In this study, we consecutively recruited treatment-seeking young autistic adults without intellectual impairment aged 16–30 years who presented to a mental health service and evaluated general health (distress, quality of life, and disability), functioning (work loss days and social functioning), and mood symptoms (depression, anxiety, and stress) in those diagnosed with autism spectrum disorder (n = 96). This group was compared to young adults presenting to the same service with primary mental health disorders (depression, n = 343; bipolar, n = 132; psychosis, n = 166; and anxiety, n = 303). This study also investigated the influence of mood symptoms on general health and functioning in the autism spectrum disorder group. Young autistic adults reported significant general health and functioning impairments that were of similar degree to those presenting with primary mental health disorders. Interestingly, the autistic group also reported similarly high levels of mood symptoms to those with primary depressive and anxiety disorders. In the autistic group, depressive symptoms were strongly associated with distress, quality of life, and work loss days, while stress symptoms were strongly associated with disability. This study highlights further research, and mental health services are required specifically targeting young autistic adults to address their significant unmet needs.
AlonsoJ.AngermeyerM. C.BernertS.BruffaertsR.BrughaT. S.BrysonH.. . . HaroJ. M. (2004). Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, 21–27.
2.
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
3.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
AntonyM. M.BielingP. J.CoxB. J.EnnsM. W.SwinsonR. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.
6.
AounS.PennebakerD.WoodC. (2004). Assessing population need for mental health care: A review of approaches and predictors. Mental Health Services Research, 6, 33–46.
BackenstrassM.FrankA.JoestK.HingmannS.MundtC.KronmüllerK. T. (2006). A comparative study of nonspecific depressive symptoms and minor depression regarding functional impairment and associated characteristics in primary care. Comprehensive Psychiatry, 47, 35–41.
9.
BaioJ.WigginsL.ChristensenD. L.MaennerM. J.DanielsJ.WarrenZ.DurkinM. S. (2018). Prevalence of autism spectrum disorder among children aged 8 years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1–23.
10.
Bishop-FitzpatrickL.MazefskyC. A.MinshewN. J.EackS. M. (2015). The relationship between stress and social functioning in adults with autism spectrum disorder and without intellectual disability. Autism Research, 8, 164–173.
11.
Buist-BouwmanM. A.De GraafR.VolleberghW. A. M.AlonsoJ.BruffaertsR.OrmelJ., &ESEMeD/MHEDEA 2000 Investigators. (2006). Functional disability of mental disorders and comparison with physical disorders: A study among the general population of six European countries. Acta Psychiatrica Scandinavica, 113, 492–500.
12.
CroenL. A.NajjarD. V.RayG. T.LotspeichL.BernalP. (2006). A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health plan. Pediatrics, 118, e1203–e1211.
13.
Cross-Disorder Group of the Psychiatric Genomics Consortium. (2013). Identification of risk loci with shared effects on five major psychiatric disorders: A genome-wide analysis. The Lancet, 381, 1371–1379.
14.
DanielsM.BerryM. S. (1989). The functioning and well-being of depressed patients. Journal of the American Medical Association, 262, 914–919.
15.
DonvanJ.ZuckerC. (2010). Autism’s first child. The Atlantic, 7, 78–90.
16.
EavesL. C.HoH. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 739–747.
17.
FarleyM. A.McMahonW. M.FombonneE.JensonW. R.MillerJ.GardnerM.. . . CoonH. (2009). Twenty-year outcome for individuals with autism and average or near-average cognitive abilities. Autism Research, 2, 109–118.
18.
GoldmanH. H.SkodolA. E.LaveT. R. (1992). Revising axis V for DSM-IV: A review of measures of social functioning. The American Journal of Psychiatry, 149, 1148–1156.
19.
GoreF. M.BloemP. J.PattonG. C.FergusonJ.JosephV.CoffeyC.. . . MathersC. D. (2011). Global burden of disease in young people aged 10–24 years: A systematic analysis. The Lancet, 377, 2093–2102.
20.
HuangI. C.WuA. W.FrangakisC. (2006). Do the SF-36 and WHOQOL-BREF measure the same constructs? Evidence from the Taiwan population. Quality of Life Research, 15, 15–24.
