To analyze the global burden of depressive disorders (1990-2021), examining trends in disability-adjusted life-years (DALYs) and incidence across SDI regions, sex, and during COVID-19, and to assess the contribution of early-life risk factors and the complex socioeconomic-depression relationship.
Methods:
Using data from the Global Burden of Disease Study, we analyzed the global burden of depressive disorders from 1990 to 2021. We examined age-standardized DALYs and incidence rates, assessing temporal changes across regions and socioeconomic contexts defined by the Social Development Index (SDI). Statistical analyses explored relationships between depression burden and factors such as sex, regional variations, the COVID-19 pandemic, and early-life risk factors like childhood sexual abuse and bullying.
Results:
DALYs due to depression increased from 600.5 per 100,000 in 1990 to 681.1 per 100,000 in 2021. Post-2018, high-SDI regions saw significant rises in DALYs (Estimated Annual Percentage Change (EAPC) = 0.388) and incidence (EAPC = 0.487), while low-SDI regions saw modest declines. High-income areas reported higher depressive burdens despite better healthcare. Women, especially in adolescence and later life, bore a greater burden. Sub-Saharan Africa had the highest burden, and high-income Asia Pacific the lowest. During COVID-19, depression rates slightly increased globally, with regional and gender variations. Early-life adversities notably contributed to the rising depression burden, particularly in high-SDI regions.
Conclusions:
The relationship between socioeconomic development and depression burden is complex and non-linear. High-SDI regions benefit from better healthcare access but face rising depression rates due to urbanization, social isolation, and work-related stress, exacerbated by COVID-19. In contrast, low-SDI regions maintain protective social support networks despite limited healthcare resources. Addressing gender disparities and regional variations requires tailored mental-health interventions, focusing on early-life support, gender-specific strategies, and strengthening mental-health infrastructure in low- and middle-income countries.
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