Global and regional burden of major depressive disorder and associated risk factors: analysis from the Global Burden of disease study, 1990-2021

Eur Arch Psychiatry Clin Neurosci. 2026 May 19. doi: 10.1007/s00406-026-02265-3. Online ahead of print.

ABSTRACT

INTRODUCTION: Major depressive disorder (MDD) is a leading cause of disability worldwide, placing a heavy burden on individuals and healthcare systems. Understanding global and regional epidemiological patterns is essential for designing effective interventions. This study aims to evaluate the burden of MDD and its major risk factors globally and in China, offering evidence for targeted mental health strategies.

METHODS: We extracted data on MDD prevalence, incidence, and disability-adjusted life years (DALYs), and selected attributable risk factors between 1990 and 2021 from the Global Burden of Disease (GBD) database. Temporal trends were assessed through estimated annual percentage change (EAPC) with 95% confidence intervals (CIs). To evaluate the association between socio-demographic development and MDD burden, natural cubic spline regression was fitted, with Spearman rank correlation applied as a sensitivity analysis.

RESULTS: In 2021, the global MDD incidence rate reached 4,322.65 per 100,000 population, with the highest rate in High-income North America; China’s rate (2,717.26 per 100,000) remained below the global average. Between 1990 and 2021, global age-standardized incidence and DALY rates rose slightly (EAPC 0.35% and 0.34%), more slowly in China (0.31% and 0.22%), while absolute case counts increased, strongly influenced by population growth and aging. The SDI-MDD burden association was weak and non-linear. Natural cubic spline analyses indicated non-linear relationships between SDI and age-standardized prevalence, incidence, and DALY rates, while Spearman rank analyses yielded weak positive ecological correlations (all P < 0.001). East Asia and Eastern Europe remained above the fitted SDI-burden trend, whereas Sub-Saharan Africa remained below it. Within the GBD comparative risk assessment framework, childhood maltreatment and intimate partner violence accounted for a substantial proportion of attributable MDD DALY burden, particularly among women.

CONCLUSION: The global MDD burden has remained substantial and has risen gradually, with marked age, gender, and regional disparities. The SDI-burden association appears weak and non-linear, suggesting that socioeconomic development alone does not adequately explain this cross-national variation.These findings highlight the urgent need for region-specific, evidence-based mental health policies focused on prevention and support for vulnerable populations.

PMID:42154271 | DOI:10.1007/s00406-026-02265-3