Anxiety and Depression in Adults with Autism: Implications for Clinical Care and Research in India

Background: Autism in India remains a highly stigmatized condition, and many adults with high functioning autism are likely to be undiagnosed and “hidden.”  Emerging evidence across the world suggests anxiety and depression are probably the most common psychiatric disorder occurring in persons with autism. However, available research on anxiety and depression has focused largely on children or adolescents. Much less has been published on adults with anxiety and depression, especially at the higher functioning end of the spectrum (Engstrom, Ekstrom, & Emilsson, 2003; Hurlbutt & Chalmers, 2004). From our clinical experience in India, we are aware that adults with Autism Spectrum Disorders (ASD) face many challenges: Barriers to meaningful work; difficulty being understood within their families; challenges related to social norms about marriage, and other related issues. Given the isolation that adults with ASD may feel, it is possible that their mental health needs are being overlooked. 

Objectives: This paper provides the first assessment of anxiety and depression in a sample of high functioning adults with autism in India. 

Methods: As part of a larger study on families of adults with autism, 15 interviews with completed with high functioning adults with ASD (13 males, 2 females; age range of 18-33 years) residing in New Delhi and the National Capital Region, India. Interviews lasted between 2.5-4 hours. Diagnosis was confirmed using Module 4 of the ADOS and the Social Responsive Scale (SRS-II), completed by the adults. In addition, parents also completed the SRS-II to ascertain diagnosis. Adults with autism completed the Glasgow Anxiety Scale (GAS) and Beck’s Depression Inventory (BDI) in an interview format. All instruments were offered to adults in the language of their preference. During a concurrent semi-structured interview with parents, extensive information was collected through interviews regarding the adults’ use of medication and interventions, daily routines, sexuality, and other related topics.  

Results: All participants met the cut off criteria for ASD on the ADOS and SRS-II. Of the 13 adults with ASD who completed both the GAS and BDI, 12 participants met the cut off criteria (Mindham & Espie, 2003) for presence of anxiety and 11 adults reported at least a mild mood disturbance. Degree of depression in adults with autism was positively associated with autism symptoms on the self-report SRS-II (p=.005). Anxiety was negatively associated with the number of hours adults spent in a structured setting (p=.04). More anxious adults spent fewer hours in such settings, and a greater percentage of their time alone (p=.03). 

Conclusions: This is the first known study from India to assess the presence of anxiety and depression in adults with ASD and suggests that the mental health needs of this population may be largely overlooked. These findings underscore the need for identification, treatment and prevention of anxiety and depression for adults with ASD as well as a need to build services and support systems for adults with autism.