Abstract
Objective The objective was to assess trends in the burdens of major depressive disorder (MDD) and dysthymia among adolescents and young adults aged 10–24 years from 1990 to 2019 at the global, regional, and national levels. Methods This study was based on average annual percentage changes in the incidence and disability-adjusted life-years (DALYs) for MDD and dysthymia among young people aged 10–24 years. We analyzed global trends by age, sex, and sociodemographic index (SDI). Joinpoint regression was used to analyze global annual change trends. Results Between 1990 and 2019, the incidence of MDD in adolescents and young adults decreased by 0.1% per year, while the incidence of dysthymia increased by 0.2% per year. The greatest increase in the incidence of MDD and dysthymia was observed in the group aged 10–14 years and in the group aged 15–19 years, respectively. The greatest increase in the incidence of and DALYs for MDD was observed in high-SDI countries, while the greatest increase in dysthymia was observed in low-middle-SDI countries. In 2019, the incidence rates of MDD and dysthymia in females were 1.7 times and 1.5 times greater than those in males, respectively. Conclusions Over a 30-year period, the global incidence of MDD in adolescents and young adults did not decrease significantly, and the incidence of dysthymia increased significantly. The results indicate an urgent need for targeted screening for depressive disorders.
Similar content being viewed by others
Data Availability
All the data will be made available upon request to the corresponding author. Proposals will be reviewed and approved by the sponsor, investigator, and collaborators on the basis of scientific merit. After the approval of a proposal, the data will be shared through a secure online platform after a data access agreement is signed.
References
Andrade, L., Caraveo-Anduaga, J. J., Berglund, P., Bijl, R. V., De Graaf, R., Vollebergh, W., Dragomirecka, E., Kohn, R., Keller, M., Kessler, R. C., Kawakami, N., Kiliç, C., Offord, D., Ustun, T. B., & Wittchen, H. U. (2003). The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) surveys. International Journal of Methods in Psychiatric Research, 12(1), 3–21. https://doi.org/10.1002/mpr.138.
Avenevoli, S., Knight, E., Kessler, R. C., & Merikangas, K. R. (2008). Epidemiology of depression in children and adolescents. In Handbook of depression in children and adolescents. (pp. 6–32). The Guilford Press. https://doi.org/10.1007/978-1-4899-1510-8.
Badrane, H., Alaoui-el-Azher, M., & Moroccan Society for, B. (2003). Biomedical research in developing countries: the case of Morocco in the 1990s. La Tunisie medicale, 81(6), 377–382. http://europepmc.org/abstract/MED/14534943.
Barican, J. L., Yung, D., Schwartz, C., Zheng, Y., Georgiades, K., & Waddell, C. (2022). Prevalence of childhood mental disorders in high-income countries: A systematic review and meta-analysis to inform policymaking. Evidence Based Mental Health, 25(1), 36–44. https://doi.org/10.1136/ebmental-2021-300277.
Bitsko, R. H., Claussen, A. H., Lichstein, J., Black, L. I., Jones, S. E., Danielson, M. L., Hoenig, J. M., Jack, D., Brody, S. P., Gyawali, D. J., Maenner, S., Warner, M. J., Holland, M., Perou, K. M., Crosby, R., Blumberg, A. E., Avenevoli, S. J., Kaminski, S., J. W., & Ghandour, R. M. (2022). Mental Health Surveillance Among Children - United States, 2013–2019. MMWR Suppl, 71(2), 1–42. https://doi.org/10.15585/mmwr.su7102a1.
Boak, A., Adlaf, H. H. A., Henderson, E. M., & Mann, J. L. (2018). R. E. The mental health and well-being of Ontario students, 1991–2017: Detailed findings from the Ontario Student Drug Use and Health Survey (OSDUHS) (CAMH Research Document Series No. 47). In The Mental Health and Well-Being of Ontario Students.
