The Burden of adolescent depression and the impact of COVID-19 across 204 countries and regions from 1990 to 2021: results from the 2021 global burden of disease study

Abstract

This study aims to analyze the trends in the burden of depression among adolescents aged 10 to 24 years globally from 1990 to 2021, with a focus on the impact of COVID-19 on adolescent depression and health inequalities. Using data from the 2021 Global Burden of Disease Study, we examined age-standardized prevalence, incidence, and disability-adjusted life years (DALYs) for depression among adolescents aged 10-24 years. Estimated annual percentage change (EAPC) was used to assess temporal trends. Age-period-cohort (APC) analysis estimated age, period, and cohort effects. Bayesian APC (BAPC) analysis projected future trends. Decomposition analysis further explored drivers of changes in depression burden. Slope Index of Inequality (SII) and Concentration Index (CI) were calculated to assess health inequalities across regions and countries. From 1990 to 2021, the global incidence, prevalence and DALY rates of adolescent depression remained stable. Depression incidence and prevalence increased with age, with the 20-24 age group showing the highest rates. The burden of depression was higher in females than in males. The COVID-19 pandemic significantly impacted adolescent depression, with reported prevalence, incidence, and DALY rates in 2020 and 2021 far exceeding predicted values, and the burden of depression is expected to continue rising. Health inequalities between adolescents in high- and low-income regions have widened, particularly following the pandemic. The COVID-19 pandemic significantly exacerbated the burden of depression and intensified health inequalities.

Keywords: Adolescents; Depression; Epidemiology; Global burden of Disease Study; Mental Health.

Fig. 1

Burden of depression trends in global and five SDI regions for adolescents aged 10–24 years, from 1990 to 2019.

Fig. 2

Maps showing (a) age-standardised incidence rate, (b) age-standardised prevalence rate and (c) age-standardised disability-adjusted life-years rate of depression among adolescents aged 10–24 years, in 204 countries and territories, between 1990 and 2021 (Image generated in R software version 4.3.1(https://www.r-project.org/)).

Fig. 3

Change in rates of depression among adolescents aged 10–24 years for both genders, in 204 countries and territories. (a). Change in incidence rates (b) Change in prevalence rates. (c) Change in disability-adjusted life-years rates(Image generated in R software version 4.3.1(https://www.r-project.org/)).

Fig. 4

Absolute (a) and relative (b) income-related health inequalities in adolescent depression for 1990, 2019, and 2021. Absolute Health Inequalities (a) is represented by the regression line, which illustrates disparities in adolescent depression burden based on income levels. Relative Health Inequalities (b) is depicted using the concentration curve (Lorenz curve) and the concentration index (CI). These metrics assess the distribution of adolescent depression cases relative to income levels across countries or regions. Points represent countries or regions, with different sizes indicating population scale (yellow for 1990, blue for 2019/2021).