Global burden of mental disorders in 204 countries and territories, 1990 - 2021: results from the global burden of disease study 2021

Background Mental disorders, one of the leading causes of the global health-related burden, which has been exacerbated by the emergence of the COVID-19 pandemic. In this study, we aim to provide global, regional, and national estimates of the mental disorders burden from 1990 to 2021, including during the COVID-19 pandemic. Methods We collected data on the incidence, DALYs, ASIR, and ASR for 12 mental disorders at the global, regional, and national levels from 204 countries and regions across 21 geographical areas spanning from 1990 to 2021. We utilized joinpoint regression analysis to estimate the Average Annual Percentage Change (AAPC). We also determined the trends in ASIR and ASR of mental disorders during the COVID-19 pandemic (2019-2021). Results Globally, between 1990 and 2021, there was an upward trend in both ASIR [15.23% (12.97% to 17.60%)] and ASR [17.28% (15.06% to 19.44%)]. Regionally, there were increases in both incidences and DALYs in all 21 GBD regions. In 2021, the highest ASIR was observed in Central Sub-Saharan Africa (8706.11), while the lowest was in East Asia (3340.99). Australia (2787.87) had the highest ASR. Nationally, Greenland, Greece, the United States, and Australia had the highest ASRs. During the COVID-19 pandemic, ASIR and ASR showed an upward trend in five SDI and 21 GBD regions, except for East Asia, where they remained stable. In 2021, the ASR for females was higher than that for males. Among the 12 subtypes, major depressive disorder (557.87) and anxiety disorders (524.33) had the highest ASR in 2021. Major depressive disorder ranked first in ASR in 13 of the 21 regions worldwide. Despite the overall upward trend in DALYs for mental disorders [AAPC: 5.96; 95%CI: (4.99, 6.92)], the ASR exhibited varying trends among different subtypes, with anxiety disorders experiencing the most significant increase. Conclusions GBD 2021 showed that the burden of mental disorders was still on the rise gradually worldwide and significantly exacerbated by the emergence of the COVID-19 pandemic. High-middle SDI regions and females should be paid more attention. To reduce the future burden, providing comprehensive mental health support, establishing effective mental health knowledge dissemination and tailored interventions are in great need.