From disease management to social risk governance: evidence and strategies for integrating anti-domestic violence, anti-bullying, and child protection into China's comprehensive depression prevention and control system

To analyze long-term trends in the burden of major depressive disorder(MDD) in China and globally from 1990 to 2023 based on the Global Burden of Disease 2023(GBD 2023), characterize pre-and post-pandemic patterns and demographic drivers, and project future burden trends.

Data were extracted from the GBD 2023 database covering 204 countries/territories. Age-standardized incidence rate(ASIR), age-standardized prevalence rate(ASPR), age-standardized disability-adjusted life year rate(ASDR), and their 95% uncertainty intervals(UI) were calculated. Joinpoint regression analysis was used to estimate average annual percent change(AAPC) with 95% confidence intervals(CI), along with correlations with sociodemographic index(SDI), inequality, and frontier gaps. Das Gupta decomposition was applied to assess demographic contributions. Autoregressive integrated moving average(ARIMA) models were developed based on 1990 to 2018 time-series to forecast trends from 2024 to 2040. Attributable burdens of major modifiable social risk factors were also analyzed.

In 2023, China's ASIR, ASPR, and ASDR were 3002.50/100000, 2107.50/100000, and 429.44/100000, respectively, all lower than the global estimates of 3464.17/100000, 2815.75/100000, and 567.77/100000, correspondingly. From 1990 to 2023, all 3 age-standardized rates showed upward trends. In China, AAPC was 1.214%(P<0.05) for ASIR, 0.920%(P<0.05) for ASPR, and 0.947%(P<0.05) for ASDR; globally, corresponding AAPCs were 1.222%(P<0.05), 1.385%(P<0.05), and 1.380%(P<0.05), respectively. Post-pandemic ASPR and ASDR maintained high plateau levels: in 2023, China's rate increased by 7.5% and 7.4% relative to 2019, while global rates increased by 24.5% and 24.1%, respectively. Age distribution patterns showed that in 2023, China's crude incidence rate peaked at 3909.88/100000(95%UI: 3009.15 to 4874.13) in the 15 to 19 years age group, and crude DALY rate also peaked at 584.29/100000(95%UI: 361.23 to 887.27) in the same age group. Whereas the crude prevalence rate increased with age and peaked at age of ≥95 years at 3084.41/100000(2410.08 to 4107.62). In 2023, correlations between ASIR/ASPR/ASDR and SDI were weak and not statistically significant(P>0.05). ARIMA projections suggested that by 2040, China's ASIR, ASPR, and ASDR would reach 3648.92/100000, 2576.16/100000, and 536.31/100000, respectively. In 2023, attributable proportions of DALYs(China/global) were 8.70%/8.32% for intimate partner violence, 8.24%/6.82% for bullying victimization, and 7.48%/8.20% for childhood sexual abuse. Sex-stratified analyses consistently showed higher burdens in females than in males.

From 1990 to 2023, the burden of MDD in China and globally continued to rise. The COVID-19 pandemic produced an additional surge, with accumulated burden maintaining high levels post-pandemic. Age patterns indicate coexistence of “high incidence and high health loss in adolescence” and “accumulation of absolute burden in middle-aged and older adults.” Projections based on pre-pandemic trends suggest that China's future burden may continue to increase.

While improving service accessibility, we recommend advancing screening and stratified interventions to priority populations, especially adolescents and females, and integrating social risk governance measures, such as anti-domestic violence, anti-bullying, and child protection, into a comprehensive MDD prevention and control system.