Bénéfices et effets nocifs des interventions visant à améliorer l’anxiété, la dépression et d’autres résultats de santé mentale chez les personnes autistes : revue systématique et méta-analyse en réseau d’essais contrôlés randomisés

Titre original en anglais : 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

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Linden, A., Best, L. M., Elise, F., Roberts, D., Branagan, A., Tay, Y. B. E., Crane, L., Cusack, J., Davidson, B. R., Davidson, I. A., Hearst, C., Mandy, W., Rai, D., Smith, E., & Gurusamy, K. S. (2022). 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. Autism, 27(1), 7-30. https://doi.org/10.1177/13623613221117931

Date de publication: 11/08/2022 Ajout dans AutiHub: 05/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
15
Auteur·ices de la publication identifié·es comme autistes
2 / 15 (13,3 %)
  1. Audrey Linden
  2. Lawrence MJ Best
  3. Freya Elise
  4. Danielle Roberts
  5. Aoife Branagan
  1. Yong Boon Ernest Tay
  2. Laura Crane
  3. James Cusack *
  4. Brian R Davidson
  5. I. A. Davidson
  1. Caroline Hearst *
  2. Will Mandy
  3. Dheeraj Rai
  4. Edward Smith
  5. Kurinchi Selvan Gurusamy

Résumé

Les difficultés de santé mentale sont fréquentes chez les personnes autistes, environ 14 % à 50 % ayant connu une dépression et environ 40 % à 80 % ayant connu des troubles anxieux. L’identification d’interventions qui améliorent la santé mentale des personnes autistes est une priorité majeure. Cependant, à l’heure actuelle, il n’existe pas de méta-analyse en réseau de haute qualité des bénéfices et effets nocifs de différentes interventions. Nous avons réalisé une revue systématique et une méta-analyse en réseau d’essais contrôlés randomisés, en effectuant des recherches dans MEDLINE, EMBASE, d’autres bases de données et des registres d’essais jusqu’au 17 octobre 2020. Nous avons inclus des essais contrôlés randomisés rapportant l’anxiété ou la dépression dans un format approprié. Nous avons calculé des estimations d’effet et des intervalles de crédibilité à 95 % à l’aide d’une méta-analyse bayésienne en réseau. Notre recherche a identifié 13 794 rapports, parmi lesquels 71 essais contrôlés randomisés (3 630 participants) étaient admissibles à l’inclusion. Tous les essais présentaient un risque élevé de biais. La période de suivi allait de 1 à 24 mois. Les données indiquent une incertitude concernant les effets des différentes interventions, et des données probantes de meilleure qualité sont nécessaires. Les données disponibles suggèrent que certaines formes de thérapie cognitivo-comportementale peuvent diminuer les scores d’anxiété et de dépression chez les enfants et les adultes autistes ; la thérapie de pleine conscience peut diminuer les scores d’anxiété et de dépression chez les adultes autistes ayant des antécédents de troubles de santé mentale ; et les interventions comportementales peuvent apporter certains bénéfices pour la dépression chez les enfants autistes. Nous recommandons que les personnes autistes aient accès aux interventions de santé mentale disponibles pour les personnes non autistes, conformément aux principes de soins centrés sur la personne. Identifiant d’enregistrement PROSPERO : CRD42019136093 Résumé en langage clair Près de trois personnes autistes sur quatre connaissent des problèmes de santé mentale tels que le stress, l’anxiété ou la dépression. Les recherches déjà réalisées ne nous guident pas sur la meilleure façon de prévenir ou de traiter les problèmes de santé mentale chez les personnes autistes. Notre objectif était d’examiner les bénéfices et les effets nocifs de différentes interventions sur les résultats de santé mentale chez les personnes autistes. Nous avons recherché tous les essais contrôlés randomisés (ECR) publiés concernant des interventions pour des troubles de santé mentale chez les personnes autistes jusqu’au 17 octobre 2020. Nous avons également recherché des ECR qui n’étaient pas publiés dans des revues évaluées par les pairs. Ceux-ci ont été obtenus à partir de registres d’essais cliniques en ligne. Nous avons ensuite combiné les informations de tous ces essais à l’aide de méthodes statistiques avancées afin d’analyser l’efficacité des interventions. Soixante et onze études (3 630 participants) ont fourni des informations pour cette recherche. Les études ont rapporté la réponse des participants à l’intervention pendant une période de temps seulement courte. Les essais n’ont pas indiqué quelles interventions fonctionnaient pour les personnes présentant une déficience intellectuelle. Chez les personnes sans déficience intellectuelle, certaines formes de thérapie cognitivo-comportementale et de thérapie de pleine conscience peuvent être utiles. Cependant, des recherches supplémentaires sont nécessaires. De nombreux essais ont utilisé des médicaments pour cibler les caractéristiques centrales de l’autisme plutôt que les troubles de santé mentale, mais ces médicaments n’ont pas aidé les personnes autistes. Jusqu’à ce que nous disposions de davantage de données probantes, le traitement des troubles de santé mentale chez les personnes autistes devrait suivre les données probantes disponibles pour les personnes non autistes. Nous prévoyons de diffuser largement les résultats auprès des professionnels de santé par l’intermédiaire de revues médicales et de conférences, et de contacter d’autres groupes représentant les personnes autistes.

