Insomnia Intervention for Depression in Young Adults and Adolescents With Autism

Young adults and adolescents autism spectrum disorder with co-occurring depression and insomnia may find insomnia an important intervention target for treating and preventing depression, according to study findings published in Autism Research.

Investigators sought to explore the relationships between fatigue, social support (belonging and connectedness), sleep quality, and depression in young adults with autism. They hypothesized a significant intercorrelation between these variables, significant variance in depressive symptomology cross-sectionally and longitudinally would be accounted for by social support, fatigue, and sleep quality, and that social support and fatigue would help the relationship between sleep quality and depressive symptomology.

They used data from the SASLA online longitudinal study (2015) at baseline (T1) and 2-year follow-up (T2) to conduct a cross-sectional review and analysis that included 114 autistic adolescents and adults (aged 15 to 25 years; 43% girls/women) without intellectual disability to examine relationships between sleep quality, social support, and fatigue with depression through a T1 survey. The association between fatigue (T1, T2), sleep quality (T1, T2), and social well-being (T1) on depression (T1, T2) was examined with hierarchical multiple regression models.

Participant self-report corroborated by parent-report for 66.7% of participants was used to ascertain autism diagnosis (7% parent-report only; 18.4% with confirming diagnostic reports). Participants of the SASLA survey (at T1, 18.90±2.51 years of age; n=112) completed demographic questions and personal questionnaires at T1 and at follow-ups 1 year and 2 years later concerning measures of social belonging and connectedness at T1 (not administered at follow-up), and fatigue, sleep quality, and depressive symptoms at T1 and T2. Some participants failed to report some demographics. Investigators noted 69.1% of participants identified their ethnicity as Australian (3.6% Australian Indigenous) and 85.5% born in Australia (n=110), 84.5% lived with 1 or both parents or a family member, 74.3% currently studying, 30.6% employed. There were 81.1% reporting at least 1 mental or physical health condition and 35 participants reporting depression. There were no reported diagnoses of a sleep disorder.

Assessments were made with the Autism Quotient-Short form (AQ-Short) measuring autistic traits, the Social Well-Being Scale (SWS) measuring the degree of individual connectedness and contribution to their community, the Pittsburgh Sleep Quality Index (PSQI) measuring sleep problems, the Flinders Fatigue Scale (FFS) measuring the intensity of fatigue over the past 2 weeks, and the Hospital Anxiety and Depression Scale (HADS-D) to confirm depressive symptoms. All questionnaires except SWS were included at T1 and T2.

Investigators found that sleep quality worsened (z=-2.004; P =.045; n=61) over the 2-year study period while depression (z=-1.441; P =.150; n=68) and fatigue (z=-0.632; P =.527; n=58) scores did not change. At T1, HADS-D score showed 27.7% with depression and at T2 it was 31.0% with depression. There were 57.6% of participants reporting poor sleep quality at T1 and 63.9% at T2. There were 35.6% of participants with an FSS score consistent with moderate fatigue at T1 and 43.7% at T2.

Fatigue and social contribution individually predicted depression symptomology in the T1 regression model (adjusted R²=36%). Social contribution (T1) was the only significant predictor of depression (T2) in the longitudinal regression model (adjusted R²=57%). Depression at T1 significantly associated with sleep quality (Spearman’s Rho [r_s]=0.390), fatigue (r_s=0.417), social integration (r_s=-0.385), and social contribution (r_s =-0.442). Depression at T2 significantly associated with sleep quality (r_s=0.409), fatigue (r_s=0.335), social integration (r_s=-0.440), and social contribution (r_s=-0.583).

They noted social well-being was a significant partial mediator of the sleep quality/depression relationship and fatigue trended towards mediating this relationship.

Significant study limitations include an underpowered sample size (moderate at T1, small at T2), the cross-sectional review design, the possibility that the relationship between sleep quality and fatigue driven by FFS question asking how much fatigue was caused by poor sleep, lack of understanding of the relationship between fatigue symptoms with both poor sleep and depression, lack of social well-being data at T2, limited age range and exclusion of participants with intellectual disability lead to limited generalizability, and response bias in self-report and/or parent-report of autism diagnosis.

“Results highlight that sleep quality, fatigue, and social well-being contribute to depression among young autistic adults,” investigators concluded. They noted fatigue and social well-being independently associated with depression leading to the additional conclusion that “addressing sleep quality and associated fatigue, and social well-being is important when treating depression in autistic individuals.”