Association of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Traits with Depression and Empathy Among Medical Students

Abstract

Purpose

This study aimed to investigate the associations of the traits of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) with depression and empathy among medical students.

Patients and Methods

A cross-sectional survey was conducted with 202 fifth-year students at a Japanese medical school for 10 months during their clinical clerkship. The survey included sociodemographic questions and validated tools to measure depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), medical students’ empathy for patients (Jefferson Scale of Empathy-Student version [JSE]), ADHD traits (ADHD Self-Report Scale Screener [ASRS Screener]), and ASD traits (Autism-Spectrum Quotient Japanese version-21 [AQ-J-21]).

Results

A total of 151 students (response rate: 74.7%) participated in the survey. Of these, 41 (27.2%) reported a total score of ≥ 20 on the HADS and were categorized as depressed. Depressed students reported significantly lower and higher rates of having a part-time job and a history of enrolment in other faculties, respectively, than non-depressed students. According to the cutoff criteria of the ASRS Screener and AQ-J-21, 31 (20.5%) and 42 (27.8%) students reported ADHD and ASD traits, respectively. Multivariate regression analysis, controlling for age and sex, reported that higher age, ASRS Screener scores, and AQ-J-21 scores were significant predictors of higher HADS total scores. Additionally, higher AQ-J-21 scores significantly predicted lower JSE scores.

Conclusion

The degree of ADHD and ASD traits was significantly associated with depression. Moreover, the degree of ASD traits was significantly associated with lower empathy for their patients. It is important to consider that about 20–30% of medical students have these neurodevelopmental traits and to develop intervention strategies for improving depression and empathy.

Keywords:

• medical education
• neurodevelopmental traits
• mental health
• empathetic attitudes

Abbreviations

ADHD, attention-deficit/hyperactivity disorder; AQ-J, Autism-Spectrum Quotient, Japanese version; ASD, autism spectrum disorder; ASRS, Adult ADHD Self Report Scale; CI, confidence interval; HADS, Hospital Anxiety and Depression Scale; IRB, Institutional Review Board; JSE, Jefferson Scale of Empathy-Student version; SD, standard deviation.

Ethical Considerations

All participants were informed of the purpose of this study. This research was conducted in accordance with the principles of the Declaration of Helsinki. The Institutional Review Boards (IRB) at the Nagoya City University of Medical Science and the Nagoya City University Graduate School of Medicine approved the study and all its scientific and ethical aspects, respectively. The authors complied with all IRB recommendations to maintain the confidentiality and anonymity of the participants.

Acknowledgments

The authors appreciate the participation of the medical students at the Nagoya City University Medical School. We also appreciate Ms. Kaori Kobori, Secretary, Department of Psychiatry, Nagoya City University Graduate School of Medicine, for her cooperation in this study. We are grateful to Editage (www.editage.com) for the English editing.

Author Contributions

TW, MK, MS, and ST were involved in the conception and design of this study. TW, MK, MS, and ST acquired the data. TW, MK, TAF, and AT analyzed and interpreted the data. TW drafted the manuscript. TAF and AK contributed substantially to the revision of the manuscript. All authors read and approved the final version of the manuscript. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

MK reports personal fees from Shionogi & Co., Ltd. and Yoshitomiyakuhin Corporation, outside the submitted work. TAF reports grants and personal fees from Mitsubishi-Tanabe, personal fees from MSD, personal fees from SONY, grants and personal fees from Shionogi, outside the submitted work. In addition, TAF has a patent 2020-548587 concerning smartphone CBT apps pending, and intellectual properties for Kokoro-app licensed to Mitsubishi-Tanabe. AK has received lectures fees from AstraZeneca, Chugai, Daiichi-Sankyo, Dainippon-Sumitomo, Eisai, Hisamitsu, Janssen, Kyowa, Kyowa Kirin, Lilly, MSD, Meiji-Seika Pharma, Mochida, Mundipharma, Nipro, Nihon-Zoki, Otsuka, Pfizer, Takeda, Tsumura, and Viatris. He has received royalties from Igaku-shoin and research funds from Daiichi-Sankyo, Eisai, Fujifilm RI Pharma, MSD, Otsuka, and Shionogi. AK is the inventor of the pending patents (2019-017498 & 2020-135195). The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was partially funded by the Nagoya City University Graduate School of Medical Sciences under grant number 2113020. The funders had no involvement in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.