Original Manuscript
Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities
K. L. Austin,
M. Hunter,
E. Gallagher,
L. E. Campbell,
Corresponding Author
K. L. Austin
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Correspondence: Ms. Kristie Lea Austin, University of Newcastle, School of Psychology, 11 Nelson Dr, Hunterview, Callaghan, New South Wales, Australia (e-mail: [email protected]; [email protected]).Search for more papers by this authorM. Hunter
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorE. Gallagher
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorL. E. Campbell
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorK. L. Austin,
M. Hunter,
E. Gallagher,
L. E. Campbell,
Corresponding Author
K. L. Austin
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Correspondence: Ms. Kristie Lea Austin, University of Newcastle, School of Psychology, 11 Nelson Dr, Hunterview, Callaghan, New South Wales, Australia (e-mail: [email protected]; [email protected]).Search for more papers by this authorM. Hunter
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorE. Gallagher
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorL. E. Campbell
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia
Search for more papers by this authorAbstract
Background
The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms.
Method
Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls.
Results
Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls.
Conclusions
Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.
References
- American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Health Disorders, 5th edn. APA, Washington DC.
- Andrews G., Henderson S. & Hall W. (2001) Prevalence, comorbidity, disability and services utilisation. Overview of the Australia National Mental Health Survey. The British Journal of Psychiatry 178, 145–153. https://doi.org/10.1192/bjp.178.2.145.
- APA (2000) Diagnostic and Statistical Manual of Mental Health Disorders: DSM-IV-TR, 4th edn. APA, Washington DC.
- Australian Bureau of Statistics (ABS) (2008) 2007 NationalSurvey of Mental Health and Wellbeing: summary ofresults. Available at: http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/6AE6DA447F985FC2CA2574EA00122BD6/$File/43260_2007.pdf (retrieved 5 July 2015)
- Beck J. S. (2011) Cognitive Behaviour Therapy: Basics and Beyond, 2nd edn. Guilford, New York.
- Cadman T., Eklund H., Howley D., Hayward H., Clarke H., Findon J. et al. (2012) Caregiver burden as people with autism spectrum disorder and attention-deficit/hyperactivity disorder transition into adolescence and adulthood in the United Kingdom. Journal of the American Academy of Child and Adolescent Psychiatry 51, 879–888. https://doi.org/10.1016/j.jaac.2012.06.017.
- Carver C. S. (1997) You want to measure coping but your protocol’ too long: consider the brief cope. International Journal of Behavioral Medicine 4, 92–100. https://doi.org/10.1207/s15327558ijbm0401_6.
- Compas B. E., Connor-Smith J. K., Saltzman H., Thomsen A. H. & Wadsworth M. E. (2001) Coping with stress during childhood and adolescence: problems, progress, and potential in theory and research. Psychological Bulletin 127, 87–127. https://doi.org/10.1037/0033-2909.127.1.87.
- Cuthill F. M., Espie C. A. & Cooper S. A. (2003) Development and psychometric properties of the Glasgow Depression Scale for people with a learning disability: individual and carer supplement versions. British Journal of Psychiatry 182, 347–353. https://doi.org/10.1192/bjp.02.286.
- Einfeld S. L., Piccinin A. M., Mackinnon A., Hofer S. M., Tagge J., Gray K. et al. (2006) Psychopathology in young people with intellectual disability. Journal of the American Medical Association 296, 1981–1989.
- Esbensen A. J. & Benson B. A. (2005) Cognitive variables and depressed mood in adults with intellectual disability. Journal of Intellectual Disability Research 49, 481–489.
- Floyd F. J., Costigan C. L. & Piazza V. E. (2009) The transition to adulthood for individuals with intellectual disability. International Review of Research in Mental Retardation 37, 31–69. https://doi.org/10.1016/S0074-7750(09)37002-0.
10.1016/S0074-7750(09)37002-0 Google Scholar
- Forte M., Jahoda A. & Dagnan D. (2011) An anxious time? Exploring the nature of worries experienced by young people with a mild to moderate intellectual disability as they make the transition to adulthood. British Journal of Clinical Psychology 50, 398–411. https://doi.org/10.1111/j.2044-8260.2010.02002.x.
- Goldney R. D., Eckert K. A., Hawthorne G. & Taylor A. W. (2010) Changes in the prevalence of major depression in an Australian community sample between 1998 and 2008. Australian and New Zealand Journal of Psychiatry 44, 901–910.
- Graetz B. (1993) Health consequences of employment and unemployment. Longitudinal evidence for young men and women. Social Science and Medicine 36, 715–724.
