The Association Between Maternal Depression and Comorbid Psychopathology In Children with Autism Spectrum Disorders

Background:  The majority of children and adolescents with Autism Spectrum Disorders (ASDs) present with comorbid psychopathology (Brereton et al. 2006; Joshi et al., 2010).  As the presence of psychiatric comorbidity has been noted to worsen ASD symptomatology (Wozniak et al., 1997), parents raising children with multiple psychiatric disorders are likely to experience tremendous amounts of stress that may be further compounded by other child-related factors (e.g. ASD symptom severity) (Benson, 2006) along with a parent’s own diathesis towards psychopathology.  These factors may result in an increased risk for parental depression (Abbeduto et al., 2004; Bromley et al., 2004).  The present study explores the association between parental depression and the presence of comorbid psychopathology in children with an ASD.

Objectives: 1) Identify predictors of maternal depression in a sample of ASD children with comorbid psychopathology. 2) Evaluate the potential for increased risk of parental depression as the number of comorbid psychopathology disorders increase.

Methods:  A restricted sample of 1270 mothers of children with an ASD was obtained from the Interactive Autism Network (IAN).  IAN is an online, national voluntary registry of families who have children with an ASD, consisting of over 10,000 children with an ASD and 20,000 family members.  A self-reported clinical diagnosis of depression was selected as the outcome of interest, with number of child comorbid psychiatric conditions serving as the main predictor. 

A three-stage sequence of multiple logistic regression models was developed to estimate the Odds Ratios (ORs) for the association between a maternal report of clinical depression and the number of comorbid diagnoses possessed by her child with ASD.  Model 1 controlled for basic child demographics (age, gender, race, ethnicity), Model 2 controlled for parent and family demographics (number of children, parental education level), and Model 3 added the child’s ASD diagnosis.  

Results:  An adjusted model revealed significantly increased ORs for parental depression for children with 1 comorbid diagnosis (OR=1.43, 95% CI: 1.16, 2.04, p=0.003), 2 comorbid diagnoses (OR=2.44, 95% CI: 1.61, 3.69, p<0.001), and 3 comorbid diagnoses (OR=2.87, 95% CI: 1.46, 5.62, p=0.002) when compared to children with no comorbid diagnoses.  These associations remained significant across all three models, as well as with the unadjusted model.   Parents of older children were less likely to experience depression (OR=0.64, 95% CI: 0.41, 0.99, p=0.045).  

Conclusions:  Unique to the literature, this study demonstrates a significant increased risk of parental depression accompanying an increase in the number of child comorbid disorders.  These results align with previous studies indicating increased levels of parental stress, along with the presence of behavioral problems in children with ASDs (Davis & Carter, 2008; Lecavalier, Leone, & Wiltz, 2006).  Taken together, these results highlight a real risk for the development of clinical depression for already stressed parents of children with ASDs. Future research should continue to evaluate risk and protective factors for parental depression; incorporating the role additional child psychopathology may play.