Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019

Abstract

Aims: Anxiety disorders are widespread across the world. A systematic understanding of the disease burden, temporal trend and risk factors of anxiety disorders provides the essential foundation for targeted public policies on mental health at the national, regional, and global levels.

Methods: The estimation of anxiety disorders in the Global Burden of Disease Study 2019 using systematic review was conducted to describe incidence, prevalence and disability-adjusted life years (DALYs) in 204 countries and regions from 1990 to 2019. We calculated the estimated annual percentage change (EAPC) to quantify the temporal trends in anxiety disorders burden by sex, region and age over the past 30 years and analysed the impact of epidemiological and demographic changes on anxiety disorders.

Results: Globally, 45.82 [95% uncertainty interval (UI): 37.14, 55.62] million incident cases of anxiety disorders, 301.39 million (95% UI: 252.63, 356.00) prevalent cases and 28.68 (95% UI: 19.86, 39.32) million DALYs were estimated in 2019. Although the overall age-standardised burden rate of anxiety disorders remained stable over the past three decades, the latest absolute number of anxiety disorders increased by 50% from 1990. We observed huge disparities in both age-standardised burden rate and changing trend of anxiety disorders in sex, country and age. In 2019, 7.07% of the global DALYs due to anxiety disorders were attributable to bullying victimisation, mainly among the population aged 5-39 years, and the proportion increased in almost all countries and territories compared with 1990.

Conclusion: Anxiety disorder is still the most common mental illness in the world and has a striking impact on the global burden of disease. Controlling potential risk factors, such as bullying, establishing effective mental health knowledge dissemination and diversifying intervention strategies adapted to specific characteristics will reduce the burden of anxiety disorders.

Keywords: Anxiety disorders; bullying victimisation; global burden; systematic analysis.

Fig. 1.

The global disease burden of anxiety disorders in 204 countries and territories: (a) the ASIR in 2019, (b) the ASPR in 2019 and (c) the EAPC in ASIR of anxiety disorders from 1990 to 2019. ASIR, age-standardised incidence rate; ASPR, age-standardised prevalence rate and EAPC, estimated annual percentage change.

Fig. 2.

The annual burden of anxiety disorders by different age groups, two sexes and SDI regions, from 1990 to 2019: (a) incidence rate and (b) prevalence rate. SDI, socio-demographic index.

Fig. 3.

The change of the burden of anxiety disorders by different age groups, sexes and SDI regions, from 1990 to 2019: (a) EAPC in incidence rate by sexes, (b) EAPC in incidence rate by SDI regions, (c) EAPC in prevalence rate by sexes and (d) EAPC in prevalence rate by SDI regions. EAPC, estimated annual percentage change and SDI, socio-demographic index.

Fig. 4.

The factors affected the EAPCs in age-standardised burden rate of anxiety disorders from 1990 to 2019, both sexes, at the national level: (a) ASIR in 1990 and EAPC in ASIR, (b) SDI in 2019 and EAPC in ASIR, (c) SDI in 2019 and EAPC in ASPR and (d) SDI in 2019 and EAPC in age-standardised DALYs rate. The circles represent countries and the size of the circle is increased with the number of burdens. The ρ indices and p values presented were derived from Spearman rank analysis. ASPR, age-standardised prevalence rate; EAPC, estimated annual percentage change; SDI, socio-demographic index; DALYs, disability-adjusted life years and ASIR, age-standardised incidence rate.

Fig. 5.

The DALYs of anxiety disorders attributable to bullying victimisation: (a) the annual DALYs rate of anxiety disorders by different age groups, two sexes and SDI regions, from 1990 to 2019, (b) the association between age-standardised DALYs rates of anxiety disorders attributable to bullying victimisation in 2019 and SDI in 2019, (c) the proportion of DALYs of anxiety disorders attributable to bullying victimisation between 1990 and 2019. DALYs, disability-adjusted life years and SDI, socio-demographic index.