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Clinical and Social Factors Associated with Depressive Disorders Among Autistic Adults

Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective/Purpose: Autistic adults make up approximately 1 in 50 adults in the United States and face a threefold increased risk of depressive disorders compared to the general population, with a prevalence of 11%. Despite this elevated risk, limited research has explored the protective and risk factors of depressive disorders in this population, hindering efforts to improve mental wellness in autistic adults. This study aims to identify clinical and sociodemographic factors associated with depressive disorders among autistic adults. Methodology: This preliminary analysis used a single-cohort retrospective design based on the OCHIN database, which includes multi-site electronic health records. The study cohort included patients who had at least two outpatient visits with an autism spectrum disorder (ASD) diagnosis and no documented diagnosis of depressive disorder prior to ASD between 2018 and 2021. Multivariate logistic regression was used to assess associations between baseline characteristics and subsequent diagnosis of depressive disorder. The baseline period for comorbidities was defined as two years before the anchor date (the date of the second ASD diagnosis), while sociodemographic factors were assessed from one year prior to the anchor date. Results: Among the 3,038 patients included in the study, 903 (30%) had at least one outpatient record indicating depressive disorder following the anchor dates The mean age of the cohort on the anchor date was 30.2 (SD=11.2) years, and 73% were male. The study cohort was predominantly non-Hispanic White (69.3%), followed by non-Hispanic Black (12.8%), Hispanic (11.0%), and individuals of other racial/ethnic backgrounds (6.9%). Higher odds of identified depressive disorder were found among patients who were female (OR=1.56 [1.18, 2.06]), had comorbid anxiety (OR=2.46 [1.85, 3.26]), or were uninsured compared to privately insured (OR=2.25 [1.19, 4.27]). Conversely, lower odds were observed among non-Hispanic Black (OR=0.65 [0.41, 0.99]) and Hispanic patients (OR=0.56 [0.31, 0.97]) compared to non-Hispanic White patients, as well as those with intellectual disabilities (OR=0.41 [0.17, 0.84]), neurodevelopmental conditions such as epilepsy or learning disorders (OR=0.25 [0.09, 0.57]), and individuals whose preferred language was not English or who required interpreter services (OR=0.31 [0.13, 0.66]). Conclusions and Implications: This preliminary analysis of multisite EHR data identified a range of sociodemographic and clinical factors associated with the diagnosis of depressive disorders among autistic adults. These associations may reflect differences in both underlying comorbidity risk and diagnostic detection. The findings highlight potential contributors to the elevated prevalence of depression in this population, underscoring the need for future research using matched cohorts of non-autistic adults to further examine these factors.
DOI: 10.5281/zenodo.19560443
Language: English
Open Access status: green
OpenAlex ID: W7154015292
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