Global, regional and national burdens of major depression disorders and its attributable risk factors in adolescents and young adults aged 10-24 years from 1990 to 2021

Abstract

Background: Major depressive disorder (MDD) is an important public health problem among adolescents and young adults, and its increasing prevalence underscores the need for region-specific and age-specific interventions. Despite its increasing burden, comprehensive data on regional and longitudinal trends in MDD among adolescents are scarce. This study analyzed global, regional, and national trends in MDD incidence, prevalence, and disability-adjusted life years (DALYs) among individuals aged 10-24 from 1990 to 2021, while examining differences by gender, age, socio-demographic factors, and emerging risk factors to guide targeted mental health strategies.

Methods: With data from the 2021 Global Burden of Disease Study, we conducted an analysis of age-standardized incidence, prevalence, and DALYs due to MDD by sex, age group, and 21 geographic regions with a special focus on sociodemographic index (SDI) levels, which measures development on a scale from low to high. Key risk factors, such as bullying and intimate partner violence, were also assessed in order to understand their contribution to the burden of MDD.

Results: Between 1990 and 2021, the global burden of MDD increased substantially. Prevalence rose by 56.36% globally, particularly among men and young adults aged 20-24 years, with the largest increases observed in Eastern Sub-Saharan Africa (184.26% increase). Incidence grew by 56.11%, with Eastern Sub-Saharan Africa experiencing the steepest rise compared to slower increases in other regions. DALYs also increased by 56.32%, with the greatest burden observed in Eastern Sub-Saharan Africa. Bullying and intimate partner violence were leading contributors to DALYs across all regions. Bullying and childhood sexual abuse increased MDD-related DALYs, with bullying peaking at ages 10-14, while childhood sexual abuse had a higher impact on females, rising sharply after 2006. Post- 2020, all metrics (prevalence, incidence, and DALYs) rose sharply, particularly in high-SDI regions, likely due to the specific impacts of the COVID- 19 pandemic, such as prolonged lockdowns, increased social isolation, and disruptions to mental health services.

Conclusions: This study highlights the need for culturally sensitive mental health policies focusing on prevention and early intervention, while also providing insights to improve resource allocation and support further research on adolescent mental health.

Trial registration: Not applicable.

Keywords: Adolescents; Incidence; Major depressive disorders; Risk factors; Young adults.

Fig. 1

Burden of MDD trends in global and five SDI regions for adolescents aged 10–24 years, from 1990 to 2021. SDI, Sociodemographic Index; ASIR, age-standardized incidence rate; ASPR, age-standardized prevalence rate; DALYs, disability-adjusted life-years

Fig. 2

Global age-standardized rates (per 100,000 population) of MDD among adolescents aged 10–24 years: incidence (A), prevalence (C), and DALYs (E) for both sexes in 1990; and incidence (B), prevalence (D), and DALYs (F) for both sexes in 2021

Fig. 3

The APC analysis of MDD among adolescents and young adults from 1990–2021 examines incidence, prevalence, and disability-adjusted life-years (DALYs) through four components: A age effects, showing longitudinal age-specific rates across birth cohorts adjusted for period effects; B period effects, presenting relative risks across time periods (1992–1996 as the reference period); C cohort effects, illustrating relative risks by birth cohorts (1977–1986 as the reference cohort); and (D) local drift, indicating annual percentage changes in age-specific rates with 95% confidence intervals. Across all measures, the panels highlight trends in MDD metrics, including differences by sex and age, showing notable increases in incidence, prevalence, and DALYs over time, with significant variations across age groups, periods, and cohorts

Fig. 4

Projected age-standardized rates of MDD in adolescents in global from 1990 to 2045. Panels A, D, and G show projections of incidence for both sexes, males, and females, respectively. Panels B, E, and H depict projections of prevalence for both sexes, males, and females, respectively. Panels C, F, and I illustrate projections of DALYs for both sexes, males, and females, respectively