Differential burden of five major mental disorders in the United States across the COVID-19 pandemic.

OBJECTIVE

This study aimed to simultaneously characterize the long-term burden trajectories of five major mental disorders across all US states from 1990 to 2023, including their responses to the COVID-19 pandemic.

METHODS

Age-standardized prevalence and years lived with disability rates for five mental disorders [anxiety disorders, major depressive disorder (MDD), dysthymia, bipolar disorder, and schizophrenia] were analyzed across US states from 1990 to 2023 using Global Burden of Disease Study data, stratified by sex and age, examining temporal trends, pandemic-period changes, geographic distributions, Socio-demographic Index (SDI) correlations, and cross-disorder associations.

RESULTS

From 1990 to 2023, anxiety disorders and MDD prevalence increased by 25.4% and 55.2%, while dysthymia (-6.7%), bipolar disorder (-1.0%), and schizophrenia (-5.3%) declined modestly; in 2023, female prevalence of anxiety disorders and MDD exceeded male rates by 77.1% and 79.3%. During 2019-2023, anxiety disorders and MDD prevalence surged by 47.9% and 23.7%, reversing pre-pandemic declining trends of -1.2% and -1.8%, yielding between-period differences of +49.2 and +25.6 percentage points, universally across all 51 states. MDD exhibited the widest disparity, ranging from 2291 per 100,000 in North Dakota to 4803 per 100,000 in West Virginia. SDI was inversely associated with anxiety disorders (ρ = -0.335) and MDD (ρ = -0.355), but positively associated with schizophrenia (ρ = 0.689; all P < 0.05). State-level schizophrenia prevalence was negatively associated with MDD (β = -57.252, P = 0.007) and anxiety disorders (β = -19.597, P = 0.006).

CONCLUSION

The COVID-19 pandemic selectively accelerated anxiety and depressive disorder burden across all US states. Substantial geographic disparities, disorder-specific sociodemographic gradients, and cross-disorder ecological patterns were identified.