Disease burden of mood disorders in china from 1990 to 2021: analysis and future trends_Chinese Journal of Evidence-Based Medicine

Authors：

ZHOU Yuanzhi , MA Jiaxin , CHEN Wenwen , YAO Keying , YUAN Ziquan , ZHANG Xu , LI Yarui ,  HE Shuixiang

Department of Gastroenterology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, P. R. China;

Corresponding author：

HE Shuixiang, Email: dyyyjxk@mail.xjtu.edu.cn

Keywords：

Mood disorder; Dysthymia; Major depressive disorder; Bipolar disorder; Disease burden; Prevalence rate; Disability-adjusted life years; Prediction analysis

DOI：

10.7507/1672-2531.202506073

Video：

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Objective This study intends to analyze the changing disease burden of mood disorders in China from 1990 to 2021 and project the epidemiological trends in the next two decades. Methods This study uses data from the Global Burden of Disease (GBD) 2021 database on three mood disorders in China (bipolar disorder, major depressive disorder, and dysthymia) from 1990 to 2021. The indicators such as age-standardized number of diseases and disability-adjusted life years (DALYs) were used to explore the characteristics of time, gender, and age distribution of the disease burden of mental disorders. The BAPC model was used to predict the disease burden in the next two decades. Results In 2021, the number of cases of dysthymia, MDD, and BD in China was 27.84 million, 26.0 million, and 2.85 million, with an increase of 73.24%, 38.33%, and 36.79% compared with 1990, respectively. In 2021, DALYs of dysthymic disorder, MDD and BD were 2.67 million, 5.2 million and 0.61 million person-years, which increased by 71.45%, 34.29% and 34.76% compared with 1990, respectively. The burden of mood disorders is heavier among women and the middle-aged and elderly population. In addition, it is expected that ASPR and ASDR of dysthymia will continue to increase after a brief decline, MDD will show a downward trend, while BD will show a slight upward trend in the next two decades. Conclusion The disease burden of mood disorders in China remains substantial, with dysthymia and BD showing persistent upward tendency. More resources should be invested in mental health care.