Mental health difficulties are prevalent in autistic people with ~14%–50% having experienced depression and ~40%–80% having experienced anxiety disorders. Identifying interventions that improve autistic people’s mental health is a top priority. However, at present, there is no high-quality network meta-analysis of benefits and harms of different interventions. We conducted a systematic review and network meta-analysis of randomised controlled trials, searching MEDLINE, EMBASE, other databases, and trial registers until 17 October 2020. We included randomised controlled trials reporting anxiety or depression in a suitable format. We calculated effect estimates and 95% credible intervals using Bayesian network meta-analysis. Our search identified 13,794 reports, of which 71 randomised controlled trials (3630 participants) were eligible for inclusion. All trials had high risk of bias. The follow-up period ranged from 1 to 24 months. Evidence indicates uncertainty about the effects of different interventions, with more high-quality evidence needed. Available evidence suggests that some forms of cognitive behavioural therapy may decrease anxiety and depression scores in autistic children and adults; mindfulness therapy may decrease anxiety and depression scores in autistic adults with previous mental health conditions; and behavioural interventions may provide some benefit for depression in autistic children. We recommend that autistic people are given access to mental health interventions available to non-autistic people, following principles of person-centred care. PROSPERO registration ID: CRD42019136093 Lay Abstract Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.

Bibliographie citée par cette référence

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Vue d’ensemble de l’inclusion dans la bibliographie

Ces indicateurs décrivent la bibliographie citée importée pour cette publication. Les métriques de références citées utilisent le total des références citées comme dénominateur. Les métriques d’auteurices cité·es indiquent si elles utilisent toutes les occurrences d’auteurices cité·es ou seulement les occurrences rattachées à des auteurices déjà intégré·es à la base de données AutiHub. Ils utilisent les rattachements mis en cache entre les auteurices cité·es et les auteurices intégré·es à la base de données AutiHub. Dernier calcul : 16/08/2026 11:30.

Références citées
94
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
3 / 94 (3,2 %)
Occurrences d’auteur·ices cité·es identifié·es comme autistes
3 / 676 (0,4 %)
Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 3 / 98 (3,1 %). Auteurices cité·es distinct·es identifié·es comme autistes : 3 / 623 (0,5 %).
Occurrences citées rattachées à la base AutiHub
98 / 676 (14,5 %)
Auteurices cité·es distinct·es rattaché·es : 85 / 623 (13,6 %)
Occurrences rattachées, non identifiées comme autistes
95 / 98 (96,9 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 95 / 676 (14,1 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 82 / 85 (96,5 %).
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