- Gray K. M., Piccinin A., Keating C. M., Taffe J., Parmenter T. R., Hofer S. et al. (2013) Outcomes in young adulthood: are we achieving community participation and inclusion? Journal of Intellectual Disability Research 58, 734–745. https://doi.org/10.1111/jir.12069.
- Halvorsen J. G. (1991) The family stress and support inventory (FSSI). Family Practice Research Journal 11, 255–277.
- Harrington R. & Loffredo D. A. (2011) Insight, rumination, and self-reflection as predictors of wellbeing. Journal of Psychology: Interdisciplinary and Applied 145, 39–57. https://doi.org/10.1080/00223980.2010.528072.
10.1080/00223980.2010.528072 Google Scholar
- Harris J. (2006) Intellectual Disability: Understanding Its Development, Causes, Classification, Evaluation, and Treatment. Oxford University Press, New York.
- Hartley S. L. & MacLean W. E. (2005) Perceptions of stress and coping strategies among adults with mild mental retardation: insight into psychological adjustment. American Journal on Mental Retardation 110, 285–297.
- Hermans H., Beekman A. T. & Evenhuis H. M. (2013) Prevalence of depression and anxiety in older users of formal Dutch intellectual disability services. Journal of Affective Disorders 144, 94–100. https://doi.org/10.1016/j.jad.2012.06.011.
- Ibrahim A. K., Kelly S. J., Adams C. E. & Glazebrook C. (2013) A systematic review of studies of depression prevalence in university students. Journal of Psychiatric Research 47, 391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015.
- Jaser S. S., Langrock A. M., Keller G., Merchant M. J., Benson M. A., Reeslund K. L. et al. (2005) Coping with the stress of parental depression II: adolescent and parent reports of coping and adjustment. Journal of Clinical Child and Adolescent Psychology 34, 193–205. https://doi.org/10.1207/s15374424jccp3401_18.
- Kazdin A. E., Rodgers A. & Colbus D. (1986) The hopelessness scale for children. Psychometric characteristics and concurrent validity. Journal of Consulting and Clinical Psychology 54, 241–245. https://doi.org/10.1037/0022-006x.54.2.241.
- Kendler, K. S. & Gardner, C. O. (2010) Dependent stressful life events and prior depressive episodes in the prediction of major depression: the problem of causal inference in psychiatric epidemiology. Archives of General Psychiatry 67, 1120-1127. doi: 10.1001.archgenpsychiatry.2010.136
- LaBarbera R. (2008) Perceived social support and self-esteem in adolescents with learning disabilities at a private school in learning disabilities. Learning Disabilities: A Contemporary Journal 6, 33–44.
- McClure K. S., Halpern J., Wolper P. A. & Donahue J. J. (2009) Emotion regulation and intellectual disability. Journal on Developmental Disability 15, 38–44.
- Meltzer H., Gatward R., Goodman R. & Ford T. (2000) The Report of a Survey Carried Out in 1999 by the Social Survey Division of the Office for National Statistics on Behalf of the Department of Health, the Scottish Health Executive and the National Assembly for Wales. The stationery office, London.
- Meyer B. (2001) Coping with severe mental illness: relations of the Brief COPE with symptoms, functioning, and wellbeing. Journal of Psychopathology and Behavioral Assessment 23, 265–277.
- Mindham J. & Espie C. A. (2003) Glasgow Anxiety Scale for people with an intellectual disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability. Journal of Intellectual Disability Research 47, 22–30. https://doi.org/10.1046/j.1365-2788.2003.00457.x.
- Olin E. & Jansson B. R. (2009) On the outskirts of normality: young adults with disabilities, their belonging and strategies. International Journal of Qualitative Studies on Health and Wellbeing 4, 256–266. https://doi.org/10.3109/17482620903180350.
- Omar, A. A., Lolli, J., Chen-McCain, S. & Dickerson, J. (2011) A comparison between full and part time lodging employees on job satisfaction, organisational commitment, and job performance’, International CHRIE conference. Available at: http://scholarworksumass.edu/cgi/viewcontent.cgi?article=1711%26context=refereed (retrieved 3 March 2016).
- Pallant J. (2010) SPSS Survival Manual: A Step-by-Step Guide to Data Analysis Using the SPSS Program, 4th edn. McGraw Hill Education, New York.
- Perez-Achiaga N., Nelson S. & Hassiotis A. (2009) Instruments for the detection of depressive symptoms in people with intellectual disabilities: a systematic review. Journal of Intellectual Disabilities 13, 55–77. https://doi.org/10.1177/1744629509104487.