21.
JonesL.GoddardL.HillE. L.HenryL. A.CraneL. (2014). Experiences of receiving a diagnosis of autism spectrum disorder: A survey of adults in the United Kingdom. Journal of Autism and Developmental Disorders, 44, 3033–3044.
22.
JoshiG.PettyC.WozniakJ.HeninA.FriedR.GaldoM.. . . BiedermanJ. (2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40, 1361–1370.
23.
Kamp-BeckerI.SchröderJ.RemschmidtH.BachmannC. J. (2010). Health-related quality of life in adolescents and young adults with high functioning autism-spectrum disorder. GMS Psycho-Social-Medicine, 7, Doc03.
24.
KatzS. J.KesslerR. C.FrankR. G.LeafP.LinE. (1997). Mental health care use, morbidity, and socioeconomic status in the United States and Ontario. Inquiry, 34, 38–49.
25.
KesslerR. C.AndrewsG.ColpeL. J.HiripiE.MroczekD. K.NormandS. L.. . . ZaslavskyA. M. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32, 959–976.
26.
KesslerR. C.BarkerP. R.ColpeL. J.EpsteinJ. F.GfroererJ. C.HiripiE.. . . ZaslavskyA. M. (2003). Screening for serious mental illness in the general population. Archives of General Psychiatry, 60, 184–189.
27.
KhannaR.JariwalaK.West-StrumD. (2015). Validity and reliability of the Medical Outcomes Study Short-Form Health Survey version 2 (SF-12v2) among adults with autism. Research in Developmental Disabilities, 43, 51–60.
28.
LeslieD. L.MartinA. (2007). Health care expenditures associated with autism spectrum disorders. Archives of Pediatric and Adolescent Medicine, 161, 350–355.
29.
LeverA. G.GeurtsH. M. (2016). Psychiatric co-occurring symptoms and disorders in young, middle-aged, and older adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 1916–1930.
30.
LiuG.PearlA. M.KongL.LeslieD. L.MurrayM. J. (2017). A profile on emergency department utilization in adolescents and young adults with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47, 347–358.
31.
LordC.LuysterR.GothamK.GuthrieW. (2012). Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) (2nd ed.). Torrance, CA: Western Psychological Services.
32.
LovibondP. F.LovibondS. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.
33.
MasonD.McConachieH.GarlandD.PetrouA.RodgersJ.ParrJ. R. (2018). Predictors of quality of life for autistic adults. Autism Research, 11, 1138–1147.
34.
MazzoneL.RutaL.RealeL. (2012). Psychiatric comorbidities in asperger yndrome and high functioning autism: Diagnostic challenges. Annals of General Psychiatry, 11(1), 16.
35.
McConachieH.MasonD.ParrJ. R.GarlandD.WilsonC.RodgersJ. (2018). Enhancing the validity of a quality of life measure for autistic people. Journal of Autism and Developmental Disorders, 48, 1596–1611.
36.
McGorryP. D.BatesT.BirchwoodM. (2013). Designing youth mental health services for the 21st century: Examples from Australia, Ireland and the UK. The British Journal of Psychiatry, 202(s54), s30–s35.
37.
McGorryP. D.PurcellR.HickieI. B.JormA. F. (2007a). Investing in youth mental health is a best buy. Medical Journal of Australia, 187(7), s5.
38.
McGorryP. D.TantiC.StokesR.HickieI. B.CarnellK.LittlefieldL. K.MoranJ. (2007b). Headspace: Australia’s National Youth Mental Health Foundation—Where young minds come first. Medical Journal of Australia, 187(7), s68.
39.
McKnightP. E.MonfortS. S.KashdanT. B.BlalockD. V.CaltonJ. M. (2016). Anxiety symptoms and functional impairment: A systematic review of the correlation between the two measures. Clinical Psychology Review, 45, 115–130.
40.
MojtabaiR.OlfsonM.MechanicD. (2002). Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry, 59, 77–84.
41.
MurphyC. M.WilsonC. E.RobertsonD. M.EckerC.DalyE. M.HammondN.McAlonanG. M. (2016). Autism spectrum disorder in adults: Diagnosis, management, and health services development. Neuropsychiatric Disease and Treatment, 12, 1669–1686.
