National and subnational burden of mental disorders in China, 1990–2023: a systematic analysis of the Global Burden of Disease Study 2023

Background Mental disorders represent a growing public health priority in China. Existing studies have largely relied on superseded data iterations and focused on specific population subsets or disease categories, leaving a gap in understanding the full epidemiological landscape of mental health across the country. This study provides the most up-to-date and comprehensive assessment of the burden of mental disorders in China and its provinces, utilizing the latest estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. Methods Following the GBD 2023 methodology, we systematically analyzed epidemiological and demographic data to assess the prevalence, disability-adjusted life year (DALY), age-standardized prevalence rate (ASPR) and age-standardized DALY rate (ASDR) for mental disorders and ten subtypes in China and its 33 provincial-level administrative units from 1990 to 2023. Findings In 2023, the estimated ASPR of mental disorders in China was 12,706 (95% uncertainty interval: 11,438, 14,573) per 100,000 population, reflecting a 14.6% (3.5, 30.7) increase since 1990. The ASDR reached 1718 (1272, 2307) per 100,000, rising by 18.4% (5.3, 36.9) over the past three decades. Depressive and anxiety disorders remained the dominant contributors, accounting for 35.6% and 26.3% of overall DALYs attributable to mental disorders, respectively. Furthermore, eating disorders exhibited the largest growth in ASPR (63.4% [58.2, 68.2]). Substantial subnational variations were observed, with the highest ASPRs in Hong Kong, Gansu, Macao, and Shandong, and the largest percentage increases in Macao, Hubei, Hong Kong, Xizang, and Ningxia. Females experienced a higher ASPR from depressive disorders, while males bore a heavier burden of autism spectrum disorders, attention-deficit/hyperactivity disorder, and conduct disorder. Across the lifespan, the burden of DALYs was relatively higher in the 5–19, 30–39, and 50–59 age groups. Interpretation China has witnessed a substantial escalation in the burden of mental disorders over the past three decades. This complex epidemiological landscape, characterized by distinct regional, sex, and age-specific vulnerabilities, underscores the necessity for structural balancing and targeted life-course interventions. These up-to-date estimates provide a valuable evidence base for policymakers to further optimize resource allocation and implement tailored life-course interventions within the "Healthy China 2030" framework. Funding Sci-Tech Innovation 2030—Major Project of Brain Science and Brain-Inspired Intelligence Technology (No. 2021ZD0200600); 2025 China Association for Science and Technology (CAST) Young Science and Technology Talents Cultivation Project—Special Program for Doctoral Students.