Bodden, D. H. M., Stikkelbroek, Y., & Dirksen, C. D. (2018). Societal burden of adolescent depression, an overview and cost-of-illness study. Journal of Affective Disorders, 241, 256–262. https://doi.org/10.1016/j.jad.2018.06.015.
Bromet, E., Andrade, L. H., Hwang, I., Sampson, N. A., Alonso, J., de Girolamo, G., de Graaf, R., Demyttenaere, K., Hu, C., Iwata, N., Karam, A. N., Kaur, J., Kostyuchenko, S., Lépine, J. P., Levinson, D., Matschinger, H., Mora, M. E., Browne, M. O., Posada-Villa, J., Viana, M. C., Williams, D. R., & Kessler, R. C. (2011). Jul 26). Cross-national epidemiology of DSM-IV major depressive episode. Bmc Medicine, 9, 90. https://doi.org/10.1186/1741-7015-9-90.
COVID-19 Mental Disorders Collaborators. (2021). Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic. Lancet, 398(10312), 1700–1712. https://doi.org/10.1016/s0140-6736(21)02143-7.
Fekadu, A., Demissie, M., Birhane, R., Medhin, G., Bitew, T., Hailemariam, M., Minaye, A., Habtamu, K., Milkias, B., Petersen, I., Patel, V., Cleare, A. J., Mayston, R., Thornicroft, G., Alem, A., Hanlon, C., & Prince, M. (2022). Under detection of depression in primary care settings in low and middle-income countries: A systematic review and meta-analysis. Systematic Reviews, 11(1). https://doi.org/10.1186/s13643-022-01893-9.
Ferrari, A. J., Somerville, A. J., Baxter, A. J., Norman, R., Patten, S. B., Vos, T., & Whiteford, H. A. (2012). Global variation in the prevalence and incidence of major depressive disorder: A systematic review of the epidemiological literature. Psychological Medicine, 43(3), 471–481. https://doi.org/10.1017/s0033291712001511.
GBD 2019 Diseases and Injuries Collaborators. (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: A systematic analysis for the global burden of Disease Study 2019. The Lancet, 396(10258), 1204–1222. https://doi.org/10.1016/s0140-6736(20)30925-9.
GBD 2019 Mental Disorders Collaborators. (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: A systematic analysis for the global burden of Disease Study 2019. The Lancet Psychiatry, 9(2), 137–150. https://doi.org/10.1016/s2215-0366(21)00395-3.
Greenland, S., Senn, S. J., Rothman, K. J., Carlin, J. B., Poole, C., Goodman, S. N., & Altman, D. G. (2016). Statistical tests, P values, confidence intervals, and power: A guide to misinterpretations. European Journal of Epidemiology, 31(4), 337–350. https://doi.org/10.1007/s10654-016-0149-3.
Hanlon, C., Moitra, M., Santomauro, D., Collins, P. Y., Vos, T., Whiteford, H., Saxena, S., & Ferrari, A. J. (2022). The global gap in treatment coverage for major depressive disorder in 84 countries from 2000–2019: A systematic review and bayesian meta-regression analysis. PLOS Medicine, 19(2). https://doi.org/10.1371/journal.pmed.1003901.
Hasler, G., Pine, D. S., Kleinbaum, D. G., Gamma, A., Luckenbaugh, D., Ajdacic, V., Eich, D., Rössler, W., & Angst, J. (2005). Depressive symptoms during childhood and adult obesity: The Zurich Cohort Study. Molecular Psychiatry, 10(9), 842–850. https://doi.org/10.1038/sj.mp.4001671.
Kilburn, K., Prencipe, L., Hjelm, L., Peterman, A., Handa, S., & Palermo, T. (2018). Examination of performance of the Center for epidemiologic studies Depression Scale Short Form 10 among African youth in poor, rural households. Bmc Psychiatry, 18(1). https://doi.org/10.1186/s12888-018-1774-z.