42.
MurrayC. J.AbrahamJ.AliM. K.AlvaradoM.AtkinsonC.BaddourL. M.. . . BolligerI. (2013). The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. Journal of the American Medical Association, 310, 591–606.
43.
MurrayC. J.LopezA. D. (1996). Evidence—based health policy—Lessons from the Global Burden of Disease Study. Science, 274, 740–743.
44.
NahY. H.BrewerN.YoungR. L.FlowerR. (2018). Brief report: Screening adults with autism spectrum disorder for anxiety and depression. Journal of Autism and Developmental Disorders, 48, 1841–1846.
45.
NaismithS. L.LongleyW. A.ScottE. M.HickieI. B. (2007). Disability in major depression related to self-rated and objectively-measured cognitive deficits: A preliminary study. BMC Psychiatry, 7(1), Article 32.
46.
ParkS. H.DemetriouE. A.PepperK. L.SongC. Y.ThomasE. E.GlozierN.… GuastellaA. J. (2018). Validation of the self-report World Health Organization Assessment Schedule II (WHODAS II) among individuals with Autism Spectrum Disorder. Manuscript submitted for publication.
47.
PellicanoE.DinsmoreA.CharmanT. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18, 756–770.
48.
PurcellR.JormA. F.HickieI. B.YungA. R.PantelisC.AmmingerG. P.HarriganS. (2015). Demographic and clinical characteristics of young people seeking help at youth mental health services: Baseline findings of the Transitions Study. Early Intervention in Psychiatry, 9, 487–497.
49.
RapaportM. H.JuddL. L. (1998). Minor depressive disorder and subsyndromal depressive symptoms: Functional impairment and response to treatment. Journal of Affective Disorders, 48, 227–232.
50.
SareenJ.CoxB. J.AfifiT. O.ClaraI.YuB. N. (2005). Perceived need for mental health treatment in a nationally representative Canadian sample. The Canadian Journal of Psychiatry, 50, 643–651.
51.
ScottE. M.HermensD. F.NaismithS. L.GuastellaA. J.WhiteD.WhitwellB. G.HickieI. B. (2013). Distress and disability in young adults presenting to clinical services with mood disorders. International Journal of Bipolar Disorders, 1, Article 23.
52.
ShattuckP. T.RouxA. M.HudsonL. E.TaylorJ. L.MaennerM. J.TraniJ. F. (2012). Services for adults with an autism spectrum disorder. The Canadian Journal of Psychiatry, 57, 284–291.
53.
SimonoffE.PicklesA.CharmanT.ChandlerS.LoucasT.BairdG. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 921–929.
54.
SohnJ. H.AhnS. H.SeongS. J.RyuJ. M.ChoM. J. (2013). Prevalence, work-loss days and quality of life of community dwelling subjects with depressive symptoms. Journal of Korean Medical Science, 28, 280–286.
55.
TaylorJ. L.HenningerN. A.MailickM. R. (2015). Longitudinal patterns of employment and postsecondary education for adults with autism and average-range IQ. Autism, 19, 785–793.
56.
TuckerG.AdamsR.WilsonD. (2010). New Australian population scoring coefficients for the old version of the SF-36 and SF-12 health status questionnaires. Quality of Life Research, 19, 1069–1076.
57.
ÜstünT. B.ChatterjiS.KostanjsekN.RehmJ.KennedyC.Epping-JordanJ.PullC. (2010). Developing the World Health Organization disability assessment schedule 2.0. Bulletin of the World Health Organization, 88, 815–823.
58.
VolkmarF. G.LordС.BaileyA.SchultzR. T.KlinA. (2004). Autism and pervasive developmental disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 135–170.
59.
WareJ. E.Jr.KosinskiM.KellerS. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.
60.
WechslerD. (1999). Wechsler Abbreviated Scale of Intel-ligence (WASI) manual. San Antonio, TX: Psychological Corporation.
61.
WechslerD. (2001). Wechsler Test of Adult Reading: WTAR. San Antonio, TX: The Psychological Corporation.
62.
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: Authofr.
63.
World Health Organization Quality of Life Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.
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