Journal of Psychiatric Research xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

Journal of Psychiatric Research

journal homepage: www.elsevier.com/locate/jpsychires

Changes in the global burden of depression from 1990 to 2017: Findings

from the Global Burden of Disease study
⁎
Qingqing Liua,b,1, Hairong Hea,1, Jin Yanga,b, Xiaojie Fenga,b, Fanfan Zhaoa,b, Jun Lyua,b,
a
Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
b
School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: Depression is the most common mental illness worldwide. It has become an important public health
Depression problem. This study aimed to determine the global burden of depression and how it has changed between 1990
The global burden of disease and 2017.
Dysthymia Methods: We used information on depression obtained by the Global Burden of Disease (GBD) study from 1990
Major depressive disorder
to 2017. The age-standardized incidence rate (ASR) and estimated annual percentage change (EAPC) were used
to assess the global burden of depression.
Results: The number of incident cases of depression worldwide increased from 172 million in 1990 to 25,8
million in 2017, representing an increase of 49.86%. The ASR of depression varied widely between the 195
analyzed countries and regions in 2017, being highest in Lesotho (6.59 per 1000) and lowest in Myanmar (1.28
per 1000). The ASR increased the most between 1990 and 2017 in Belgium (EAPC = 0.88, 95% confidence
interval [CI] = 0.78 to 0.97), and decreased the most in Cuba (EAPC = −1.26, 95% CI = −1.36 to −1.14). The
ASR increased in regions with a high sociodemographic index, such as high-income North America
(EAPC = 0.41, 95% CI = 0.31 to 0.51), and decreased significantly in South Asia (EAPC = −0.63, 95%
CI = −0.85 to −0.41). The proportions of the population with major depressive disorder and dysthymia were
essentially stable both globally and in various countries, with a much larger proportion having major depressive
disorder.
Conclusion: Depression remains a major public health issue, and governments should support the research ne-
cessary to develop better prevention and treatment interventions.

1. Introduction
Depression is a common mental health disorder that can affect both
the mental and physical health. The main symptoms of depression are a
lack of interest in usual life activities, insomnia, inability to enjoy life,
and even suicidal thoughts (Cui, 2015). Depression is nowadays a
common chronic disease in most societies worldwide that can impair
normal functioning, cause depressive thoughts, and adversely affect the
quality of life. In addition, patients with major depressive disorder have
increased risks of developing cardiovascular disease and receiving poor
treatment, and increased morbidity and mortality (Luo et al., 2018;
Seligman and Nemeroff, 2015). It is estimated that more than 300
million people in the world suffer from depression, which is listed by
the World Health Organization (WHO) as the single largest factor
contributing to global disability (Smith, 2014). One of the most-
worrying aspects is that adolescents with severe depression are 30 times
more likely to commit suicide (Stringaris, 2017). However, while de-
pression is now one of the most important global health problems, its
complex pathogenesis remains poorly understood, although it is known
that cultural, psychological, and biological factors contributed to de-
pression (Gross, 2014; Menard et al., 2016).
The Global Burden of Disease (GBD) study provides specific data on
multiple diseases in 195 countries and regions around the world, in-
cluding information about depression. The GBD database represents a
wealth of information for understanding the incidence of depression
worldwide, and it divides depression into two major categories: dys-
thymia and major depressive disorder. In this study we used the data on
depression in the GBD database from 1990 to 2017 to analyze the
temporal trends in the incidence of depression. Our findings will help to
improve the understanding of the burden of depression worldwide and

⁎
Corresponding author. Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.
E-mail address: lujun2006@xjtu.edu.cn (J. Lyu).
1
These authors contributed equally to this work.

https://doi.org/10.1016/j.jpsychires.2019.08.002
Received 22 June 2019; Received in revised form 3 August 2019; Accepted 8 August 2019
0022-3956/ © 2019 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/BY-NC-ND/4.0/).

