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Association between autism diagnosis rates and adolescent depression : A population-based study in Sweden

Boström, Adrian E.Desai ; Andersson, Peter ; Wachtel, Lee E. ; Jarbin, Håkan LU ; Jokinen, Jussi and Lundberg, Johan (2025) In Psychiatry Research 344.
Abstract

Introduction: The association between increasing diagnosis rates of autism-related disorders (ASD-R) in Swedish regions and diagnosis rates of major depressive disorders (MDD) in adolescents remains unexplored. Methods: Following STROBE guidelines, this pre-registered (https://osf.io/duvq7) observational study, utilizing registry data from 2008 to 2022 across the 21 Swedish regions, employed a generalized linear mixed model (GLMM) to analyze the association between ASD-R (ICD-10: F84) and MDD diagnosis rates (ICD-10: F32) in 15–19 year olds, with registered primary diagnoses considered. The GLMM included psychiatric care affiliation rates (PCAR) as fixed effects and variations across years and regions as random intercepts. The model... (More)

Introduction: The association between increasing diagnosis rates of autism-related disorders (ASD-R) in Swedish regions and diagnosis rates of major depressive disorders (MDD) in adolescents remains unexplored. Methods: Following STROBE guidelines, this pre-registered (https://osf.io/duvq7) observational study, utilizing registry data from 2008 to 2022 across the 21 Swedish regions, employed a generalized linear mixed model (GLMM) to analyze the association between ASD-R (ICD-10: F84) and MDD diagnosis rates (ICD-10: F32) in 15–19 year olds, with registered primary diagnoses considered. The GLMM included psychiatric care affiliation rates (PCAR) as fixed effects and variations across years and regions as random intercepts. The model incorporated bipolar disorder (BD) rates and the male-to-female ratio of ASD-R diagnoses when justified. Separate models were created for combined sexes, males, and females. Results: A significant inverse relationship was observed between ASD-R and MDD diagnosis rates across all sex groups. In the combined-sex model, the mean ratio was 0.40 (P = 0.003), while the sex-specific models showed ratios of 0.28 for males (P < 0.001) and 0.37 for females (P = 0.017). All ratios were significantly below 1, indicating a negative association between ASD-R and MDD diagnosis rates. Conclusions: The study's observational nature limits causal inferences, but findings reveal that higher primary diagnosis rates of ASD-R correlate with lower primary diagnosis rates of MDD in adolescents of both sexes, although more pronounced in males. These results highlight the importance of further research on the relationship between ASD-R and MDD diagnosis rates, emphasizing the need for prospective, longitudinal, and individualized register data that include both primary and co-diagnoses.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adolescents, Autism, Diagnostics, Differential diagnosis, Major depressive disorder
in
Psychiatry Research
volume
344
article number
116341
publisher
Elsevier
external identifiers
  • pmid:39742678
  • scopus:85213567573
ISSN
0165-1781
DOI
10.1016/j.psychres.2024.116341
language
English
LU publication?
yes
id
18426f22-5b0b-418a-b353-1faff4beaf42
date added to LUP
2025-03-10 12:19:33
date last changed
2025-06-30 22:28:47
@article{18426f22-5b0b-418a-b353-1faff4beaf42,
  abstract     = {{<p>Introduction: The association between increasing diagnosis rates of autism-related disorders (ASD-R) in Swedish regions and diagnosis rates of major depressive disorders (MDD) in adolescents remains unexplored. Methods: Following STROBE guidelines, this pre-registered (https://osf.io/duvq7) observational study, utilizing registry data from 2008 to 2022 across the 21 Swedish regions, employed a generalized linear mixed model (GLMM) to analyze the association between ASD-R (ICD-10: F84) and MDD diagnosis rates (ICD-10: F32) in 15–19 year olds, with registered primary diagnoses considered. The GLMM included psychiatric care affiliation rates (PCAR) as fixed effects and variations across years and regions as random intercepts. The model incorporated bipolar disorder (BD) rates and the male-to-female ratio of ASD-R diagnoses when justified. Separate models were created for combined sexes, males, and females. Results: A significant inverse relationship was observed between ASD-R and MDD diagnosis rates across all sex groups. In the combined-sex model, the mean ratio was 0.40 (P = 0.003), while the sex-specific models showed ratios of 0.28 for males (P &lt; 0.001) and 0.37 for females (P = 0.017). All ratios were significantly below 1, indicating a negative association between ASD-R and MDD diagnosis rates. Conclusions: The study's observational nature limits causal inferences, but findings reveal that higher primary diagnosis rates of ASD-R correlate with lower primary diagnosis rates of MDD in adolescents of both sexes, although more pronounced in males. These results highlight the importance of further research on the relationship between ASD-R and MDD diagnosis rates, emphasizing the need for prospective, longitudinal, and individualized register data that include both primary and co-diagnoses.</p>}},
  author       = {{Boström, Adrian E.Desai and Andersson, Peter and Wachtel, Lee E. and Jarbin, Håkan and Jokinen, Jussi and Lundberg, Johan}},
  issn         = {{0165-1781}},
  keywords     = {{Adolescents; Autism; Diagnostics; Differential diagnosis; Major depressive disorder}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Psychiatry Research}},
  title        = {{Association between autism diagnosis rates and adolescent depression : A population-based study in Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.psychres.2024.116341}},
  doi          = {{10.1016/j.psychres.2024.116341}},
  volume       = {{344}},
  year         = {{2025}},
}