Comparative Trends in the Burden of Depressive Disorders in China and Globally, 1990-2021: Evidence From the Global Burden of Disease 2021.

Abstract

Background: Depressive disorders are among the leading causes of global disability, with steadily increasing incidence and prevalence posing serious challenges to public health systems. As one of the most populous countries worldwide, China's disease burden trajectory holds significant implications for global mental health trends. However, few studies have systematically compared China's long-term trends with global patterns. This study aimed to evaluate the disease burden of depressive disorders in China from 1990 to 2021 using Global Burden of Disease Study 2021 (GBD 2021) data and to systematically compare these trends with global trajectories, with additional analysis across age and sex subgroups.

Methods: We extracted data on the number of incident cases, prevalent cases, and disability-adjusted life years (DALYs) for depressive disorders, along with their corresponding age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized DALY rate (ASDR) from the GBD 2021 database. Joinpoint regression was used to estimate the estimated annual percentage change (EAPC) and the average annual percentage change (AAPC). The statistical significance of temporal trends was assessed based on 95% confidence intervals and two-sided p values (<0.05), with stratified analyses by age group and sex.

Results: From 1990 to 2021, the number of depressive disorder cases in China showed an overall increasing trend, whereas ASIR, ASPR, and ASDR exhibited a gradual overall decline; in contrast, these age-standardized indicators showed a slight overall increase at the global level. Age-stratified analyses showed that ASIR, ASPR, and ASDR increased rapidly among individuals aged 10-24 years in both China and globally. From age 25 onward, the global burden of depressive disorders was mainly concentrated in the 25-49-year age group and declined with increasing age; in China, however, the disease burden remained at relatively high levels among middle-aged and older adults, with ASPR and ASDR peaking in the 40-69-year age group and then declining gradually. Sex-stratified analyses showed that, in both China and globally, females had higher overall disease burden levels than males in terms of incident cases, prevalent cases, DALYs, and corresponding age-standardized indicators.

Conclusions: Despite China's declining standardized burden, depressive disorders remain a major public health concern. The observed differences in age distribution and sex-specific burden, as well as divergent trends between China and global levels, underscore the need for targeted mental health interventions focused on adolescents, older adults, and women. These findings contribute to the evidence base for formulating population-specific mental health policies through a global comparative lens.