The prevalence and incidence of mental ill-health in adults with Down syndrome.
Adults with Down syndrome get mental health problems less often than other adults with ID, with depression and dementia the main new cases.
01Research in Context
What this study did
McLennan et al. (2008) counted how many adults with Down syndrome develop mental health problems. They looked at both a single point in time and across several years.
They compared these numbers to adults with other intellectual disabilities. The study gives us the first big picture of mental ill-health risk in Down syndrome.
What they found
Adults with Down syndrome had about half the rate of mental ill-health seen in other adults with ID.
The two most common new problems were depression and dementia.
How this fits with other research
Spanoudis et al. (2011) later agreed there is no extra depression risk in Down syndrome, backing the low rate D found.
Eisenhower et al. (2006) and Kleinert et al. (2007) had already shown dementia climbs sharply after age 50. D’s wider count confirms dementia is the top new diagnosis, but still shows Down syndrome adults stay mentally healthier overall.
Rojahn et al. (1994) saw more psychological problems in elderly Down syndrome residents. D’s larger, longer view explains the gap: when you track all adults, not just the elderly, total mental ill-health stays lower.
Why it matters
You can reassure families that Down syndrome alone does not raise overall mental health risk. Screen on time for depression and dementia, but avoid over-pathologizing everyday behavior changes. Use this data to advocate for balanced mental-health funding: these clients need targeted dementia care, not blanket psychiatric services.
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02At a glance
03Original abstract
BACKGROUND: While there is considerable literature on adults with Down syndrome who have dementia, there is little published on the epidemiology of other types of mental ill-health in this population. METHOD: Longitudinal cohort study of adults with Down syndrome who received detailed psychiatric assessment (n = 186 at the first time point; n = 134 at the second time point, 2 years later). RESULTS: The prevalence of Down syndrome for the 16 years and over population was 5.9 per 10 000 general population. Point prevalence of mental ill-health of any type, excluding specific phobias, was 23.7% by clinical, 19.9% by Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities/Mental Retardation (DC-LD), 11.3% by ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR-ICD-10) and 10.8% by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Revised (DSM-IV-TR) criteria. Two-year incidence of mental ill-health of any type was 14.9% by clinical and DC-LD, 9.0% by DCR-ICD-10 and 3.7% by DSM-IV-TR criteria. The highest incidence was for depressive episode (5.2%) and dementia/delirium (5.2%). Compared with persons with intellectual disabilities (ID) of all causes, the standardized rate for prevalence of mental ill-health was 0.6 (0.4-0.8), or 0.4 (0.3-0.6) if organic disorders are excluded, and the standardized incidence ratio for mental ill-health was 0.9 (0.6-1.4), or 0.7 (0.4-1.2) if organic disorders are excluded. Urinary incontinence was independently associated with mental ill-health, whereas other personal factors, lifestyle and supports, and other types of health needs and disabilities were not. CONCLUSIONS: Mental ill-health is less prevalent in adults with Down syndrome than for other adults with ID. The pattern of associated factors differs from that is found for other adults with ID, with few associations found. This suggests that the protection against mental ill-health is biologically determined in this population, or that there are other factors protective for mental ill-health yet to be identified for the population with Down syndrome.
Journal of intellectual disability research : JIDR, 2008 · doi:10.1111/j.1365-2788.2007.00985.x