Repetitive Cognition Mediates the Relationship Between Autism Symptoms and Depression

Background:

In typically-developing (TD) populations, repetitive cognition (e.g., rumination) often correlates with internalizing psychopathologies (Nolen-Hoeksema, 2000). In individuals with autism spectrum disorder (ASD), depression is similarly associated with rumination (Gotham et al., 2014), and there is an increased prevalence of depression in ASD (Buck et al., 2014).

Rumination has likewise shown correlations with some types of repetitive behavior seen in ASD, specifically those related to rigidity/insistence on sameness factor (Carcani-Rathwell et al., 2006; Gotham et al., 2014). Individuals with ASD exhibit a higher prevalence of rumination than TD peers (Crane et al., 2013).

It is unknown whether other forms of repetitive cognition seen in ASD (rigidity, fixation on interests, etc) are associated with increased depression risk or risk for other internalizing constructs, such as rejection sensitivity (an anxious preoccupation with expected rejection; Downey & Feldman, 1996); while these repetitive cognitions may be developmentally distinct from rumination as seen in TD peers, they may function similarly to predispose an individual to depression.

Objectives:

The present study aims to investigate whether increased levels of repetitive cognition may explain increased levels of a) depression and b) rejection sensitivity seen in individuals with more ASD symptoms.

Methods:

200 typically-developing adults were recruited through an online subject pool of university undergraduates. The following measures were used to assess our hypotheses: The Autism Quotient (AQ; Baron-Cohen et al., 2001), the Perseverative Thinking Questionnaire (PTQ; Ehring et al., 2011) and Rumination Response Scale (RRS; Treynor et al., 2003), the Patient Health Questionnaire – 9 item version (PHQ-9; Kroenke et al., 2001), and the Rejection Sensitivity Questionnaire (RSQ; Downey & Feldman, 1996).

Results:

There was a positive association between AQ and PHQ-9 (b = .26, p < .001) as well as AQ and PTQ (b = .32, p < .001) and RSQ (b = .39, p < .001). A model assessing PTQ as a mediator between AQ and PHQ-9 had a significant indirect effect (b = .18, 95% CI [.09, .28]). The direct effect of AQ on PHQ-9 after taking the mediator into account was nonsignificant (b = .07, p = .18), consistent with full mediation. Effect size was medium (κ² = .13, 95% CI [.03, .23]). Another model assessing PTQ as a mediator between AQ and RSQ was similarly supported with a significant indirect effect (b = .14, 95% CI [.07, .24]).

Conclusions:

A positive association was found between ASD symptoms and depression, which was at least partially explained by increased perseveration. Similarly, perseveration partially explained the relationship between ASD symptoms and rejection sensitivity. These findings support the use of cognitive approaches, such as cognitive-behavioral and mindfulness therapies, for treating depression in ASD, given their explicit focus on addressing repetitive thinking and other maladaptive cognitions (Anderson & Morris, 2006; Spek et al., 2012). Relatedly, these findings may indicate that repetitive cognition is a cognitive factor underpinning increased depression risk in ASD. Further research should clarify the role of increased perseveration in the development of internalizing psychopathologies in individuals with ASD.