. Some overlap in the psychopathology observed in epilepsy and migraine cannot rule out the presence of common pathways of psychiatric comorbidity in neurologic conditions. However, associations of epilepsy with conditions such as autism spectrum disorders point to comorbidities specific to epilepsy that may not be shared by other neurologic conditions.
The purpose of this study is to explore the views of autistic adults on randomised controlled trials, specifically on processes such as randomisation and blinding, to understand the barriers and ...facilitators for recruiting autistic people to randomised controlled trials involving medications. We conducted one-to-one interviews with 49 autistic adults. Interviews were audio-recorded and analysed thematically. The participants found randomised controlled trial processes acceptable and linked positive attitudes towards randomised controlled trial participation to autistic peoples’ heightened sense of fairness and preference for evidence-driven knowledge. However, randomised controlled trial designs may be incompatible with a (1) preference for a controlled predictable world, (2) perceived vulnerability at physical and mental health levels and (3) history of misunderstanding and exclusion, crucially from healthcare professionals. Suggestions that emerged from our findings include efforts to co-produce research to nurture trust and adapting communication practices to improve access to trials. Autistic people are a highly motivated group to work with research teams to mitigate barriers to randomised controlled trial participation. We explored what psychosocial determinants play a role in the acceptability of randomised controlled trials to test interventions to improve quality of life and mental health in autistic adults. The study provides useful information that may help the design and conduct of more accessible trials with and for the autistic community.
Lay abstract
Large randomised controlled trials are used to test healthcare treatments. Yet there are no large randomised controlled trials on effective treatments for common mental health issues affecting autistic adults. The purpose of this study was to learn what autistic adults think about randomised controlled trials in preparation for a randomised controlled trial testing a medication for anxiety. This means we wanted to know their opinions about the way randomised controlled trials are done, such as how people are chosen to be in the study and how the study is carried out. We did this by talking to 49 autistic adults individually and asking them questions. We found that most of the people we talked to were okay with the way randomised controlled trials are done. They thought it was fair and they liked that it was based on evidence. However, some autistic people might find it hard to take part in randomised controlled trials. Some people did not like the uncertainty of not knowing what treatment they would receive in a randomised controlled trial. Others felt too vulnerable and may have had bad experiences with healthcare in the past. We found that it is important to involve autistic people early on and at every stage when designing a clinical trial. Care about how clear and precise the study communication is will build trust and improve access to research. Our study indicates that it is possible to conduct large randomised controlled trials with and for autistic people. This can ultimately contribute to the improvement of healthcare outcomes for this population.
Aims Adults with Down syndrome (DS) face significant health inequalities and are at increased risk of numerous health concerns. Despite the need, there is a lack of high-quality randomised trial ...evidence and clinical interventions for people with DS are largely based on consensus guidelines or clinician preferences. As life-expectancy of those with DS increases, the research gap continues to widen. There is a perception that randomised controlled trials (RCTs) involving people with DS may be hard to carry out due to difficulties in recruitment and retention of participants. However, there is no scientific literature exploring this topic. This systematic review aimed to assess planned vs actual recruitment and retention in RCTs involving adults with DS, and to summarise reported facilitators and barriers to participation of adults with DS in relevant trials. Methods The MEDLINE, PsycINFO, EMBASE databases were searched systematically to retrieve all RCTs involving adults with DS aged 16 years or older published from 01.11.1961 to 15.12.2023. Ongoing RCTs were identified from trial registries and searches were supplemented by review of reference lists. Data extraction is ongoing but seeks to elicit details of trial design; planned and achieved recruitment sample size; planned and achieved retention rate, and any specific recruitment or retention strategies described. Risk of bias analysis was not relevant to the research question and so not performed. The review was prospectively registered on Prospero (CRD42023447126). Results The database searches retrieved 1,825 results. Post deduplication, 1,518 articles underwent title and abstract screening, of which 82 full texts were reviewed. 53 papers were included in the final analysis, reflecting 47 RCTs involving 1,772 individuals. Commonly studied interventions included exercise programmes for physical fitness and pharmaceuticals that may augment neuropsychological function. Studies typically reported small sample sizes at the point of randomisation (mean = 38.5, SD = 49.6), with over half reporting a sample size of n < 50. A significant number of studies reported difficulty recruiting and retaining participants (detailed data will be available in the poster). Of the minority of articles that reported power calculations, several reported failure to meet target sample size. Conclusion Initial results point to a paucity of high-quality, large-scale RCTs involving adults with DS and challenges related to recruitment of participants. The results may aid development of strategies that allow clinical trial teams to overcome challenges in recruitment and retention in RCTs, and may eventually contribute to the improved health and wellbeing of adults with DS.
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