Depression is a common mental health condition defined by pervasive feelings of sadness and/or loss of interest in rewarding activities. For some people, depression can affect the ability to eat, sleep, concentrate, or make decisions and can cause functional limitations in social, occupational, or other areas of life.1 Depression often co-occurs with other mental health problems and increases risk for suicidal thoughts and behaviors.1 The societal economic burden of depression is an estimated $326.2 billion per year, considering workplace costs, direct costs, and suicide-related costs.2 These estimates do not include unmeasured emotional costs to individuals and families living with the disorder.

Autism spectrum disorder (ASD) is a developmental disability (DD) defined by social communication and interaction deficits and restricted and repetitive behaviors and interests.1 Depression is more common in autistic adults than those from the general population.3 Although estimates vary, the lifetime prevalence of depression is about 21% in general population samples and 37% in autistic samples.3, 4 The estimated prevalence of current depression (i.e., past 12 months) is 10% in population samples and 23% in autistic samples.3, 4 In comparison to adults without ASD, autistic adults are three times as likely to die by suicide and nine times as likely to attempt suicide.5

Risk factors for depression in autistic people and those with other DD include chronic health conditions, lack of supportive employment, few meaningful friendships, difficulty accessing needed services, and lack of engagement in recreational or other organized activities.6, 7, 8, 9, 10 One protective factor is social supports.11 In one study, Hedley and colleagues (2018) defined social supports as “feeling cared for, loved, and being a member of a larger social network.” They surveyed 194 college students regarding ASD traits, loneliness, social supports, suicidal ideation, and depressive symptoms. Social supports were inversely related to depression, loneliness, and suicidal ideation. Moreover, social supports partially mediated the relationship between ASD traits and depressive symptoms.

Increasing social supports may be especially important for people who are experiencing social isolation, which is common among autistic people. In one study, 48% of autistic adults reported that they never talked to friends on the phone and were never invited to social activities with friends and 39% reported that they never saw friends in the past 12 months.12 A total of 24% of autistic adults reported being totally socially isolated compared to 8% of adults with other DD.12 Social contacts counteract social isolation and lack of social supports, and are associated with fewer depressive symptoms.13 Yet less than half of autistic people are engaged in activities that enhance social contacts.12

Previous research suggests that recreational and other organized activities are important for increasing social contacts and positive mental health outcomes. For instance, activity engagement is significantly and inversely associated with loneliness and depressive symptoms in autistic people. This relationship persists even after controlling for social impairment and poor behavioral and emotional control,14 and may be more important than current employment or psychotherapy when managing symptoms of depression.10 Sports have been found to mitigate loneliness and depressive symptoms among autistic people and those with other DD.14, 15 Finally, a recent systematic review suggested that social connections may serve as protective factors against suicidal thoughts and behaviors in autistic people.16

While the current body of evidence suggests that engagement in recreational and other organized activities could be an important strategy against both depression and suicide in autistic people, most research in this area has focused on adult populations. Little is known about the relationships between activities and mental health among autistic adolescents. The objectives of this analysis were to (1) describe depressive symptoms and activity engagement in autistic adolescents and those with other DD and no DD and (2) explore the types of activities associated with depressive symptoms in each study group.