Processes Associated with the Development of Depression in Autistic Individuals: A Narrative Review

Autistic individuals are disproportionately likely to experience mental health challenges during their lifetime, with depressive disorders being particularly common. High rates of depression among autistic individuals are a particular matter of clinical and policy concern, given the well-established links between depression and a range of negative outcomes, including suicidality. By proposing a novel integrative model, we aim to synthesize existing knowledge and prompt innovation in previously under-explored areas. In this narrative review, we first briefly discuss the prevalence of depression in autism, potential differences in how depression may present in autistic vs. non-autistic populations, and conceptual considerations for research on co-occurring autism and mental health challenges. We then provide a summary of cognitive, developmental, and clinical factors that have been identified through previous studies as important contributors to elevated rates and severity of depression in autistic individuals. Several, often closely interrelated, factors may affect the development and maintenance of depression in this population, including core autism features as well as cognitive and emotional experiences that are common in autistic individuals but not part of the diagnostic criteria for autism. Further, we propose a conceptual integration of the noted factors, specifying potential patterns of their interrelatedness. Finally, we put forward conceptual and empirical strategies for formally testing and refining our proposed model, and describe its implications for research, clinical practice, and societal reform.