Data_Sheet_1_Population-Based Psychiatric Comorbidity in Children and Adolescents With Autism Spectrum Disorder: A Meta-Analysis.docx

Psychiatric comorbidity in autism spectrum disorder (ASD) is a subject of critical scientific importance, affecting the quality of life, prognosis, and functional outcomes. The prevalence of psychiatric disorders vary considerably according to variables such as index subject characteristics, study setting, sampling frame, diagnostic methods used, as well as country of geographic origin. To date, most studies comprise clinical or treatment referral samples in tertiary care or subjects enrolled in clinical trials and genetic cohort collections. Such samples carry the potential for overestimation of both the frequency and severity of psychiatric comorbidity. A systematic literature search was performed using PubMed and Web of Science databases restricted to population-based study publications in the English between May 1, 2015, and May 31, 2020. A comprehensive keyword list was generated to investigate co-occurrence of psychiatric disorders in children and adolescents with ASD. A wide range of DSM-5 based disorders such as anxiety, mood, ADHD, intellectual disability/intellectual developmental disorder, eating/feeding, gender dysphoria and sleep-wake disorders were assessed. Initial search revealed a total of 1674 articles after removal of duplicates. Two independent researchers conducted a parallel-blinded screening process to identify the eligible studies based on titles and abstracts; 39 studies were analyzed in the current review. The main findings show prevalence estimates of 22.9% (95% CI: 17.7- 29.2) for intellectual disability; 26.2% (22-31) for attention-deficit hyperactivity disorder; 11.1% (8.6-14.1) for anxiety disorders; 19.7% (11.9-30.7) for sleep disorders; 7% (5.2- 9.3) for disruptive disorders; 2% (1.3- 3.1) for bipolar disorders; 2.7% (1.8- 4.2) for depression; 1.8% (0.4–8.7) for obsessive-compulsive disorder; and 0.6% (0.3–1.1) for psychosis. Psychiatric comorbidity in population-based studies is lower than in clinical and referred samples. However, our results also indicate that the frequency of psychiatric comorbidity in children and adolescents with ASD in the population context is considerable, without the influence of referral bias implicit in clinical and treatment samples. There is a need for better targeted diagnostic tools to detect psychiatric comorbidity in children and youth in future population-based studies, as an essential component in providing care as well as new insights into the nature and mechanisms of its underlying associations.
Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234464].

自闭症谱系障碍（Autism Spectrum Disorder, ASD）患者的精神共病问题是具有重要科学意义的研究主题，其对患者的生活质量、预后及功能结局均产生显著影响。精神障碍的患病率会因诸多变量出现显著差异，包括研究对象特征、研究场景、抽样框架、所用诊断方法以及来源国家等。截至目前，绝大多数相关研究均采用三级医疗保健机构的临床或诊疗转诊样本，或是纳入临床试验与遗传队列研究的受试者。此类样本存在高估精神共病发生率与严重程度的潜在偏倚。本研究通过PubMed与Web of Science数据库开展系统文献检索，检索时限为2015年5月1日至2020年5月31日，且仅纳入英文发表的基于人群的研究文献。研究团队构建了全面的关键词列表，以探究自闭症谱系障碍儿童与青少年的精神障碍共病情况。本次评估涵盖了一系列基于《精神障碍诊断与统计手册第五版（Diagnostic and Statistical Manual of Mental Disorders 5th Edition, DSM-5）》的精神障碍类型，包括焦虑障碍、心境障碍、注意缺陷多动障碍、智力障碍/智力发育障碍、进食/喂养障碍、性别烦躁及睡眠-觉醒障碍等。初步检索共得到1674篇文献，经去重后进入筛选环节。两名研究人员采用双盲平行筛查流程，依据标题与摘要筛选符合纳入标准的研究，最终共纳入39项研究进行本综述的分析。本综述的主要患病率估算结果如下：智力障碍为22.9%（95%置信区间：17.7~29.2）；注意缺陷多动障碍为26.2%（22~31）；焦虑障碍为11.1%（8.6~14.1）；睡眠障碍为19.7%（11.9~30.7）；破坏性障碍为7%（5.2~9.3）；双相障碍为2%（1.3~3.1）；抑郁障碍为2.7%（1.8~4.2）；强迫障碍为1.8%（0.4~8.7）；精神病性障碍为0.6%（0.3~1.1）。基于人群的研究中报告的精神共病患病率低于临床及转诊样本。但本研究结果同时表明，在人群场景下，自闭症谱系障碍儿童与青少年的精神共病发生率仍处于较高水平，不受临床与诊疗样本中固有的转诊偏倚影响。未来的基于人群的研究亟需开发更具针对性的诊断工具，以识别儿童与青少年群体中的精神共病问题，这既是临床照护的核心环节，也可为探究精神共病潜在关联的本质与机制提供新的研究视角。系统评价注册信息[https://www.crd.york.ac.uk/prospero/]，标识符[CRD42021234464]。