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2.	Vandeleur CL, Fassassi S, Castelao E, et al. Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Res, 2017, 250: 50-58.
3.	Blanco C, Compton WM, Saha TD, et al. Epidemiology of DSM-5 bipolar I disorder: results from the national epidemiologic survey on alcohol and related conditions - III. J Psychiatr Res, 2017, 84: 310-317.
4.	Monroe SM, Harkness KL. Major depression and its recurrences: life course matters. Annu Rev Clin Psychol, 2022, 18: 329-357.
5.	Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
6.	Paul B, Usha VK. Prevalence and Predictors of Depression Among Adolescents. Indian J Pediatr, 2021, 88(5): 441-444.
7.	Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry, 2007, 20(4): 359-364.
8.	Wicke FS, Ernst M, Otten D, et al. The association of depression and all-cause mortality: explanatory factors and the influence of gender. J Affect Disord, 2022, 303: 315-322.
9.	Yeung A, Chang D. Mood disorders in Asians. Asian J Psychiatr, 2014, 7(1): 71-73.
10.	Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2021, 8(11): 981-990.
11.	GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Psychiatry, 2022, 9(2): 137-150.
12.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
13.	姚立群, 柯昌荣, 亓建羽, 等. 1990—2019年我国与世界不同社会人口学指数地区归因于饮酒导致的疾病负担比较分析. 中国卫生经济, 2022, 41(5): 64-67.
14.	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
15.	Bai Z, Han J, An J, et al. The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040. EClinicalMedicine, 2024, 77: 102873.
16.	Wang Q, Tian W. Prevalence, awareness, and treatment of depressive symptoms among the middle-aged and elderly in China from 2008 to 2015. Int J Health Plann Manage, 2018, 33(4): 1060-1070.
17.	Xiao Y, Wu XH, Liu L. From bench to bedside: challenges in implementing precision psychiatry. Gen Hosp Psychiatry, 2023, 85: 251-252.
18.	Zimmerman M, Martinez JA, Attiullah N, et al. Why do some depressed outpatients who are in remission according to the Hamilton depression rating scale not consider themselves to be in remission. J Clin Psychiatry, 2012, 73(6): 790-795.
19.	Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun, 2020, 89: 594-600.
20.	Tian W, Yan G, Xiong S, et al. Burden of depressive and anxiety disorders in China and its provinces, 1990-2021: findings from the global burden of disease study 2021. Br J Psychiatry, 2025, 22: 1-11.
21.	Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2019, 6(3): 211-224.
22.	Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull, 2017, 143(8): 783-822.
23.	Bogren M, Brådvik L, Holmstrand C, et al. Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population. Eur Arch Psychiatry Clin Neurosci, 2018, 268(2): 179-189.
24.	Blanco C, Vesga-López O, Stewart JW, et al. Epidemiology of major depression with atypical features: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry, 2012, 73(2): 224-232.
25.	Kuehner C. Why is depression more common among women than among men. Lancet Psychiatry, 2017, 4(2): 146-158.
26.	Eid RS, Gobinath AR, Galea LAM. Sex differences in depression: Insights from clinical and preclinical studies. Prog Neurobiol, 2019, 176: 86-102.
27.	Blier P, Ward NM. Is there a role for 5-HT1A agonists in the treatment of depression. Biol Psychiatry, 2003, 53(3): 193-203.
28.	Ma L, Xu Y, Wang G, et al. What do we know about sex differences in depression: a review of animal models and potential mechanisms. Prog Neuropsychopharmacol Biol Psychiatry, 2019, 89: 48-56.
29.	Dagher RK, Bruckheim HE, Colpe LJ, et al. Perinatal depression: challenges and opportunities. J Womens Health (Larchmt), 2021, 30(2): 154-159.
30.	Nguyen TT, Darnell A, Weissman A, et al. Social, economic, and political events affect gender equity in China, Nepal, and Nicaragua: a matched, interrupted time-series study. Glob Health Action, 2020, 13(1): 1712147.
31.	Christiansen DM. Examining sex and gender differences in anxiety disorders [Internet]. A fresh look at anxiety disorders. InTech: 2015.
32.	Bedaso A, Adams J, Peng W, et al. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health, 2021, 18(1): 162.
33.	Gomez-Bernal F, Madva EN, Puckett J, et al. Relationships between life stressors, health behaviors, and chronic medical conditions in mid-life adults: a narrative review. Psychosomatics, 2019, 60(2): 153-163.
34.	Abe Y, Fujise N, Fukunaga R, et al. Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan. Int Psychogeriatr, 2012, 24(8): 1235-1241.
35.	Commission NH. Communiqué on the development of the national cause for ageing in 2021. 2022.
36.	Mayor S. Bipolar disorder: most patients receive suboptimal treatment, finds Scottish study. BMJ, 2019, 364: l957.
37.	Schramm E, Klein DN, Elsaesser M, et al. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry, 2020, 7(9): 801-812.

