Anxiety and depressive disorders in adolescent injury prevention and safety promotion: frontier and inequality mapping across 953 locations.

PURPOSE: Anxiety and depressive disorders constitute major contributors to global mental health burdens, disproportionately affecting 10-24-year-olds during critical neurodevelopmental windows. Despite their substantial disease burden, persistent treatment gaps and inequitable resource allocation remain worldwide. This study aims to systematically examine the evolving disease burden, inequalities, and achievable frontiers for anxiety and depressive disorders among 10-24 years from 1990 to 2021, providing critical epidemiological evidence to inform integrated adolescent mental health and injury prevention strategies.

METHODS

Employed the data from the Global Burden of Disease Study (GBD) 2021, this study analyzed anxiety and depressive indicators across 953 locations at global, regional, national, and subnational levels, with stratification by sociodemographic index (SDI) quintiles to examine socioeconomic inequalities and identify potentially achievable frontiers. Data analysis occurred from August 2024 to January 2025.

RESULTS

Key findings reveal a marginal increase in incidence rates over three decades, driven by a marked surge during the pandemic. Significant inter-regional disparities emerged, with high SDI regions such as Western Europe and High-income North America bearing disproportionately greater burdens. Notably, while some countries like Pakistan and Nigeria demonstrated relatively low burdens, subnational analyses uncovered accelerated disease trajectories and persistent health inequities, underscoring emerging challenges in resource-constrained settings. Among the top 100 affected subnational locations in 2021, Iran (31%), Brazil (27%), and Italy (19%) recorded the highest anxiety DALY rates, while the United States of America (51%), the United Kingdom (25%), and Iran (19%) dominated depressive DALYs. Socioeconomic inequalities in disease burdens intensified globally from 1990 to 2021, most pronounced in high SDI countries. In 2021, 89.2% and 92.2% of 204 countries and territories fell behind the anxiety and depressive DALYs frontiers respectively, with 99.0% and 97.1% experiencing an increasing frontier deviation between 1990 and 2021. Among 494 subnational locations, 49.2% fell behind the anxiety DALYs frontiers, and 35.8% fell behind the depressive DALYs.

CONCLUSION

These findings emphasize the urgency of implementing targeted interventions addressing developmental-stage vulnerabilities, and integrating equity-focused strategies into mental health prevention and promotion policy frameworks, with direct implications for adolescent self-harm prevention and child safety promotion.