Effective response: China’s performance and sex-and region-based disparities amid global increase in depressive disorder burden during the COVID-19

To investigate changes in the depressive disorder burden in China, global, and across socio-demographic index (SDI) regions during the COVID-19 (from 2019 to 2021) compared with 1990 to 2019, and to analyze sex-regional disparities.

Using depressive disorder data from the Global Burden of Disease (GBD) database (from 1990 to 2021) for China, global populations, and 5 SDI regions, we characterized depressive disorder burden distribution during the pandemic via metrics including age-standardized prevalence rate (ASPR), age-standardized disability-adjusted life years (ASR-DALYs), and estimated annual percentage change (EAPC). Joinpoint regression modeled temporal trends, and the Bayesian age-period-cohort (BAPC) model estimated the excess depressive disorder burden attributable to COVID-19 in 2020—2021.

China’s depressive disorder ASPR increased to 2 875.68/100 000 person-years (95%CI: 2 589.96 to 3 203.43) in 2021 from 2 825.00/100 000 (95%CI: 2 550.42 to 3 136.08) in 2019; ASR-DALYs rose to 430.61/100 000 (95%CI: 305.24 to 586.21) from 430.14/100 000 person-years (95%CI: 303.92 to 580.82). Joinpoint analysis identified an inflection point for China’s ASPR in 2019, with a significant upward annual percentage change (APC=0.95, P<0.05) from 2019 to 2021—a smaller increase than global and other SDI regions. No significant inflection was observed for China’s ASR-DALYs, whereas other regions showed clear upward inflection points near 2019 (P<0.05). China exhibited the lowest excess depressive disorder burden due to COVID-19: excess ASPR was 121.67/100 000 and excess ASR-DALYs was 12.25/100 000 person-years in 2021, only 28% and 14% of global levels, respectively. Females had higher ASPR/ASR-DALYs and excess burden than males, with females in high-SDI regions bearing the heaviest burden.

COVID-19 imposed severe excess depressive disorder burdens worldwide. China’s effective pandemic response policies and psychological assistance measures mitigated this burden.

Governments should increase investment in mental healthcare resources, enhance public mental health literacy, and ensure rapid implementation of containment measures during public health emergencies—including regular information updates to stabilize public sentiment—alongside community-based psychological support.