1. Li M, Gao W, Zhang Y, et al. Secular trends in the incidence of major depressive disorder and dysthymia in China from 1990 to 2019. BMC Public Health, 2023, 23(1): 2162.
2. Vandeleur CL, Fassassi S, Castelao E, et al. Prevalence and correlates of DSM-5 major depressive and related disorders in the community. Psychiatry Res, 2017, 250: 50-58.
3. Blanco C, Compton WM, Saha TD, et al. Epidemiology of DSM-5 bipolar I disorder: results from the national epidemiologic survey on alcohol and related conditions - III. J Psychiatr Res, 2017, 84: 310-317.
4. Monroe SM, Harkness KL. Major depression and its recurrences: life course matters. Annu Rev Clin Psychol, 2022, 18: 329-357.
5. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 2006, 3(11): e442.
6. Paul B, Usha VK. Prevalence and Predictors of Depression Among Adolescents. Indian J Pediatr, 2021, 88(5): 441-444.
7. Kessler RC, Amminger GP, Aguilar-Gaxiola S, et al. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry, 2007, 20(4): 359-364.
8. Wicke FS, Ernst M, Otten D, et al. The association of depression and all-cause mortality: explanatory factors and the influence of gender. J Affect Disord, 2022, 303: 315-322.
9. Yeung A, Chang D. Mood disorders in Asians. Asian J Psychiatr, 2014, 7(1): 71-73.
10. Lu J, Xu X, Huang Y, et al. Prevalence of depressive disorders and treatment in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2021, 8(11): 981-990.
11. GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the global burden of disease study 2019. Lancet Psychiatry, 2022, 9(2): 137-150.
12. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet, 2024, 403(10440): 2133-2161.
13. 姚立群, 柯昌荣, 亓建羽, 等. 1990—2019年我国与世界不同社会人口学指数地区归因于饮酒导致的疾病负担比较分析. 中国卫生经济, 2022, 41(5): 64-67.
14. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
15. Bai Z, Han J, An J, et al. The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040. EClinicalMedicine, 2024, 77: 102873.
16. Wang Q, Tian W. Prevalence, awareness, and treatment of depressive symptoms among the middle-aged and elderly in China from 2008 to 2015. Int J Health Plann Manage, 2018, 33(4): 1060-1070.
17. Xiao Y, Wu XH, Liu L. From bench to bedside: challenges in implementing precision psychiatry. Gen Hosp Psychiatry, 2023, 85: 251-252.
18. Zimmerman M, Martinez JA, Attiullah N, et al. Why do some depressed outpatients who are in remission according to the Hamilton depression rating scale not consider themselves to be in remission. J Clin Psychiatry, 2012, 73(6): 790-795.
19. Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain Behav Immun, 2020, 89: 594-600.
20. Tian W, Yan G, Xiong S, et al. Burden of depressive and anxiety disorders in China and its provinces, 1990-2021: findings from the global burden of disease study 2021. Br J Psychiatry, 2025, 22: 1-11.
21. Huang Y, Wang Y, Wang H, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry, 2019, 6(3): 211-224.
22. Salk RH, Hyde JS, Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull, 2017, 143(8): 783-822.
23. Bogren M, Brådvik L, Holmstrand C, et al. Gender differences in subtypes of depression by first incidence and age of onset: a follow-up of the Lundby population. Eur Arch Psychiatry Clin Neurosci, 2018, 268(2): 179-189.
24. Blanco C, Vesga-López O, Stewart JW, et al. Epidemiology of major depression with atypical features: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). J Clin Psychiatry, 2012, 73(2): 224-232.
25. Kuehner C. Why is depression more common among women than among men. Lancet Psychiatry, 2017, 4(2): 146-158.
26. Eid RS, Gobinath AR, Galea LAM. Sex differences in depression: Insights from clinical and preclinical studies. Prog Neurobiol, 2019, 176: 86-102.
27. Blier P, Ward NM. Is there a role for 5-HT1A agonists in the treatment of depression. Biol Psychiatry, 2003, 53(3): 193-203.
28. Ma L, Xu Y, Wang G, et al. What do we know about sex differences in depression: a review of animal models and potential mechanisms. Prog Neuropsychopharmacol Biol Psychiatry, 2019, 89: 48-56.
29. Dagher RK, Bruckheim HE, Colpe LJ, et al. Perinatal depression: challenges and opportunities. J Womens Health (Larchmt), 2021, 30(2): 154-159.
30. Nguyen TT, Darnell A, Weissman A, et al. Social, economic, and political events affect gender equity in China, Nepal, and Nicaragua: a matched, interrupted time-series study. Glob Health Action, 2020, 13(1): 1712147.
31. Christiansen DM. Examining sex and gender differences in anxiety disorders [Internet]. A fresh look at anxiety disorders. InTech: 2015.
32. Bedaso A, Adams J, Peng W, et al. The relationship between social support and mental health problems during pregnancy: a systematic review and meta-analysis. Reprod Health, 2021, 18(1): 162.
33. Gomez-Bernal F, Madva EN, Puckett J, et al. Relationships between life stressors, health behaviors, and chronic medical conditions in mid-life adults: a narrative review. Psychosomatics, 2019, 60(2): 153-163.
34. Abe Y, Fujise N, Fukunaga R, et al. Comparisons of the prevalence of and risk factors for elderly depression between urban and rural populations in Japan. Int Psychogeriatr, 2012, 24(8): 1235-1241.
35. Commission NH. Communiqué on the development of the national cause for ageing in 2021. 2022.
36. Mayor S. Bipolar disorder: most patients receive suboptimal treatment, finds Scottish study. BMJ, 2019, 364: l957.
37. Schramm E, Klein DN, Elsaesser M, et al. Review of dysthymia and persistent depressive disorder: history, correlates, and clinical implications. Lancet Psychiatry, 2020, 7(9): 801-812.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesDisease burden of mood disorders in china from 1990 to 2021: analysis and future trends

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