Please cite this article as: Qingqing Liu, et al., Journal of Psychiatric Research, https://doi.org/10.1016/j.jpsychires.2019.08.002
Q. Liu, et al.
in developing effective prevention strategies.
2. Methods
2.1. Data source
The data utilized in this study are available on the Global Health
website (http://ghdx.healthdata.org). Each step used in this study to
analyze the GBD database was consistent with the Guidelines for
Accurate and Transparent Health Estimates Reporting, which has been
described in detail previously (2016a; 2016b; 2016c; Stevens et al.,
2016). The GBD database contains data on different diseases in 195
countries and regions, and we extracted data on depression from 1990
to 2017. In order to describe the prevalence of depression from multiple
angles, we divided the world into five regions according to their so-
ciodemographic index (SDI): low, low-middle, middle, high-middle,
and high SDI. These 195 countries and regions were geographically
divided into 21 areas, such as Andean Latin America, Central Europe,
and Southeast Asia. This study used these data to describe the pre-
valence of dysthymia and major depressive disorder according to dif-
ferent SDI regions and geographical locations. In GBD, depression is
divided into two categories: dysthymia and major depressive disorder.
The study also described the prevalence of these two types of depres-
sion in different countries and regions, different SDI regions, and geo-
graphical locations.
2.2. Statistical analysis
The age-standardized incidence rate (ASR) and estimated annual
percentage change (EAPC) were used to quantify the incidence trends of
depression (Hankey et al., 2000). The age-standardized morbidity is the
morbidity after excluding the effects of age. The ASR of depression does
not reflect the actual incidence of depression, but is only used to
compare the incidence of depression in different countries, different
regions, or different historical periods in the same region, so as to fa-
cilitate data comparisons. If the age structures of the populations in two
regions are very different, comparing the incidence rates alone will not
reveal whether a high incidence in a certain region is caused by the
difference in the age compositions or other influencing factors. It is
therefore necessary to standardize the incidence rate according to age.
The method used to calculate ASR has been reported previously (Liu
et al., 2019).
EAPC is a summary and widely used measure of the ASR trend over
a specific time interval. A regression line was fitted to the natural
logarithm of the ASR values; that is, y = α + βx + ϵ, where y = ln
(ASR) and x = calendar year. The EAPC was calculated as 100 × (exp
(β) − 1), and its 95% confidence interval (CI) was obtained from a
linear regression model (Liu et al., 2019). The ASR is considered to be
(1) decreasing when the EAPC and the upper boundary of its 95% CI are
both ≤0, (2) increasing when the EAPC and the lower boundary of its
95% CI are ≥0, and (3) stable in all other cases. In addition, the ASR
values for the two types of depression were analyzed by hierarchical
cluster analysis, and the countries and regions were divided into four
states: significantly increased, slightly increased, remaining stable or
slightly decreased, and significantly decreased. All statistical analyses
in this study were performed using R software.
3. Results
3.1. Global burden of depression
The ASR of depression in the 195 analyzed countries and regions
varied widely in 2017 (Fig. 1A), being highest in Lesotho (6.59 per
1000), followed by Morocco (6.31 per 1000) and Greenland (6.26 per
1000), and lowest in Myanmar (1.28 per 1000), followed by Indonesia
(1.79 per 1000) and the Philippines (1.97 per 1000). The number of
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Journal of Psychiatric Research xxx (xxxx) xxx–xxx
incident cases of depression worldwide increased from 172 million in
1990 to 25,8 milion in 2017, representing an increase of 49.86%. The
