Global burden of mental disorders in 204 countries and territories results from the Global Burden of Disease Study 2021

Abstract

Background: Mental disorders have become a major contributor to the Global Burden of Disease (GBD), a situation that has worsened with the onset of the coronavirus disease 2019 (COVID-19) pandemic. Updated data on their impact and a clear understanding of long-term trends are essential for global and national health authorities to implement effective prevention and intervention strategies for mental well-being.

Aim: To generate insights that will enhance global awareness of the burden of mental disorders and support the development of targeted, region-specific prevention and intervention strategies tailored to current global and local health challenges.

Methods: We extracted data on incidence, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASDR) for 12 categories of mental disorders from 1990 to 2021 across 204 countries and territories grouped into 21 regions. Trends in ASIR and ASDR were also analyzed during the COVID-19 period (2019-2021).

Results: From 1990 to 2021, global ASIR rose by 15.23% (12.97% to 17.60%), while ASDR increased by 73.52% (70.24% to 76.71%). All 21 GBD regions saw a rise in cases and DALYs. In 2021, Central sub-Saharan Africa had the highest ASIR (8706.11), and East Asia reported the lowest (3340.99). Australasia recorded the highest ASDR (2787.87). On the national level, Greenland, Greece, United States, and Australia had the greatest ASDR values. During the pandemic years, ASIR and ASDR rose across all five socio-demographic index levels and GBD regions, with the exception of East Asia, where rates remained stable. Females experienced a higher ASDR than males in 2021. Major depressive disorder (557.87) and anxiety disorders (524.33) were the most burdensome among the 12 types, with depressive disorders ranking first in 13 out of the 21 regions.

Conclusion: The GBD study 2021 results highlight a continued and worsening global burden of mental disorders, further intensified by the COVID-19 crisis. This underscores the urgent need to reinforce mental health care systems. Special attention should be directed toward high-middle socio-demographic index areas and female populations. Expanding access to mental health services, enhancing public awareness, and delivering targeted interventions are essential to lessen the growing impact of mental disorders.

Keywords: Age-standardized disability-adjusted life year rate; Age-standardized rate; Disability-adjusted life year; Global Burden of Disease; Health inequality; Mental disorders.

Figure 1

The burden of mental disorders across 204 countries and territories in 2021. A: The age-standardized incidence rate in 204 countries and territories; B: The age-standardized disability-adjusted life years rate in 204 countries and territories; C: The age-standardized incidence rate in 21 global burden of disease regions by sexes; D: The age-standardized disability-adjusted life years rate in 21 global burden of disease regions by sexes. ASIR: Age-standardized incidence rate; ASDR: Age-standardized disability-adjusted life-year rate.

Figure 2

The age-standardized burden for the 12 subtypes of mental disorders across regions in 2021. A: Age-standardized incidence rate percentage of the age-standardized rates for the 12 subtypes of mental disorders; B: Age-standardized disability-adjusted life-year rate percentage of the age-standardized rates for the 12 subtypes of mental disorders; C: Age-standardized incidence rate ranking of the age-standardized rates for mental disorders; D: Age-standardized disability-adjusted life-year rate ranking of the age-standardized rates for mental disorders. ASIR: Age-standardized incidence rate; ASDR: Age-standardized disability-adjusted life-year rate.

Figure 3

Trend of the age-standardized rates of mental disorders in 1990-2021. A: Temporal trends in the sex-specific age-standardized incidence rate in global and all the socio-demographic index (SDI) regions; B: Temporal trends in the sex-specific age-standardized disability-adjusted life-years rate in global and all the SDI regions; C: The age-standardized rates of mental disorders in 21 global burden of disease regions by SDI; D: The age-standardized disability-adjusted life-year rate of mental disorders in 21 global burden of disease regions by SDI. For each region, points from left to right depict estimates from each year from 1990 to 2021. The black line represents the average expected relationship between SDI and burden estimates rates for mental disorders based on values from each geographical region over the 1990-2021 estimation period. ASIR: Age-standardized incidence rate; SDI: Socio-demographic index; ASDR: Age-standardized disability-adjusted life-year rate.