Burden and trends of anxiety, depressive, and bipolar disorders in China from 1990 to 2023: Joinpoint, age-period-cohort effects, and forecasts.

BACKGROUND

Anxiety disorders, depressive disorders, and bipolar disorder are major contributors to global disability and functional impairment. Updated evidence on temporal trends, demographic patterns, and projected burden is needed to characterise the population-level burden of these disorders in China.

METHODS

Using Global Burden of Disease Study 2023 estimates, we assessed disability-adjusted life-year (DALY) counts and age-standardised DALY rates (ASDRs) for anxiety disorders, depressive disorders, and bipolar disorder in China from 1990 to 2023. We described age- and sex-specific DALY patterns in 2023, evaluated ASDR trends using Joinpoint regression, examined age-, period-, and cohort-related patterns using an age-period-cohort estimable-function framework, and decomposed changes in DALY counts into contributions from population growth, population ageing, and epidemiological change. Bayesian age-period-cohort modelling was used to project ASDRs for 2024-2038. We characterised attributable DALY burden for violence- and trauma-related risk factors across applicable disorder-exposure pairs.

RESULTS

From 1990 to 2023, ASDRs increased overall for anxiety disorders and depressive disorders, whereas bipolar-disorder ASDRs remained comparatively stable. Anxiety-disorder burden showed a younger age distribution, whereas depressive-disorder burden was more concentrated in middle-to-older adulthood; bipolar-disorder burden was primarily concentrated in midlife. Females generally had higher age-standardised DALY rates than males across all three disorders, with sex disparities largest for anxiety and depressive disorders. Decomposition analyses indicated distinct contributions of population growth, population ageing, and epidemiological change across disorders. Projections suggested a continued increase in the anxiety-disorder ASDR, an initial increase followed by stabilisation or gradual decline in the depressive-disorder ASDR, and a relatively stable bipolar-disorder ASDR through 2038. GBD-derived attributable DALY burden related to bullying victimisation, sexual violence against children, and intimate partner violence varied across eligible risk-outcome pairs and age groups.

CONCLUSIONS

Mental-disorder burden in China showed heterogeneous temporal and demographic patterns from 1990 to 2023. Anxiety and depressive disorders showed increasing age-standardised burden, whereas bipolar disorder remained comparatively stable in age-standardised terms despite sustained absolute health loss. These population-level descriptive findings and model-based projections provide updated evidence on burden magnitude and trajectories but do not establish individual-level causal mechanisms or intervention effects.