increase was largest in Qatar (559.33%), followed by the United Arab
Emirates (511.76%) and Equatorial Guinea (221.87%) (Fig. 1B). The
number of incident cases of depression decreased from 1990 to 2017 in
18 countries, by the most in Latvia (−30.99%), followed by Bosnia and
Herzegovina (−25.75%) and Georgia (−23.98%).
The increase in ASR across the 195 countries and regions was largest
in Belgium (EAPC = 0.88, 95% CI = 0.78 to 0.97), followed by Guyana
(EAPC = 0.53, 95% CI = 0.42 to 0.64) and South Korea (EAPC = 0.52,
95% CI = 0.41 to 0.64) (Fig. 1C). The decrease in ASR was largest in
Cuba (EAPC = −1.26, 95% CI = −1.36 to −1.14), followed by Den-
mark (EAPC = −1.21, 95% CI = −1.37 to −1.04) and Estonia
(EAPC = −1.06, 95% CI = −1.18 to −0.94).
Cluster analysis (Fig. S1) classified the ASR as (1) significantly in-
creased in 29 countries, including Armenia, Belgium, and Iran; (2)
slightly increased in 132 countries, including Afghanistan, Albania, and
Australia; (3) remaining stable or slightly decreased in 25 countries,
including Austria, Bahrain, and Bermuda; and (4) significant decreased
in 9 countries, including Cuba, Bosnia and Herzegovina, and Denmark.
The number of people with depression increased in all five SDI re-
gions between 1990 and 2017 (Fig. 2). However, the ASR decreased in
the high-middle-SDI, low-SDI, low-middle-SDI, and middle-SDI regions,
only increasing in the high-SDI region (Table 1). The number of people
with depression increased in all geographical regions (Fig. 3), by the
most in Central sub-Saharan Africa (124.56%), followed by Western
sub-Saharan Africa (124.42%) and Oceania (107.19%). The ASR in-
creased significantly in high-income North America (EAPC = 0.41, 95%
CI = 0.31 to 0.51) and decreased significantly in South Asia
(EAPC = −0.63, 95% CI = −0.85 to–0.41) (Fig. 4, Table 1).
Fig. 4 shows the proportions of cases of dysthymia and major de-
pressive disorder worldwide in 1990 and 2017. The proportion of the
population with the two types of depression remained essentially stable
both globally and regionally, with a much larger proportion having
major depressive disorder.
3.2. Global burden of major depressive disorder
The majority (93.7%) of patients with depression in 2017 had major
depressive disorder (Fig. 5). The ASR of major depressive disorder
varied widely among the 195 countries and regions in 2017, being
highest in Lesotho (6.41 per 1000), followed by Morocco (6.13 per
1000) and Greenland (6.01 per 1000) (Fig. S2), and lowest in Myanmar
(1.06 per 1000), Indonesia (1.57 per 1000), and the Philippines (1.75
per 1000). The number of incident cases of major depressive disorder
worldwide increased from 162 million in 1990 to 241 million in 2017,
representing an increase of 49.29%. The increase was largest in Qatar
(557.67%), followed by the United Arab Emirates (509.93%) and
Equatorial Guinea (221.51%) (Fig. S3, Table S3). The number of in-
cident cases decreased from 1990 to 2017 in 20 countries, by the most
in Latvia (−31.49%), followed by Bosnia and Herzegovina (−26.65%)
and Georgia (−23.69%).
The increase in ASR across the 195 countries and regions was largest
in Belgium (EAPC = 0.93, 95% CI = 0.83 to 1.02), followed by South
Korea (EAPC = 0.57, 95% CI = 0.45 to 0.69) and Guyana
(EAPC = 0.55, 95% CI = 0.44 to 0.66) (Fig. S4). The decrease in the
ASR was largest in Cuba (EAPC = −1.31, 95% CI = −1.42 to −1.19),
followed by Denmark (EAPC = −1.29, 95% CI = −1.47 to −1.11) and
Estonia (EAPC = −1.12, 95% CI = −1.24 to −0.99).
The number of cases of major depressive disorder in the five SDI
regions increased between 1990 and 2017. However, the ASR decreased
in the high-middle-SDI, low-SDI, low-middle-SDI, and middle-SDI re-
gions, only increasing in the high-SDI region (Fig. 2, Table S1). The
number of cases of major depressive disorder increased in all geo-
graphical regions (Fig. 3), by the most in Central sub-Saharan Africa
(124.33%), followed by Western sub-Saharan Africa (124.11%) and
Q. Liu, et al. Journal of Psychiatric Research xxx (xxxx) xxx–xxx

Fig. 1. The global disease burden of depression for both sexes in 195 countries and territories. (A) The ASR of depression in 2017; (B) The relative change in incident
cases of depression between 1990 and 2017; (C) The EAPC of depression ASR from 1990 to 2017. ASR, age-standardized rate; EAPC, estimated annual percentage
change.

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Fig. 2. The depression cases caused by different types, by SDI regions, from 1990 to 2017. SDI, socio-demographic index.

Table 1
The incident cases and age-standardized incidence of depression in 1990 and 2017, and its temporal trends from 1990 to 2017.
Characteristics 1990 2017 1990–2017

Incident cases ASR per 1000 Incident cases ASR per 1000 EAPC

No. × 106 (95%UI) No.(95%UI) No. × 106 (95%UI) No.(95%UI) No.(95%UI)

Global 172.27 (157.81–189.31) 3.43 (3.16–3.77) 258.16 (238.28–281.67) 3.25 (3–3.54) −0.26 (−0.31 to −0.22)
Sex
Male 65.1 (59.58–71.43) 2.6 (2.4–2.85) 99.87 (92.07–108.9) 2.54 (2.34–2.76) −0.15 (−0.2 to −0.1)
Female 107.16 (98.23–117.69) 4.25 (3.91–4.66) 158.29 (146.19–172.75) 3.95 (3.64–4.31) −0.33 (−0.38 to −0.29)
Etiology
Depressive disorders 172.27 (157.81–189.31) 3.43 (3.16–3.77) 258.16 (238.28–281.67) 3.25 (3–3.54) −0.26 (−0.31 to −0.22)
Major depressive disorder 162.03 (147.45–178.81) 3.23 (2.96–3.55) 241.89 (222.03–265.57) 3.04 (2.8–3.34) 0.01 (−0.01 - 0.02)
Dythymia 10.23 (8.97–11.61) 0.2 (0.18–0.23) 16.27 (14.24–18.42) 0.2 (0.18–0.23) −0.28 (−0.33 to −0.23)
Socio-demographic index
High SDI 37.08 (34.51–40.25) 3.51 (3.26–3.81) 45.18 (42.01–48.88) 3.57 (3.3–3.89) 0.12 (0.1–0.15)
High-middle SDI 37.79 (34.58–41.53) 3.47 (3.18–3.79) 51.88 (47.53–56.74) 3.23 (2.97–3.53) −0.29 (−0.3 to −0.27)
Low SDI 21.04 (19.05–23.28) 4.03 (3.68–4.44) 40.01 (36.52–44.16) 3.82 (3.5–4.18) −0.32 (−0.44 to −0.2)
Low-middle SDI 33.66 (30.64–37.11) 3.99 (3.65–4.38) 57.55 (52.85–63.2) 3.73 (3.42–4.08) −0.39 (−0.52 to −0.25)
Middle SDI 41.99 (38.19–46.41) 3.01 (2.76–3.3) 62.61 (57.55–68.3) 2.78 (2.56–3.02) −0.36 (−0.4 to −0.33)
Region
Andean Latin America 0.84 (0.76–0.93) 2.62 (2.41–2.89) 1.53 (1.4–1.67) 2.56 (2.34–2.79) −0.18 (−0.2 to −0.15)
