Benefits and harms of interventions to improve anxiety, depression, and other mental health outcomes for autistic people: A systematic review and network meta-analysis of randomised controlled trials.
Audrey Linden, Lawrence Best, Freya Elise and 12 others
PMID 35957523WHAT IT FOUND
No intervention was shown to be clearly better than another for anxiety or depression in autistic people across 71 trials.
Some CBT and behavioural approaches showed modest benefit over no treatment, but the evidence is very low certainty and no specific treatment can be recommended.
Key findings
01The network meta-analysis found no evidence of differences between interventions for anxiety or depression in either children or adults, and the authors state that ranking one treatment above another is inappropriate given the uncertainty.
02In direct head-to-head comparisons against no additional intervention, some forms of CBT showed lower anxiety scores in children and adults, and behavioural interventions or self-directed CBT showed lower depression scores in children and adults, but all of these findings are rated very low or low certainty.
03An intervention's effect on core features of autism does not predict its effect on anxiety or depression scores, meaning that treating autistic traits is not a route to improving mental health.
STILL TO COME
How it was doneWhat they found
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Every included trial had at least some concerns about bias or was at high risk of bias overall. Sample sizes were small: most trials had fewer than 100 participants, and only six had 100 or more. No trials included only autistic people with intellectual disability, and none reported mental health outcomes for that subgroup, so the findings do not apply to that population. 387 participants were excluded after randomisation, and 38 of the 71 trials did not assess whether participants had a mental health diagnosis at baseline. Follow-up was short: most trials measured outcomes within 12 months, and only one went beyond that. 608 other trials that tested these same interventions in autistic people did not report mental health outcomes, so the evidence base is incomplete. The authors note that blinding is often not feasible for psychological interventions (you cannot hide from a patient that they received CBT), which may inflate the apparent risk of bias, but they also note that conflicts of interest in autism research are often underreported, which may deflate it.
Declared interests
Funded by the UK National Institute for Health Research (Research for Patient Benefit Programme). One co-author (James Cusack) is the chief executive of Autistica, an organisation that has funded mental health intervention studies in autistic people. Several other authors receive research support from Autistica, NIHR, Wellcome Trust, MRC, and other public funders. The authors note that some included trials were industry-funded medication studies or funded by organisations with an emphasis on 'curing' autism, which they flag as a potential source of bias.
The easy way to misread this
Do not read the direct comparisons showing CBT or behavioural interventions outperforming no treatment as evidence that these are the best options for autistic people. The network meta-analysis, which is the main analysis, found no clear differences between interventions, all evidence is rated very low certainty, and the authors state they cannot recommend one treatment over another.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →