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Journal of Intellectual Disability Research doi: 10.1111/jir.12478

1

Depression and anxiety symptoms during the transition to

early adulthood for people with intellectual disabilities
K. L. Austin, M. Hunter, E. Gallagher & L. E. Campbell
School of Psychology, Faculty of Science, University of Newcastle, Callaghan, New South Wales, Australia

Abstract predictor of depression for YA with ID. In compari-

Background The transition to adulthood is a major
developmental milestone; a time of self-discovery and
increased independence. For young adults (YA) with
intellectual disabilities (ID), however, this period is
especially challenging. The increased incidence of
mental health disorders in this population, such as
depression and anxiety, make this transition even
more difficult, increasing caregiver burden at a time
when the young adult would traditionally be gaining
independence. It is not clear, however, why YA with
ID are more susceptible and what factors may predict
mental health symptoms.
Method Potential risk and protective factors
(demographic variables, coping styles, sense of
hopelessness, unmet achievement of adulthood
milestones, self-reflection and insight) of anxiety and
depression symptoms were assessed in 55 YA with ID
and a sample of age-matched controls.
Results Insight was the strongest predictor of anxiety
(with gender in the controls) for YA with and without
ID, with increased insight predicting fewer anxiety
symptoms. However, YA with ID had significantly
less insight than their aged-matched counterparts and
significantly higher levels of anxiety. They were also
less likely to have achieved traditional adulthood
milestones. Maladaptive coping was the strongest
Correspondence: Ms. Kristie Lea Austin, University of Newcastle,
School of Psychology, 11 Nelson Dr, Hunterview, Callaghan,
New South Wales, Australia (e-mail: austinkristie@gmail.com;
kristie.austin@newcastle.edu.au).
son, both maladaptive coping and insight predicted
depression in controls. More maladaptive coping
predicted increased depressive symptoms in both
populations, whilst increased insight predicted fewer
depressive symptoms in controls.
Conclusions Insight and maladaptive coping are
potential targets in the treatment of anxiety and
depression among YA with ID. Longitudinal
intervention studies exploring the efficacy of such
targeted programmes in reducing mental health
symptoms and improving the transition to adulthood
for these young people are recommended.
Keywords anxiety, depression, insight, intellectual
disability, maladaptive coping, perceived support
Introduction
The transition to adulthood is a major developmental
milestone. For most, the life period between 18 and
30 years is a time of self-discovery and increased
independence when important decisions about
housing, employment and further education are
made. Understandably, this period can be quite
challenging and for some, especially those with
intellectual disability [ID; indicated by an intelligence
quotient (IQ) score of 75 or below and adaptive
functioning deficits; American Psychiatric
Association (APA) 2013], the traditional milestones
of adulthood may never be achieved (Forte et al.
2011). Despite similar aspirations to typically

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd
 Journal of Intellectual Disability Research
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K. L. Austin et al. • Depression and anxiety in young adults with ID
developing peers, young adults (YA) with ID are
often delayed in reaching milestones like financial
independence or living independently (Floyd et al.
2009; Gray et al. 2013). It is therefore not surprising
that these YA are at high risk of developing mental
illnesses. Between 3% and 6% of the population suffer
from anxiety or depression (Andrews et al. 2001;
World Health Organisation 2017), however, YA are
nearly twice as likely to develop such disorders
(Meltzer et al. 2000; Goldney et al. 2010). For YA
with ID, rates are estimated to be around three times
higher with almost one-third of 19- to 33-year olds
with ID having psychopathology (Einfeld et al. 2006).
Despite high prevalence rates and the importance of
early adulthood experiences for future mental health,
research investigating the factors that contribute to
this increased risk remain scarce.
The lack of research, service funding, community
awareness and treatment accessibility is further
complicated by diagnostic difficulties and subsequent
under-diagnoses and underestimated prevalence rates
of mental health disorders in people with ID
(Hermans et al. 2013). Determining whether
symptoms are in excess of normal behavioural
repertoire is difficult when symptoms like weight gain,
insomnia and difficulties concentrating are common
to not only anxiety and depression but also to ID,
more generally (Harris 2006; APA 2013). Mental
health symptoms are often misattributed as inherent
to the disability (Rush et al. 2004) or missed due to
the emphasis on verbal reporting of symptoms. Many
people with ID have difficulty naming complex
emotions, and this often results in carers being relied
upon to detect symptoms, further compromising
assessment validity (McClure et al. 2009).
Under-diagnosis, reduced treatment accessibility
and reduced awareness of co-mordbid mental health
disorders and ID among YA, is problematic. Co-
morbidities can reduce inclusiveness by exacerbating
already existing difficulties such as communication,
self-care, decision-making, social interaction and
occupational performance impairments (APA 2013).
Even if successfully diagnosed, people with ID face
additional problems; they are less responsive to
psychotherapeutic treatments like cognitive behaviour
therapy and pharmacological intervention (Wilkins
et al. 2010). These additional impairments can also
increase caregiver pressure and reduce their well-
being (Cadman et al. 2012). Thus, it is important that
© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd
the specific cognitive and emotional domains that
contribute to mental health concerns in YA with ID
are explored to better identify and treat these
disorders through targeted therapeutic interventions
(Willner 2005).
One possibly involved factor is coping style, as the
ability to self-regulate responses to stressful events
often is impaired among people with ID (Compas
et al. 2001). Among YA, the use of maladaptive
(rumination, emotional numbing, escape, avoidance
and intrusive thoughts) and adaptive coping
(cognitive restructuring, problem solving, acceptance,
humour and using emotional support) strategies have
been linked to mental health symptoms (Jaser et al.
2005; Thompson et al. 2010). In adults with ID,
maladaptive coping (e.g. avoidance) predicted
depressive symptoms and adaptive coping (e.g.
gaining control over the stressor and personal
emotional reactions) predicted reduced psychological
distress (Hartley & MacLean 2005). The younger the
participant, the more distress experienced.
Rumination (maladaptive and repetitive thoughts
about a perceived threat or loss) is also more
frequently reported in YA with ID compared with age
matched peers (Forte et al. 2011) but no studies
appear to have examined adaptive coping in this
population.
Other factors are also known to predict well-being
in YA. For instance, the ability to evaluate one’s own
thoughts, affect and behaviour (insight), rather than a
simple awareness of them (self-reflection), is also a
strong predictor of well-being in YA (Trapnell &
Campbell 1999; Sauter et al. 2010; Harrington &
Loffredo 2011). Well-being also declines when YA
perceive they have not achieved key employment,
social or romantic adulthood milestones
(Schulenberg et al. 2004). As reduced well-being can
also hinder the achievement of these key milestones, a
recurring cycle can easily eventuate. Therefore, a link
between hopelessness and increased mental health
symptoms in YA with ID is also plausible and has
been found to be predictive of depressive symptoms
in adults with ID and in adolescents without ID
(Esbensen & Benson 2005; Stewart et al. 2011).
Lastly, social support and recent positive and
negative life events may also be potential risk factors
for poorer mental health among YA (Wang et al.
2003; Kendler & Gardner 2010). Negative life events
may be exacerbated by poor coping abilities and low
 Journal of Intellectual Disability Research
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K. L. Austin et al. • Depression and anxiety in young adults with ID
social support but as no studies have considered or
compared these risk factors in people with ID, the
extent that these factors influence one another
remains unclear. Moreover, the satisfaction with,
rather than the amount of support received, may also
be a better predictor of mental health outcomes in
adolescents with perceived parental support
predicting more than one-third of the variance in self-
worth scores (LaBarbera 2008).
Despite the unknowns, two things are clear from
the research to date. YA with ID and mental health
disorders are at an increased risk of significant
negative outcomes relative to typically developing
peers. Second, there is a lack of research delineatating
the factors that contribute to mental health disorders
in YA with ID. In response to this gap, this
exploratory study aimed to investigate factors that
may predict anxiety and depression for YA with and
without ID. It also explored whether certain
predictive factors may be related to the higher
prevalance of these disorders in YA with ID.
Consistent with the literature from typically
developing YA and adults with ID, it was
hypothesised that more maladaptive coping,
perceived need for support, unmet expectations and
hopelessness would predict more depressive and
anxiety symptoms. In contrast, adaptive coping,
insight and being employed were expected to predict
fewer symptoms. Self-reflection was not expected to
predict symptoms. Given the expected higher
prevalence of anxiety and depression in people with
ID, it was predicted that the risk factors identified
would be more prevalent in the ID sample compared
with controls.
Method
Participants
Participants included 137 YA aged 18–30 years
(Table 1). Of these, 55 (27 women) had ID
(7 borderline, 35 mild and 13 moderate; as defined
by APA 2000) and were recruited from 12 disability
support providers. The remaining 82 (54 women)
were age-matched controls recruited from the
University of Newcastle and social media with ethical
approval obtained. Details of the study were
provided and written, informed consent was
obtained. In consideration of this informed consent,
© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
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only participants assessed as having a borderline,
mild or moderate ID were included. Of the
participants with ID, 92.72% had a Full Scale IQ
(FSIQ) greater than 51.
Measures
Transition to adulthood questionnaire
Self-reported depressive symptoms over the
previous 2 weeks were assessed using the 20-item
Glasgow Depression Scale for people with a
Learning Disability (GDS-LD; Cuthill et al. 2003).
The measure had good internal consistency
(α = .90). Three-point Likert response items from
‘never’ (0) to ‘a lot’ (2) were used, with higher scores
indicating more symptoms of depression. Items
included, ‘Have you felt sad’? Scores of 13 or above
reliably identify people with clinically relevant
symptoms (Cuthill et al. 2003).
Anxiety symptoms were measured using the
Glasgow Anxiety Scale for people with an ID
(GAS-ID; Mindham & Espie 2003). It possessed
good test–retest reliability, r = .95. Responses to the
27 items were measured using a 3-point Likert scale
from ‘never’ (0) to ‘always’ (2). The clinically relevant
cut-off score was 17 or above (Hermans et al. 2013).
Items included worries (e.g. ‘Do you worry a lot?’),
fears (e.g. ‘Are you afraid of dogs?’) and physiological
symptoms (e.g. ‘Do you ever feel hot and sweaty
when you haven’t been exercising?’).
Coping style was assessed using the 28-item Brief
Cope self-report measure with acceptable test–retest
reliability (r = >.50) and validity for people with
impairment (Carver 1997; Meyer 2001). Responses to
stressful situations were assessed as maladaptive or
adaptive with items including ‘I give up trying to deal
with it’ and ‘I try to get advice about what to do’,
respectively. A 4-point Likert scale from ‘very true’
(1) to ‘not true’ (4) was used.
Self-reflection and Insight were assessed via the
respective subscales of the Self-Reflection and Insight
Scale for Youth. The scale has good internal
consistency (α = .77) and is developmentally
appropriate for young people (Sauter et al. 2010).
Items were ranked using a Likert scale from ‘yes’
(1) to ‘no’ (6). Six items assessed insight
(e.g. ‘I usually know why I feel the way I feel’) and 11
items assessed self-reflection (e.g. ‘I often think about
how I feel about things’).
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Table 1 Demographic variables of participants and differences between YA with ID and control participants

Control Intellectual disability Total Group differences between groups

2
Demographic variable Number % Number % Number % x P

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Gender 3.80
Male 28 34.15 28 50.91 56 40.88
Female 54 65.85 27 49.10 81 59.12
Age
18–21 51 62.19 33 60.00 84 61.31
22–25 21 25.61 14 25.45 35 25.55
Journal of Intellectual Disability Research

26–28 6 7.32 5 9.10 11 8.03

29–30 4 4.88 3 5.45 7 5.11
Marital status† 7.72 0.02
Single 33 40.24 34 61.82 67 48.90
Partnered 45 54.88 21 38.18 66 48.17
Married 4 4.88 0 0 4 2.92
Living arrangements† 16.7 <0.01
With family/parents 51 62.19 49 89.09 100 72.99
Alone 2 2.44 3 5.45 5 3.65
With friends/others 18 21.95 2 3.63 20 14.6
With partner 11 13.41 1 1.82 12 8.75
K. L. Austin et al. • Depression and anxiety in young adults with ID

Employment 12.94 <0.01

Not employed 24 29.27 33 60.00 57 41.61
Employed casually/part-time 45 54.88 18 32.73 63 45.98
Employed full-time 13 15.85 4 7.27 17 12.41
Education† 49.63 <0.01
Some high school 2 2.44 4 7.27 6 4.38
Graduated high school 28 34.14 45 81.82 73 53.28
Trade apprenticeship or equivalent 4 4.88 6 10.91 10 7.30
Undertaken some undergraduate university education 29 35.37 0 0 29 21.17
Undergraduate university degree 10 12.2 0 0 10 7.30
Some postgraduate university education 3 3.66 0 0 3 2.19
Postgraduate university degree 6 7.32 0 0 6 4.38
Antidepressants 1 0.32
Yes 7 8.54 8 14.55 79 57.66
No 71 86.58 47 85.45 54 39.42
No response 4 4.89 0 0 4 2.92

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
P value represents Monte-Carlo significance level due to assumptions of the chi-square being violated
 Journal of Intellectual Disability Research
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K. L. Austin et al. • Depression and anxiety in young adults with ID
Hopelessness was measured using the 17-item
Hopelessness Scale for Children (Kazdin et al. 1986);
a scale validated in YA with cognitive disabilities, with
good discrimination between high and low
hopelessness (Kazdin et al. 1986; Wehmeyer &
Palmer 1998). Responses to items (e.g. ‘I want to get
older because I think things will get better’) were
recorded as ‘true’ (1) or ‘not true’ (2). Higher scores
reflected greater perceived hopelessness.
Expected/Achieved Adulthood was assessed
using a questionnaire based on Floyd et al. (2009),
Olin and Jansson (2009) and Soenens et al. (2007)’s
criteria for adulthood. It assessed educational,
vocational, familial, social, communication and
decision-making domains. Expected and achieved
adulthood was measured by asking participants their
feelings about what they should be doing at their
current life stage (e.g. ‘Should you have finished
school by now?’) and what adulthood tasks they had
achieved (e.g. ‘Have you finished school?’). A 5-point
Likert scale from ‘always’ (5) to ‘never’ (1) and ‘yes’
(2)/‘no’ (1) response items were used. Higher scores
indicated greater expectations of adulthood and a
greater sense of achievement, respectively. The
expected scores were subtracted from the achieved
scores, to generate a difference score indicating if the
person was meeting their expectations of adulthood.
Positive scores indicated expectations had been
exceeded, whereas negative scores indicated the
person was not fulfilling their expectations.
Additional measures completed by the intellectual
disability group only
Cognitive abilities were assessed using the two-
subscale form of the Wechsler Abbreviated Scale of
Intelligence (WASI-II). Vocabulary (verbal) and
Matrix Reasoning (non-verbal) subscale scores
combine to estimate an FSIQ and has good validity in
predicting the level of intellectual impairment
(Wechsler 1999).
Positive and negative life events were measured
through recalling the quantity of ‘good things’
(positive) and ‘problems’ (negative) from the past
year. Questions were ‘Have you had any really good
things happen in the past year?’ and ‘Have you had
any serious problems in the past year?’ and mirrored
those used by Seedat et al. (2009) with adolescents
and people with mental illness.
© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd
Perceptions of support needs were assessed by
participants reporting ‘How much support and help
do you (sic) feel from …?’ home, day programmes
and from friends with 3-point Likert scale responses:
‘Enough help, no more needed’ (1); ‘Some help but
not enough’ (2); and ‘No help, much more needed’
(3). Questions were similar to those in the family
stress and support inventory; two validated measures
(Halvorsen 1991).
Procedure
Participants with ID were offered reading and
recording assistance and completed all measures
during a face-to-face session lasting approximately 2 h
with a researcher. The control participants completed
the transition to adulthood inventories online but did
not complete the recent life events and perceptions of
support needs inventories or the cognitive ability
assessment as these were added to the protocol
following the data collection of control participants.
Statistical analyses
The current exploratory study utilised a cross-
sectional between-group and correlational design
with analyses performed using SPSS-20 (Pallant
2010). Non-parametric statistical equivalents were
utilised for skewed data identified during assumptions
testing. Random missing data points (173, <.01%)
were replaced using the individual’s mean score
(Pituch & Stevens 2016) from the relevant subtest.
Group differences were assessed using independent
sample t-tests or chi-square tests. Bi-variate, across-
group analyses (correlational and ANOVAs)
identified predictor variables. Tukey’s post hoc
analyses and Bonferroni adjustments were applied for
multiple comparisons [alpha levels for employment
P < 0.017 (P = 0.05/3) and P < 0.002 (P = 0.05/21)
for education].
In order to better understand the relative influence
of the measured variables on the groups, regression
analyses were performed. Four separate regression
analyses were constructed exploring the impact of the
hypothesised predictor variables in each group
(ID and controls) separately and across the two key
outcomes measures (anxiety and depression),
respectively: ID group and anxiety; control group and
anxiety; ID group and depression; and control group
and depression. Predictors with more explanatory
 Journal of Intellectual Disability Research
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K. L. Austin et al. • Depression and anxiety in young adults with ID

power (as indicated by the coefficient of
determination: r2) were added to the model first
before other predictors were added and assessed.
Predictors that were (1) still significant and (2) added
explanatory power remained in the model, whereas
those that did not add to the model were removed to
maximise explanatory power and minimise the
number of predictor variables. The depression data
was ranked prior to the regressions due to skewness.
Results
The control participants were more likely to be
woman, employed, have higher levels of education,
live out of home, be partnered or married and have
higher FSIQs with no between-group differences in
the use of antidepressants (Tables 1 and 2). In
contrast, the ID participants had higher anxiety scores
[t(135) = 2.57, P = 0.01], reported more unmet
expectations of achieving adulthood milestones
[t(78.9) = 2.25, P = 0.03], less self-reflection
[t(135) = 3.18, P < 0.01] and less insight [t(135) = 2.67,
P = 0.01] compared with controls (Table 2).
Across-groups, being woman, predicted higher
anxiety scores. Those employed full-time had lower
levels of anxiety and depression in comparison to the
unemployed [t(42.28) = 2.95, P = 0.04 and
Z = 2.49, P = 0.01]. Full-time employees also had
fewer depressive symptoms than those employed
casually or part-time (Z = 2.40, P< 0.017). People
with a trade education (or equivalent) had more
anxiety symptoms than those who had completed
[t(18) = 3.58, P = 0.02] or partially completed an
undergraduate university education [t(37) = 3.25,
P < 0.05]. However, after Bonferroni adjustments,
educational levels did not predict depressive
symptoms (Table 3).
Of the ID sample, 80% presented with clinically
significant anxiety symptoms and 64% met criteria for
depression compared with 61% and 50% of the
control group, respectively, but the differences were
not significant [depression, U = 642, P = 0.43 or
anxiety t(80.80) = 1.58 P = 0.12]. Across-groups,
11% were taking antidepressants, and these
participants had more symptoms of both depression
and anxiety with 87–93% of these people meeting
clinical criteria (respectively).
Across-group two-tailed correlations (Spearman’s
rho for non-parametric data distributions and
Pearson’s r otherwise) were conducted to identify
significant associations between variables. More
maladaptive coping (rs = 37, P < 0.01), more
hopelessness (rs = 18, P < 0.05), lower cognitive
abilities (rs = .19, P < 0.05), and less insight
(r = .45, P < 0.01) were associated with more
symptoms of anxiety. More maladaptive coping
(rs = 45, P < 0.01), more hopelessness (rs = .12,
P < 0.01), reduced insight (rs = .50, P < 0.01) and
more unmet expectations of adulthood milestone
achievement (rs = .21, P < 0.05) were associated

