This page provides a plain-language summary.
The full paper includes the search strategy, included studies, and full synthesis.

Depression is reported more frequently in autistic people than in the general population, but identifying and assessing depression can be complicated by symptom overlap with autism-related characteristics and by limitations of standard depression measures. This systematic review synthesised studies on how depression has been described in autistic people and examined how reported presentations align with DSM-5-TR symptom constructs and where additional indicators are commonly described.

Why this review was needed
Research has clarified autism-related presentations of anxiety and post-traumatic stress, including experiences that are not well captured by standard diagnostic assumptions. In contrast, evidence on the presentation of depression in autistic adults has been less consolidated. This makes it harder to determine when depression is present, what it looks like, and how clinicians can differentiate depression from baseline autistic characteristics.

What we did
We reviewed published studies describing depression in autistic people and synthesised how depressive presentations were reported across study types and reporters (self-report and informant observations).

What the review found

1. Overlap and attribution challenges
   Across the literature, depressive symptoms can be difficult to differentiate from autism-related characteristics. Diagnostic overshadowing can occur when depressive symptoms are mistakenly attributed to autism rather than recognised as a co-occurring depressive disorder, particularly where there are communication differences and intellectual disability.

2. Self-reports and informant reports often focus on different aspects of depression
   Autistic adults without intellectual disability more often described internal experiences associated with depression (e.g., mood, worthlessness, fatigue, anhedonia, suicidal ideation, concentration). In contrast, informant reports, often describing autistic people with intellectual disability, focused on observable changes (e.g., facial expression, activity levels, sleep, appetite). None of the included studies directly compared self-reported and informant-reported presentations, despite these differences in reporting focus.

3. Many studies reported additional indicators concurrent with depression that are not DSM-5-TR symptoms
   In addition to the nine DSM-5-TR symptoms, 91.66% of the reviewed articles reported at least one additional presentation concurrent with depression. In the review, these were termed “other indicators of depression”.

4. Irritability co-occurred with depression across ages and cognitive profiles in the reviewed literature
   Irritability was reported alongside depression across ages and intellectual abilities. The paper argues this pattern warrants reconsideration of how irritability is conceptualised within autism-informed depression assessment, and notes that evidence on irritability and suicidality in autistic people remains limited.

What this may mean for practice
The synthesis indicates that autism-informed depression assessment should explicitly address symptom overlap and diagnostic overshadowing in both directions. Autism-related characteristics can be mistaken for depression, and depression-related change can be misattributed to autism. A practical focus on change from the person’s baseline, supported by both internal experience and, where relevant, observable behaviour, may improve recognition and reduce misclassification.

Method considerations highlighted in the paper
The review notes that clinical interviews tended to yield more detailed descriptions than standardised questionnaires, although interviews can introduce interviewer bias and rely on subjective interpretation. Questionnaires can reduce interviewer-related variability but may miss depth and variability in complex emotional states.