Kim, H. J., Fay, M. P., Feuer, E. J., & Midthune, D. N. (2000). Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 19(3), 335–351. https://doi.org/10.1002/(sici)1097-0258(20000215)19:3%3C335::aid-sim336%3E3.0.co;2-z
Liu, Q., He, H., Yang, J., Feng, X., Zhao, F., & Lyu, J. (2020). Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. Journal of Psychiatric Research, 126, 134–140. https://doi.org/10.1016/j.jpsychires.2019.08.002.
Lu, J., Xu, X., Huang, Y., Li, T., Ma, C., Xu, G., Yin, H., Xu, X., Ma, Y., Wang, L., Huang, Z., Yan, Y., Wang, B., Xiao, S., Zhou, L., Li, L., Zhang, Y., Chen, H., Zhang, T., Yan, J., Ding, H., Yu, Y., Kou, C., Shen, Z., Jiang, L., Wang, Z., Sun, X., Xu, Y., He, Y., Guo, W., Jiang, L., Li, S., Pan, W., Wu, Y., Li, G., Jia, F., Shi, J., Shen, Z., & Zhang, N. (2021). Prevalence of depressive disorders and treatment in China: A cross-sectional epidemiological study. The Lancet Psychiatry, 8(11), 981–990. https://doi.org/10.1016/s2215-0366(21)00251-0.
Marwaha, S., Palmer, E., Suppes, T., Cons, E., Young, A. H., & Upthegrove, R. (2023). Novel and emerging treatments for major depression. The Lancet, 401(10371), 141–153. https://doi.org/10.1016/S0140-6736(22)02080-3.
Mullen, S. (2018). Major depressive disorder in children and adolescents. The Mental Health Clinician, 8(6), 275–283. https://doi.org/10.9740/mhc.2018.11.275.
National Cancer Institute. (2022) Joinpoint Trend Analysis Software. (2022). Retrieved Aug 01 from https://surveillance.cancer.gov/joinpoint/Joinpoint_Help_4.9.1.0.pdf.
Network, G. B., & o., D. C. (2020). Global Burden of Disease Study 2019 (GBD 2019) Socio-Demographic Index (SDI) 1950–2019. Institute for Health Metrics and Evaluation (IHME). Retrieved Jan. 25 from https://ghdx.healthdata.org/record/ihme-data/gbd-2019-socio-demographic-index-sdi-1950-2019.
Nicholson, A., Kuper, H., & Hemingway, H. (2006). Depression as an aetiologic and prognostic factor in coronary heart disease: A meta-analysis of 6362 events among 146 538 participants in 54 observational studies. European Heart Journal, 27(23), 2763–2774. https://doi.org/10.1093/eurheartj/ehl338.
Nobile, M., Cataldo, G. M., Marino, C., & Molteni, M. (2003). Diagnosis and treatment of Dysthymia in Children and adolescents. Cns Drugs, 17(13), 927–946. https://doi.org/10.2165/00023210-200317130-00001.
Parker, G., & Brotchie, H. (2010). Gender differences in depression. Int Rev Psychiatry, 22(5), 429–436. https://doi.org/10.3109/09540261.2010.492391.
Patel, V., Chisholm, D., Parikh, R., Charlson, F. J., Degenhardt, L., Dua, T., Ferrari, A. J., Hyman, S., Laxminarayan, R., Levin, C., Lund, C., Mora, M., Petersen, M. E., Scott, I., Shidhaye, J., Vijayakumar, R., Thornicroft, L., G., & Whiteford, H. (2016). Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition. The Lancet, 387(10028), 1672–1685. https://doi.org/10.1016/s0140-6736(15)00390-6.
Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., Hedden, S. L., Crosby, A. E., Visser, S. N., Schieve, L. A., Parks, S. E., Hall, J. E., Brody, D., Simile, C. M., Thompson, W. W., Baio, J., Avenevoli, S., Kogan, M. D., & Huang, L. N. (2013). Mental health surveillance among children–United States, 2005–2011. MMWR Suppl, 62(2), 1–35.