Table 2 Differences between participants with ID and controls on predictor and outcome variables

Control ID

M (Md) SD (IQR) M (Md) SD (IQR) P

Anxiety 19.35 7.06 22.83 8.72 0.01

Adaptive coping 42.84 5.94 44.13 9.28 0.37
Difference between expectations 8.14 11.30 14.91 19.30 0.03
and achievements of adulthood
Self-reflection 47.13 9.54 42.27 7.48 <0.01
Insight 22.37 7.49 18.98 6.93 <0.01
Depression† 13.04 (13.00) 6.37 (9.00) 15.04 (14.00) 7.09 (9.00) 0.10
Age† 21.01 (20.00) 3.09 (4.00) 21.67 (20.00) 3.24 (5.00) 0.20
Cognitive ability† 112.04 (112.00) 14.51 (20.00) 61.00 (59.00) 7.51 (9.00) <0.01
Maladaptive coping† 23.82 (25.00) 4.26 (7.00) 24.73 (25.00) 6.06 (7.00) 0.43
Hopelessness† 22.68 (22.00) 1.93 (3.00) 22.44 (22.00) 3.00 (4.00) 0.29

†
Mean, median (Md), standard deviation (SD) and interquartile ranges (IQR) reported due to positively skewed variables

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John Wiley & Sons Ltd
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Table 3 The impact of the demographic variables on the outcomes variables (anxiety and depression)

Anxiety Depression*

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M SE F df P M SE x df P

Gender†
Males 19.11 1.05 67.77 0.30
Females 21.89 0.87 4.17 136 0.04 69.85 0.30 0.09 1 0.76
Taking antidepressants†
Journal of Intellectual Disability Research

Yes 27.47 1.98 109.77 4.57

No 19.80 0.71 13.29 132 <.01 61.56 4.57 20.88 1 <.01
Employment
Full-time 17.35 1.89 45.56 2.60
Casually/part-times 20.08 0.98 69.37 0.10
Not employed 22.51 1.03 3.30 (2,134) 0.04 75.59 1.64 7.53 (2,134) 0.02
Education
Some high school 22.50 3.11 48.58 1.29
Graduated final year of high school 21.58 0.89 75.86 2.16
Trade apprenticeship or equivalent 27.40 2.41 92.45 1.94
Undertaken some university education 18.97 1.41 61.69 1.12
K. L. Austin et al. • Depression and anxiety in young adults with ID

Undergraduate university degree 16.10 2.41 57.85 0.92

Some post-graduate university degree 14.33 4.40 30.50 1.69
Post-graduate university degree 17.50 3.11 2.89 (6,130) 0.01 40.00 1.83 2.89 (6,130) 0.01
Marital Status
Single 20.54 0.97 20.54 0.97
Partnered 20.61 0.97 20.61 0.97
Married 26.75 3.96 1.18 (2,134) 0.31 26.75 3.96 1.18 (2,134) 0.31
Living Arrangement
Family/parents 70.18 0.57 70.18 0.57
Alone 72.70 0.21 72.70 0.21
Friends 60.78 0.94 60.78 0.94
Group home 76.40 0.61 76.40 0.61
With partner 53.38 0.79 1.32 (4,32) 0.27 53.38 0.79 1.88 (4,32) 0.76

†
For the anxiety outcome variables, these variables were assessed using independent samples t tests. The t value is listed in the F column
*Non-parametric equivalents used