Australasia 0.94 (0.86–1.03) 4.38 (4–4.79) 1.27 (1.17–1.4) 4.31 (3.93–4.77) −0.07 (−0.16 - 0.02)
Caribbean 1.18 (1.08–1.3) 3.58 (3.29–3.9) 1.57 (1.43–1.71) 3.2 (2.93–3.49) −0.5 (−0.54 to −0.46)
Central Asia 1.75 (1.61–1.93) 2.91 (2.68–3.18) 2.47 (2.27–2.68) 2.81 (2.59–3.05) −0.16 (−0.19 to −0.13)
Central Europe 3.45 (3.19–3.76) 2.54 (2.34–2.77) 3.39 (3.13–3.67) 2.31 (2.13–2.51) −0.45 (−0.49 to −0.41)
Central Latin America 3.66 (3.31–4.04) 2.69 (2.46–2.96) 7.04 (6.46–7.7) 2.74 (2.52–3) 0 (−0.08 - 0.08)
Central Sub-Saharan Africa 1.92 (1.72–2.14) 4.64 (4.21–5.11) 4.3 (3.88–4.8) 4.52 (4.13–4.98) −0.12 (−0.14 to −0.11)
East Asia 37.65 (34.37–41.59) 3.08 (2.83–3.38) 48.27 (44.11–52.77) 2.62 (2.41–2.85) −0.58 (−0.66 to −0.5)
Eastern Europe 9.6 (8.67–10.71) 3.78 (3.42–4.21) 9.21 (8.29–10.27) 3.54 (3.2–3.94) −0.43 (−0.53 to −0.33)
Eastern Sub-Saharan Africa 5.91 (5.32–6.57) 4.43 (4.03–4.87) 12.06 (10.91–13.35) 4.19 (3.84–4.59) −0.26 (−0.31 to −0.21)
High-income Asia Pacific 5.4 (4.99–5.88) 2.84 (2.62–3.09) 6.73 (6.25–7.29) 3.14 (2.9–3.42) 0.38 (0.29–0.47)
High-income North America 11.91 (10.93–13.1) 4 (3.66–4.41) 16.16 (14.99–17.48) 4.32 (3.98–4.7) 0.41 (0.31–0.51)
North Africa and Middle East 12.54 (11.32–13.93) 4.4 (4–4.86) 25.74 (23.36–28.58) 4.36 (3.98–4.81) −0.07 (−0.1 to −0.03)
Oceania 0.14 (0.13–0.16) 2.6 (2.37–2.87) 0.29 (0.26–0.33) 2.61 (2.39–2.88) −0.01 (−0.03 - 0.02)
South Asia 36.1 (32.87–40.03) 4.05 (3.7–4.47) 61.19 (56.13–67.06) 3.66 (3.36–4) −0.63 (−0.85 to −0.41)
Southeast Asia 8.6 (7.78–9.53) 2.09 (1.9–2.29) 13.58 (12.43–14.87) 2 (1.84–2.19) −0.2 (−0.22 to −0.17)
Southern Latin America 1.71 (1.57–1.87) 3.48 (3.21–3.81) 2.34 (2.13–2.57) 3.38 (3.08–3.73) −0.17 (−0.2 to −0.14)
Southern Sub-Saharan Africa 1.71 (1.55–1.9) 3.97 (3.63–4.36) 2.83 (2.59–3.12) 3.91 (3.6–4.28) −0.06 (−0.1 to −0.03)
Tropical Latin America 5.29 (4.81–5.86) 3.85 (3.53–4.22) 8.03 (7.42–8.72) 3.44 (3.18–3.75) −0.47 (−0.95 - 0.01)
Western Europe 16.34 (15.28–17.6) 3.78 (3.52–4.08) 17.53 (16.19–19) 3.51 (3.23–3.84) −0.23 (−0.28 to −0.19)
Western Sub-Saharan Africa 5.62 (5.11–6.22) 4.05 (3.69–4.45) 12.62 (11.45–13.97) 4.02 (3.68–4.4) 0.11 (0.04–0.18)