Pinquart, M., & Duberstein, P. R. (2010). Depression and cancer mortality: A meta-analysis. Psychological Medicine, 40(11), 1797–1810. https://doi.org/10.1017/s0033291709992285.
Potter, J. R., & Yoon, K. L. (2023). Interpersonal Factors, Peer Relationship Stressors, and Gender Differences in Adolescent Depression. Current Psychiatry Reports, 25(11), 759-767. https://doi.org/10.1007/s11920-023-01465-1
Prescott, C. A., McArdle, J. J., Hishinuma, E. S., Johnson, R. C., Miyamoto, R. H., Andrade, N. N., Edman, J. L., Makini, G. K., Nahulu, L. B., Yuen, N. Y. C., & Carlton, B. S. (1998). Prediction of Major Depression and Dysthymia from CES-D scores among ethnic minority adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 37(5), 495–503. https://doi.org/10.1097/00004583-199805000-00012.
Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., Bruffaerts, R., Bunting, B., de Almeida, J. M. C., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hinkov, H., Karam, E., Kawakami, N., Lee, S., Navarro-Mateu, F., Piazza, M., Posada-Villa, J., de Galvis, Y. T., & Kessler, R. C. (2018). Undertreatment of people with major depressive disorder in 21 countries. British Journal of Psychiatry, 210(2), 119–124. https://doi.org/10.1192/bjp.bp.116.188078.
Waddell, C., Schwartz, C., & Andres, C. (2017). Making children’s Mental Health a Public Policy Priority: For the one and the many. Public Health Ethics, 11(2), 191–200. https://doi.org/10.1093/phe/phx018.
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/j.socscimed.2013.04.026.
Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102.
Sassarini, D. J. (2016). Depression in midlife women. Maturitas, 94, 149–154. https://doi.org/10.1016/j.maturitas.2016.09.004.
Sawyer, S. M., Azzopardi, P. S., Wickremarathne, D., & Patton, G. C. (2018). The age of adolescence. The Lancet Child & Adolescent Health, 2(3), 223–228. https://doi.org/10.1016/s2352-4642(18)30022-1.
Schramm, E., Klein, D. N., Elsaesser, M., Furukawa, T. A., & Domschke, K. (2020). Review of dysthymia and persistent depressive disorder: History, correlates, and clinical implications. The Lancet Psychiatry, 7(9), 801–812. https://doi.org/10.1016/s2215-0366(20)30099-7.
Shamsuddin, K., Fadzil, F., Ismail, W. S. W., Shah, S. A., Omar, K., Muhammad, N. A., Jaffar, A., Ismail, A., & Mahadevan, R. (2013). Correlates of depression, anxiety and stress among Malaysian university students. Asian Journal of Psychiatry, 6(4), 318–323. https://doi.org/10.1016/j.ajp.2013.01.014.
Shorey, S., Ng, E. D., & Wong, C. H. J. (2021). Global prevalence of depression and elevated depressive symptoms among adolescents: A systematic review and meta-analysis. British Journal of Clinical Psychology, 61(2), 287–305. https://doi.org/10.1111/bjc.12333.
Spoelma, M. J., Sicouri, G. L., Francis, D. A., Songco, A. D., Daniel, E. K., & Hudson, J. L. (2023). Estimated prevalence of depressive disorders in Children from 2004 to 2019: A systematic review and Meta-analysis. JAMA Pediatr, 177(10), 1017–1027. https://doi.org/10.1001/jamapediatrics.2023.3221.
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Jama, 302(5), 537–549. https://doi.org/10.1001/jama.2009.1132.
Syed Sheriff, R. J., Jayaram, M., Tharyan, P., Duley, L., & Adams, C. E. (2006). Randomised trials relevant to mental health conducted in low and middle-income countries: Protocol for a survey of studies published in 1991, 1995 and 2000 and assessment of their relevance. Bmc Psychiatry, 6(1). https://doi.org/10.1186/1471-244x-6-40.