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
 Journal of Intellectual Disability Research
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K. L. Austin et al. • Depression and anxiety in young adults with ID
with more depressive symptoms. Depression and
anxiety were also strongly correlated (rs = .63,
P < 0.01). Specific to the ID sample, the perceived
need overall (r2 = 0.25, P < 0.05 and r2 = 0.26,
P < 0.05, respectively) and from family (r2 = 0.25,
P < 0.05 and r2 = 0.24, P < 0.05, respectively) for
more support was positively correlated with higher
scores of depression and anxiety. The remaining
variables were not associated with anxiety or
depression.
The across-group predictor variables that showed
significant correlations were then examined in the ID
and control groups separately through four regression
models (Table 4). For the ID and anxiety regression
model A, insight and maladaptive coping were the only
variables to significantly predict anxiety. Additionally,
when the contribution of insight was accounted for,
maladaptive coping was no longer a significant
predictor (Model 1). Model 2 with insight as the only
predictor was the preferred model. In YA with ID,
insight explained 16% of the variance in anxiety with
every 1 point increases in insight predicting an average
0.52 point decrease in anxiety levels.
In regression model B (control group), anxiety,
insight, maladaptive coping, gender and education
were significant predictors of anxiety. Model 3, which
included insight and gender, had the most power and
explained 21% of the variance in anxiety. Every
1-point increase in insight predicted an average 0.36
point decrease in anxiety, and being woman predicted
an average increase of 3.40 in anxiety scores relative to
being man. Once insight and gender were accounted
for, maladaptive coping and education failed to
predict any further variation in anxiety.
In the regression model C for depression in YA
with ID, the only significant individual predictors
were maladaptive coping, insight, education and
employment. Model 1 with maladaptive coping only
had the most predictive power and accounted for
17% of the variance in depression. One point
increases in maladaptive coping scores predicted an
average depression ranked score increase of
2.83 units. Including additional predictors did not
significantly add to the variance already by explained
by this model.
Finally, the control group regression model D for
depression showed insight, maladaptive coping,
education and the difference between achievements
and expectations to be significant predictors when
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assessed individually. Employment was not
significant. Model 1, which included insight and
maladaptive coping, accounted for 39% of the
variance in depression. A 1-point increase in insight
predicted an average ranked score decrease of 2.47
depression units. Maladaptive coping predicted an
average ranked score increase of 2.21 depression
units. The remaining predictors were not significant
when added to this model.
Discussion
The present exploratory study assessed factors that
potentially contribute or protect YA living with ID
from developing anxiety and depression. As
hypothesised, the incidences of depression and
anxiety were greater than population estimates (~6%,
Andrews et al. 2001) but were far greater than
expected. Prevalence rates in previous studies were
based on meeting diagnostic criteria (APA 2000),
whereas in this study, prevalence was determined by
clinically relevant cut-offs on validated self-reported
measures. Whilst this methodological difference may
account for the variation, the items from the measures
(GDS-LD and GAS-ID) closely align to the
diagnostic criterion (Perez-Achiaga et al. 2009) and
have been found to effectively discriminate people
with diagnoses from those without (Cuthill et al.
2003). As expected, the prevalence rates of anxiety
and depression were greater in YA with ID than in
age-matched controls albeit not statistically
significant for depression. With a disproportionate
number of university students in the control sample,
depressive symptoms may have been higher than in
typical community samples as depression is more
common in university students (Ibrahim et al. 2013).
The convenience sampling method utilised in the
current study precluded a comparison with an
education-matched sample that would help to clarify
this. Nevertheless, one thing remains clear, a high
prevalence of distress exists among YA both with
and without ID during this important
developmental period.
In addition to more anxiety, YA with ID reported
more difficulties achieving traditional adulthood
milestones (e.g. living out home, being employed,
being partnered and completing higher education),
consistent with Floyd et al. (2009). Expanding on these
findings though, YA with ID also achieved fewer
 9

Table 4 Regression models

Co-efficient Model summary Model ANOVA

2 2
Unstandardised B Std. Error t P r r Adjusted r F P

John Wiley & Sons Ltd

Regression model A: anxiety in the ID group
Insight 0.52 0.16 3.33 <.01 0.42 0.17 0.16 11.06 <.01
Maladaptive coping 0.54 0.18 2.96 0.01 0.38 0.14 0.13 8.79 0.01
Gender 2.43 2.35 1.03 0.31 0.14 0.02 0.00 1.07 0.31
Highest level of education achieved 3.76 2.75 1.37 0.18 0.19 0.03 0.02 1.87 0.18
Journal of Intellectual Disability Research

Employment 1.83 1.87 0.98 0.33 0.13 0.02 0.00 0.96 0.33
Cognitive ability 0.13 0.16 0.82 0.41 0.11 0.01 -0.01 0.68 0.41
Hopelessness 0.50 0.39 1.28 0.21 0.17 0.03 0.01 1.64 0.21
Overall perceived need for more support 1.39 0.79 1.77 0.08 0.26 0.07 0.04 3.14 0.08
Model 1
Insight 0.40 0.17 2.38 0.02
Maladaptive coping 0.36 0.19 1.90 0.06 0.48 0.23 0.20 7.60 <.01
Model 2
Insight 0.52 0.16 3.33 <.01 0.42 0.17 0.16 11.06 <.01
Regression model B: anxiety in the control group
K. L. Austin et al. • Depression and anxiety in young adults with ID

Insight 0.40 0.96 4.13 <.01 0.42 0.18 0.17 17.03 <.01
Maladaptive coping 0.64 0.17 3.72 <.01 0.38 0.15 0.14 13.82 <.01
Gender 4.23 1.59 2.67 0.01 0.29 0.08 0.07 7.11 0.01
Highest level of education achieved 1.11 0.49 2.26 0.03 0.25 0.06 0.05 5.11 0.03
Employment 2.06 1.17 1.76 0.08 0.19 0.04 0.03 3.10 0.08
Cognitive ability <.01 0.06 0.02 0.99 <.01 <.01 -0.01 <.01 0.99
Hopelessness 0.69 0.37 1.87 0.07 0.21 0.04 0.03 3.51 0.07
Model 1
Insight 0.29 0.11 2.66 0.01
Maladaptive coping 0.39 0.19 2.05 0.04 0.47 0.22 0.20 10.96 <.01
Model 2
Insight 0.27 0.11 2.55 0.01
Maladaptive coping 0.34 0.19 1.85 0.07
Gender 3.10 1.47 2.12 0.04 0.51 0.26 0.23 9.13 <.01
Model 3
Insight 0.36 0.09 3.86 <.01
Gender 3.40 1.48 2.30 0.02 0.48 0.23 0.21 11.62 <.01