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Q. Liu, et al. Journal of Psychiatric Research xxx (xxxx) xxx–xxx

Fig. 3. The incident cases of depression at a regional level. The left column in each group is case data in 1990 and the right column in 2017.

Oceania (106.85%). The ASR increased significantly in high-income
North America (EAPC = 0.46, 95% CI = 0.35 to 0.56) and decreased
significantly in South Asia (EAPC = −0.67, 95% CI = −0.90 to
−0.43) (Fig. 4, Table 1).
3.3. Global burden of dysthymia
Only 6.3% of the patients with depression in 2017 had dysthymia in
2017 (Fig. 5). The ASR of dysthymia varied widely among the 195
countries and regions in 2017, being highest in the United States (0.26
per 1000), followed by Canada (0.25 per 1000) and Greenland (0.25

Fig. 4. The EAPC of depression ASR from 1990 to 2017, both sexes, by region, and by types.

5
Q. Liu, et al.
Fig. 5. Contribution of major depressive disorder and dysthymia to absolute depression incident cases, both sexes, globally and by region, in 1990 and 2017.
per 1000) (Fig. S5), and lowest in Colombia (0.13 per 1000), followed
by Romania (0.15 per 1000) and Panama (0.15 per 1000). The number
of incident cases of dysthymia worldwide increased from 10 million in
1990 to 16 million in 2017, representing an increase of 58.98%. The
increase was largest in Qatar (601.91%), followed by the United Arab
Emirates (547.94%) and Bahrain (250.72%) (Fig. S6, Table S5). The
number of incident cases decreased from 1990 to 2017 in 11 countries,
by the most in Georgia (−27.65%), followed by Latvia (−22.52%) and
Lithuania (−15.44%).
The increase in ASR across the 195 countries and regions was largest
in Iran (EAPC = 0.12, 95% CI = 0.06 to 0.21), followed by India
(EAPC = 0.11, 95% CI = 0.09 to 0.13) and Portugal (EAPC = 0.11,
95% CI = 0.05 to 0.16) (Fig. S7). The decrease in ASR was largest in the
United States (EAPC = −0.33, 95% CI = −0.43 to −0.24), followed
by Colombia (EAPC = −0.21, 95% CI = −0.25 to–0.16) and Singa-
pore (EAPC = −0.21, 95% CI = −0.31 to −0.09).
The number of dysthymia cases in the five SDI regions increased
between 1990 and 2017. However, the ASR only increased in the high-
middle-SDI, low-SDI, and low-middle-SDI regions, and decreased in the
high-SDI and middle-SDI regions (Fig. 2, Table S1). The number of
dysthymia cases increased in all geographical regions (Fig. 3), by the
most in Western sub-Saharan Africa (130.23%), followed by Central
sub-Saharan Africa (130.04%) and Eastern sub-Saharan Africa
(117.02%). The ASR increased significantly in South Asia
(EAPC = 0.09, 95% CI = 0.07 to 0.11) and decreased significantly in
high-income North America (EAPC = −0.31, 95% CI = −0.39 to
−0.22) (Fig. 4, Table 1).
4. Discussion
Depression is a major public health problem and a major cause of
disability (Ferrari et al., 2013). This study used data published in the
GBD database to analyze the trends in depression from 1990 to 2017
and the global burden of depression. The results of this study can be
used by governments in all regions to develop appropriate preventive
measures for depression.
This study found that the number of incident cases of depression
worldwide increased by 49.86% from 1990 to 2017. The ASR was
highest in Lesotho, which is a poor landlocked country surrounded by
South Africa that has the third highest rate of HIV infection in the
world, the highest rate of HIV transmission among the high-prevalence
countries of southern Africa, and the lowest coverage of antiretroviral
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Journal of Psychiatric Research xxx (xxxx) xxx–xxx
treatment (Cerutti et al., 2016). People diagnosed with HIV/AIDS often
face social stigma and restrictions in employment and marriage, which
in some cases leads to divorce and family exclusion (Ironson et al.,
2017). People with HIV may experience depression for many reasons,
such as over concern about disease progression, pain, and death
(Junqueira et al., 2008). These characteristics of the situation in Le-
sotho mean that preventing AIDS could be a key measure to control
depression.
The ASR increased the most in Belgium, followed by Guyana and
South Korea. More research is needed to understand the causes of in-
creased ASR in depression in these countries. The country with the
largest reductions in ASR was Cuba, followed by Denmark and Estonia.
The ASR increased significantly in the high-SDI region and high-income
North America (EAPC = 0.41, 95% CI = 0.31 to 0.51). The rapid in-
creases in the ASR of depression in these regions could be due to them
having high levels of economic development, education, and social
pressure. Studies have found that education can affect cognitive ability.
It can affect depression in individuals and even in spouses (Lee, 2011).
Social stress is also a recognized risk factor for depression (Smith,
2014).
Our findings show that the proportions of both types of depression
were essentially stable both globally and regionally, with a large pro-