Thapar, A., Collishaw, S., Pine, D. S., & Thapar, A. K. (2012). Depression in adolescence. The Lancet, 379(9820), 1056–1067. https://doi.org/10.1016/s0140-6736(11)60871-4.
Ustün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C., & Murray, C. J. (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry, 184, 386–392. https://doi.org/10.1192/bjp.184.5.386.
Vahratian, A., Blumberg, S. J., Terlizzi, E. P., & Schiller, J. S. (2021). Symptoms of anxiety or depressive disorder and use of Mental Health Care among adults during the COVID-19 pandemic - United States, August 2020-February 2021. Mmwr. Morbidity and Mortality Weekly Report, 70(13), 490–494. https://doi.org/10.15585/mmwr.mm7013e2.
Ventriglio, A., Bhugra, D., Sampogna, G., Luciano, M., De Berardis, D., Sani, G., & Fiorillo, A. (2020). From dysthymia to treatment-resistant depression: Evolution of a psychopathological construct. International Review of Psychiatry, 32(5–6), 471–476. https://doi.org/10.1080/09540261.2020.1765517.
Wasserstein, R. L., & Lazar, N. A. (2016). The ASA Statement on p-Values: Context, process, and purpose. The American Statistician, 70(2), 129–133. https://doi.org/10.1080/00031305.2016.1154108.
Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., Charlson, F. J., Norman, R. E., Flaxman, A. D., Johns, N., Burstein, R., Murray, C. J. L., & Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of Disease Study 2010. The Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/s0140-6736(13)61611-6.
World Health Organization. (2013). Mental health action plan 2013–2020. Retrieved Aug 20 from https://iris.who.int/handle/10665/89966
World Health Organization. (2018). Time to Wait for Global Action on Mental Health: Building Momentum for Mental Health in the Age of the Sustainable Development Goals. Retrieved Sept 26 from https://www.who.int/zh/director-general/speeches/detail/time-to-act-on-global-mental-health-building-momentum-on-mental-health-in-sdg-era
World Health Organization. (2021). Mental health of adolescents. Retrieved Sept 20 from https://www.who.int/news-room/factsheets/detail/adolescent-mental-health
World Health Organization. (2023). Adolescent health Retrieved June 28 from https://www.who.int/health-topics/adolescent-health#tab=tab_1
World Health Organization & Disease Control Priorities Project. (2006). Disease control priorities related to mental, neurological, developmental and substance abuse disorders. World Health Organization. (2006). Retrieved Aug 20 from https://iris.who.int/handle/10665/43565.
Zhdanava, M., Pilon, D., Ghelerter, I., Chow, W., Joshi, K., Lefebvre, P., & Sheehan, J. J. (2021). The prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. The Journal of Clinical Psychiatry, 82(2). https://doi.org/10.4088/JCP.20m13699.
Funding
This research received no external funding.
Author information
Authors and Affiliations
Contributions
LW and DZ designed the study. LW, DZ, JW, MW, CZ, JG, DQ and HZ analysed the data and did the statistical analyses. LW and DZ drafted the initial manuscript. All authors reviewed the drafted manuscript and approved the final version. All authors have directly accessed and verified the underlying data reported in the manuscript. All data will be made available on request to the corresponding author. Proposals will be reviewed and approved by the sponsor, investigator, and collaborators on the basis of scientific merit. After approval of a proposal, data will be shared through a secure online platform after the signing of a data access agreement.
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, L., Zhang, D., Wu, J. et al. Global, Regional, and National Burdens of Major Depressive Disorder and Dysthymia in Adolescents and Young Adults Aged 10–24 Years from 1990 to 2019: A Trend Analysis Based on the Global Burden of Disease Study 2019. Int J Ment Health Addiction (2024). https://doi.org/10.1007/s11469-024-01284-2
Accepted:
Published:
DOI: https://doi.org/10.1007/s11469-024-01284-2