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
 10

Table 4. (Continued)

Co-efficient Model summary Model ANOVA

2 2
Unstandardised B Std. Error t P r r Adjusted r F P

John Wiley & Sons Ltd

Model 4
Insight 0.33 0.96 3.46 <.01
Gender 3.27 1.47 2.22 0.03
Education 0.62 0.46 1.35 0.18 0.50 0.25 0.22 8.44 <.01
Regression model C: depression in the ID group
Insight 2.01 0.75 2.70 0.01 0.35 0.12 0.10 7.26 0.01
Journal of Intellectual Disability Research

Maladaptive coping 2.83 0.82 3.45 <.01 0.43 0.18 0.17 11.89 <.01
Highest level of education achieved 26.42 12.33 2.14 0.04 0.28 0.08 0.06 4.59 0.04
Employment 17.00 8.37 2.03 <.05 0.27 0.07 0.06 4.13 <.05
Difference between expected and achieved 0.15 0.29 0.53 0.60 0.07 0.01 -0.01 0.28 0.60
milestones of adulthood
Perceived need for more support from family 15.15 8.76 1.73 0.09 0.25 0.06 0.04 2.99 0.09
Overall perceived need for more support 6.08 3.58 1.70 0.10 0.25 0.06 0.04 2.88 0.10
Model 1
Maladaptive coping 2.83 0.82 3.45 <.01 0.43 0.18 0.17 11.89 <.01
Model 2
Maladaptive coping 2.28 0.88 2.59 0.01
K. L. Austin et al. • Depression and anxiety in young adults with ID

Insight 1.22 0.77 1.58 0.12 0.47 0.22 0.19 7.36 <.01
Model 3
Maladaptive coping 2.65 0.81 3.28 <.01
Highest level of education achieved 22.00 11.41 1.93 0.06 0.49 0.24 0.21 8.11 <.01
Model 4
Maladaptive coping 2.69 0.81 3.33 <.01
Employment 14.54 7.71 1.89 0.07 0.49 0.24 0.21 8.01 <.01
Regression model D: depression in the control group
Insight 3.09 0.47 6.64 <.01 0.60 0.36 0.35 44.05 <.01
Maladaptive coping 4.34 0.89 4.86 <.01 0.48 0.23 0.22 23.62 <.01
Highest level of education achieved 6.98 2.67 2.62 0.01 0.28 0.08 0.07 6.84 0.01
Employment 7.06 6.51 1.08 0.28 0.12 0.01 0.00 1.18 0.28
Difference between expected and achieved 0.86 0.37 2.32 0.02 0.25 0.06 0.05 5.36 0.02
milestones of adulthood
Model 1
Insight 2.47 0.52 4.76 <.01
Maladaptive coping 2.21 0.91 2.43 0.02 0.63 0.40 0.39 26.34 <.01

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
 Journal of Intellectual Disability Research
11
K. L. Austin et al. • Depression and anxiety in young adults with ID

adulthood milestones than they expected relative to

<.01

<.01
Model ANOVA

P
the controls. The known link between failures to
achieve expected adulthood milestones and increased
depressive symptoms makes this especially

18.99

18.88
F concerning.
Self-reflection was also found to differ between the
groups but, consistent with Harrington and Loffredo
(2011), anxiety and depression symptoms were not
2
Adjusted r

correlated with self-reflection. In contrast, current

0.40

0.40
employment status was associated with both anxiety
Model summary

and depression. More specifically, those working full-

time had fewer anxiety and depressive symptoms than
those unemployed and fewer depressive symptoms
0.42

0.42
2

than people working casually or part-time supporting

r

Graetz’s (1993) findings. As previously proposed, the

cultural shift towards delaying milestones like
0.65

0.65
r

full-time employment may contribute to reduced

well-being (Schulenberg et al. 2004), possibly because
full-time employment could financially aid the
0.01
0.09

0.02
0.10
<.01

<.01
P

achievement of other adulthood milestones

(e.g. independent living, buying a home or getting
married). Job satisfaction is unlikely to explain these
2.42
4.29
2.52
1.72