portion of patients having major depressive disorder. As the most
common cause of disability affecting nearly 16% of the global popu-
lation (Kessler et al., 2003), major depressive disorder is attracting in-
creasing attention. A WHO report predicted that major depressive dis-
order will become the leading cause of disability in the world by 2030
(Yang et al., 2015), and stated that controlling major depressive dis-
order is the best way to address depression. Regarding the ASR of
dysthymia, although this has decreased the most in the United States,
that country still had the highest ASR in 2017. This shows that the
United States should pay more attention to this problem and continue
to take measures aimed at controlling dysthymia. The ASR of dysthymia
decreased the most in the high-SDI region and high-income North
America, while the ASR of major depressive disorder increased the most
in these areas. This might be because some of the patients with dys-
thymia in these areas progressed to major depressive disorder.
This study identified that there are especially high rates of depres-
sion in some countries and regions, indicating the importance of iden-
tifying the underlying reasons. Although the pathogenesis of depression
is unknown, some studies have identified risk factors for depression.
Depressed people have a genetic predisposition, with the risk of
Q. Liu, et al.
depression being significantly higher in relatives of depressed peo-
ple—especially their first-degree relatives—than in the general popu-
lation (Mullins and Lewis, 2017). Research has shown that age and
gender are also linked to depression, with women more likely to suffer
from depression than men, and older people more likely to suffer from
depression as a result of more underlying illnesses (Faravelli et al.,
2013; Zhao et al., 2012). In addition to genetic and psychological fac-
tors, studies have found that unhealthy lifestyles such as smoking and
alcohol consumption increase the risk of depression (Gravely-Witte
et al., 2009; Pavkovic et al., 2018). In addition, insomnia reportedly
increases the risks of depression and anxiety (Li et al., 2016). Numerous
studies have shown that certain diseases are related to the occurrence of
depression. Depression is one of the most common neuropsychiatric
consequences of stroke, affecting about one-third of stroke patients
(Hackett et al., 2005). The prevalence of depressive symptoms in cancer
patients exceeds that in the general population, and depression is as-
sociated with a poor prognosis in cancer patients (Sotelo et al., 2014). It
has been found that children and adolescents with enterovirus infection
are susceptible to secondary depression (Liao et al., 2017). The risk of
depression is also higher in AIDS patients than in the general population
(Elbadawi and Mirghani, 2017).
The governments of countries with high rates of depression need to
focus on supporting relevant research to identify the underlying causes
and take measures to actively control the occurrence of depression.
Healthy lifestyles such as increasing the amount of physical exercise
and giving up smoking and drinking should be advocated. Patients with
stroke, cancer, AIDS, and other diseases should be followed up and
provided with appropriate medications to prevent the occurrence of
depression. Medication and psychological interventions should be ap-
plied to people who are already suffering from depression in order to
prevent suicidal behavior.
This study has performed the most comprehensive assessment yet of
the burden of depression. However, it was also subject to some lim-
itations. Firstly, the analyzed data were obtained from the GBD data-
base, in which depressive disorder is classified into major depressive
disorder and dysthymia, and so we were only able to analyze the global
burden of depression according to this classification method without
further subdivision. Secondly, only the global disease burden of de-
pression was analyzed, and the risk factors of depression in different
countries and regions were not addressed. Future studies are needed to
focus on this issue in order to guide the development and im-
plementation of specific policies for controlling depression in different
countries and regions.
5. Conclusion
Depression affects the mental and physical health of patients and, as
the most common mental illness, has become an important public
health problem. The findings of this study on the global burden of de-
pression from 1990 to 2017 will help governments around the world to
understand their own burdens of depression, and to formulate and
implement measures for the prevention and early treatment of de-
pression.
Conflicts of interest
The author reports no conflicts of interest in this work.
Funding
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
Journal of Psychiatric Research xxx (xxxx) xxx–xxx
doi.org/10.1016/j.jpsychires.2019.08.002.
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