Down syndrome: systematic review of the prevalence and nature of presentation of unipolar depression
| Published date | 06 July 2015 |
| DOI | https://doi.org/10.1108/AMHID-11-2014-0037 |
| Pages | 151-162 |
| Date | 06 July 2015 |
| Author | Catherine Walton,Mike Kerr |
| Subject Matter | Health & social care,Learning & intellectual disabilities |
Down syndrome: systematic review of the
prevalence and nature of presentation of
unipolar depression
Catherine Walton and Mike Kerr
Dr Catherine Walton is Core
Trainee in Psychiatry, Wales
Deanery at the Cwm Taf
University Health Board,
Wales, UK.
Mike Kerr is Professor
at the Institute of Psychological
Medicine and Clinical
Neurosciences, Cardiff
University, Cardiff, Wales, UK.
Abstract
Purpose –The purpose of this paper is to assess the prevalence and nature of presentation of unipolar
depression in individuals with Down syndrome (DS).
Design/methodology/approach –The PRISMA (2009) checklist for systematic review was followed
where possible.
Findings –Eight studies were included in the qualitative synthesis from a total of 634 records identified. The
quality of the studies was then assessed: the studies all scored either 5 or 6 out of 6. The incidence of
depression ranged between studies from 5 to 13 per cent. It was found that depression is more common in
DS than the general intellectual disability population; this on a background of mental ill health of all causes
being less common in DS. It was suggested that, excluding organic disorders, depression is the most
common psychiatric problem in DS. In terms of the nature of depression,the evidence was less clear. Various
“vegetative”and biological symptoms were observed, with no fixed pattern. There was evidence for
withdrawal symptoms and psychosis.
Research limitations/implications –The small number of studies included in this review, and their
heterogeneity, highlights the need for further original research in this field.
Practical implications –An increased awareness of the frequency of depression in individuals with DS will
aid in a timely diagnosis, therefore reduce psychiatric morbidity. Clinicians should be aware of the varied
presentation, with no clear clinical picture, in order to maintain a high index of suspicion in an individual
presenting with “atypical”symptoms.
Originality/value –This review has provided preliminary evidence that depression may be the most
commonly experienced psychiatric disorder in DS.
Keywords Intellectual disability, Depression, Down syndrome, Mood disorder, Psychopathology,
Unipolar depression
Paper type Literature review
Down syndrome (DS) is the most common chromosomal abnormality leading to intellectual disability
(ID) (Walker et al., 2011), which occurs in approximately one in every 650 live births. About 95 per cent
of cases are due to trisomy chromosome 21, with the remainder of cases being due to either
translocation involving chromosome 21 or mosaicism. Individuals with DS will generally have an IQ of
between 20 and 50; however, around 15 per cent will have an IQ above 50 (Gelder et al., 2006).
Walker et al. (2011) reported that there has been an increase in interest in psychopathology in
people with DS in recent years, due to the suggestion that depression may be more prevalent in
those with DS in comparison to the ID population in general. In addition to the proposed
increased rate of depression, there is also increased risk for Alzheimer’s disease (AD) (Collacott
et al., 1992). Depression and low mood have been observed as “prodromal features”of
dementia in DS (Burt et al., 1992).
Received 26 November 2014
Revised 9 April 2015
Accepted 15 April 2015
DOI 10.1108/AMHID-11-2014-0037 VOL. 9 NO. 4 2015, pp. 151-162, © Emerald Group Publishing Limited, ISSN 2044-1282
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ADVANCESIN MENTAL HEALTH AND INTELLECTUALD ISABILITIES
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