4.53

1.67

differences (Omar et al. 2011). Education levels also

t

predicted differences in mental health. YA with less

education were more prone to anxiety. YA with trade
Co-efficient

Std. Error

qualifications had more anxiety symptoms than YA

0.90
0.53
0.90
2.21

0.52

0.30

with some university education. It is not clear though

if anxiety deters YA from higher education or is an
effect of not accessing it.
The mental health risk factors in YA with and
Unstandardised B

without ID were relatively similar. Insight was the

2.27

2.18
2.26

3.80

2.35

0.50

strongest predictor of anxiety for both groups. This

negated the influence of education, employment and
maladaptive coping and, thus, strengthens previous
links between insight and well-being in YA
(Harrington & Loffredo 2011). The negative
correlation suggests that an inability to evaluate
Difference between expected and achieved

personal internal states (insight) predicts an increased

risk of anxiety symptoms. As such, it is not surprising
Highest level of education achieved

that treatments like cognitive behaviour therapy

(which facilitate insight through thought monitoring,
behavioural activation and cognitive restructuring
techniques; Beck 2011) have been found to be
milestones of adulthood
Maladaptive coping

ID, intellectual disability

Table 4. (Continued)

effective. With insight being pivotal to treatment, it is

not surprising that these treatments may be less
Maladaptive

effective for people with ID than those without

(Taylor et al. 2008) given the reduced insight of YA
Insight

Insight
Model 2

Model 3

with ID compared with peers. People with ID may

need more assistance to develop insight. The

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd
 Journal of Intellectual Disability Research
12
K. L. Austin et al. • Depression and anxiety in young adults with ID
identified link between anxiety and being woman in
controls was consistent with population studies
[Australian Bureau of Statistics (ABS) 2008] but not
in the ID group (Tsakanikos et al. 2006), suggesting
an absence of a typical gender bias in YA with ID.
However, sampling biases including the smaller ID
group size and the recruitment of primarily female
participants (65%) in the control group (due to a
psychology undergraduate sample, where women are
in majority) may have contributed to a lack of power
to discern such differences in the ID group. Gender
matched samples comparing anxiety in YA with and
without ID in the future would help to determine this.
For depression, another predictive factor was found
for both groups: Maladaptive coping. In the control
group, however, insight also helped to predict
depressive symptoms. Interestingly though, excluding
maladaptive coping, insight was the strongest
predictor of depressive symptoms in the ID. This
reiterates the interconnectedness between
maladaptive coping and insight, especially in people
with ID. As such, treatment models that
simultaneously address both insight and maladaptive
coping (e.g. avoidance of thoughts and feelings and
rumination) may predict fewer depressive symptoms.
The co-morbidity of mental health disorders, fewer
symptoms of depression and anxiety may also predict
fewer symptoms of other mental health disorders and,
thus, further improve overall well-being for YA in
their transition to adulthood.
Another finding that deserves attention was the link
between the perceived need for more support overall
with increases of both anxiety and depressive
symptoms. Additionally, the expressed need for more
family support was also correlated with depressive
symptoms, consistent with LaBarbera (2008). As
such, fostering relationships between YA with ID and
their families (whether this be through caregiver
support or more family-based interactions) is
important for well-being. Formal providers (e.g. day
programmes) and friends may also be able to assist by
fulfilling the person’s overall support needs. Targeting
perceived support needs should be a complementary
rather than a solitary treatment though. Increased
insight and reduced maladaptive coping are better
predictors of depressive and anxiety symptoms and
therefore should be the primary target areas.
Unfortunately, a limitation exists within these
findings; causal pathways between the variables
© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd
cannot be assumed. Whilst relationships exist, due to
the design of the study, the direction and origins for
these cannot be determined. Insight and maladaptive
coping may precede or be bi-products of the disorders
or a third unknown factor may mediate these
relationships. However, the findings of the study do
indicate that both insight and maladaptive coping are
linked with depression and anxiety in this population
and that it is important to consider targeting both
insight and coping in clinical interventions.
Longitudinal studies that follow YA through the
transition to adulthood are necessary though as such
designs would be better placed to identify the
temporal relationships between risk and protective
variables and help to prevent the onset of these mental
health symptoms. It also needs to be acknowledged
that the current study was exploratory in nature.
Therefore, subsequent research should include a
larger sample, preferably gender and education
matched, to ensure that the sample is representative
of the wider population of YA with ID.
In conclusion, this study synthesised and expanded
the literature by identifying insight and maladaptive
coping as the strongest predictors of anxiety and
depressive symptoms in YA with ID. Similar
predictor variables were also found in age-matched
controls. As hypothesised, YA with ID were less likely
to achieve traditional adulthood milestones such as
moving out of the family home, being employed or
being partnered or married. They also had less insight
and more anxiety than their age-matched
counterparts with reduced insight possibly explaining
the between-group prevalence differences in anxiety.
Thus, with further research that confirms these
relationships, treatment programmes that target
insight and maladaptive coping may reduce the high
prevalence of anxiety and depressive symptoms in
these populations. These types of research informed
and targeted psychotherapeutic treatments are likely
to not only be more efficacious improving the
responsiveness of YA with ID to treatment but may
also reduce caregiver burden and improve the
transition to adulthood for young people.
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Accepted 18 January 2018

© 2018 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and
John Wiley & Sons Ltd