- Pituch K. A. & Stevens J. P. (2016) Applied Multivariate Statistics for the Social Sciences, 6th edn. Routledge, New York.
- Rush K. S., Bowman L. G., Eidman S. L., Toole L. M. & Mortenson B. P. (2004) Assessing psychopathology in individuals with developmental disabilities. Behavior Modification 28, 621–637. https://doi.org/10.1177/0145445503259830.
- Sauter F. M., Heyne D., Blöte A. W., Van Widenfelt B. M. & Westenberg P. M. (2010) Assessing therapy-relevant cognitive capacities in young people: Development and psychometric evaluation of the self-reflection and insight scale for youth. Behavioural and Cognitive Psychotherapy 38, 303–317. https://doi.org/10.1017/s1352465810000020.
- Schulenberg J. E., Bryant A. L. & O'Malley P. M. (2004) Taking hold of some kind of life: how developmental tasks relate to trajectories of wellbeing during the transition to adulthood. Development and Psychopathology 16, 1119–1140.
- Seedat, S., Stein, D. J., Jackson, P. B., Heeringa, S. G., Williams, D. R. & Myer, L. (2009) Life stress and mental disorders in the South African stress and health study’, South African Medical Journal, vol. 99, no. 5, pp. 375–382. Available at: http://scholar.harvard.edu/files/davidrwilliams/files/2009-life_stress_and-williams.pdf (retrieved 23 October 2015).
- Soenens B., Vansteenkiste M., Lens W., Luyckx K., Goossens L., Beyers W. et al. (2007) Conceptualizing parental autonomy support: adolescent perceptions of promotion of independence versus promotion of volitional functioning. Developmental Psychology 43, 633–646. https://doi.org/10.1037/0012-1649.43.3.633.
- Stewart S. H., Sherry S. B., Comeau M. N., Mushquash C. J., Collins P. & Van Wilgenburg H. (2011) Hopelessness and excessive drinking among aboriginal adolescents: the mediating roles of depressive symptoms and drinking to cope. Depression Research and Treatment 2011, 1–11. https://doi.org/10.1155/2011/970169.
10.1155/2011/970169 Google Scholar
- Taylor J. L., Lindsay W. R. & Willner P. (2008) CBT for people with intellectual disabilities: emerging evidence, cognitive ability and IQ effects. Behavioural and Cognitive Psychotherapy 36, 723–733. https://doi.org/10.1017/S1352465808004906.
- Thompson R. J., Mata J., Jaeggi S. M., Buschkuehl M., Jonides J. & Gotlib I. H. (2010) Maladaptive coping, adaptive coping and depressive symptoms: variations across age and depressive state. Behaviour Research and Therapy 48, 459–466. https://doi.org/10.1016/j.brat.2010.01.007.
- Trapnell P. D. & Campbell J. D. (1999) Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. Journal of Personality and Social Psychology 76, 284–304. https://doi.org/10.1037/0022-3514.76.2.284.
- Tsakanikos E., Bouras N., Sturmey P. & Holt G. (2006) Psychiatric co-morbidity and gender differences in intellectual disability. Journal of Intellectual Disability Research 50, 582–587.
- Wang H. H., Wu S. Z. & Liu Y. Y. (2003) Association between social support and health outcomes: a meta-analysis. Kaohsiung Journal of Medical Sciences 19, 345–351.
- Wechsler D. (1999) Wechsler Abbreviated Scale of Intelligence. The Psychological Corporation, San Antonio, Texas.
- Wehmeyer M. L. & Palmer S. B. (1998) Factor structure and construct validity of scores on the hopelessness scale for children with students with cognitive disabilities. Educational and Psychological Measurement 58, 661–667. https://doi.org/10.1177/00131644980.
- Wilkins V. M., Kiosses D. & Ravdin L. D. (2010) Late-life depression with co-morbid cognitive impairment and disability: non-pharmacological interventions. Clinical Interventions in Aging 5, 323–331. https://doi.org/10.2147/CIA.S908858004008.
- Willner P. (2005) The effectiveness of psychotherapeutic interventions for people with learning disabilities: a critical review. Journal of Intellectual Disability Research 49, 73–85.
- World Health Organisation (2017) Depression and other common mental disorders: global health estimates. Available at: http://apps.who.int/iris/bitstream/10665/254610/1/WHO-MSD-MER-2017.2-eng.pdf (retrieved 25 November 2017).
