Introduction
Anxiety disorders are chronic and disabling conditions characterised by intense and prolonged feelings of fear and distress.1 They stand as the most prevalent mental disorders globally, causing health loss, role impairment2 and disadvantages across the life span.3 Anxiety disorders may occur early in life and often recur intermittently,4 making them one of the most disabling mental disorders.5
The estimated number of newly diagnosed patients with anxiety disorders has increased significantly over the years,6 7 causing more than 44.5 million disability-adjusted life years (DALYs).8 It is crucial to grasp the latest spatial distribution and temporal trends of anxiety disorders worldwide, as they not only affect individuals and households but also communities and economies. The estimated global cost of anxiety disorders averages 2.08% of health expenditures, equivalent to 0.22% of global gross domestic product (GDP).9
Adolescents aged 10–19 years, as defined by the United Nations, are particularly vulnerable to anxiety disorders due to the transitional period they undergo between childhood and adulthood,10 which involves physical, emotional and psychosocial changes. Developmental theorists have identified adolescence as a phase of increased risk for stress and mental disorders.11 During this phase, adolescents establish behaviour patterns related to physical activity and social activity, which may serve as potential risk or protective factors for their current and future health.12 In high-income countries, the prevalence of total childhood mental disorders is 12.7%, with anxiety disorders accounting for 5.2%.13 Additionally, it is estimated that 6.5% of adolescents aged 13–17 years have been diagnosed with anxiety disorders,14 suggesting that the incidence of adolescent anxiety disorders may fluctuate with changes in social development. While several reviews have reported varying burdens of anxiety disorders among children and adolescents,15 16 few studies have used DALYs to describe the burden in detail. Given that adolescents constitute almost a sixth of the global population,17 it is crucial to estimate the burden of anxiety disorders in this age group.
Significant geographical disparities exist in the burden of anxiety disorders and accessibility to mental health resources. Limited incidence data hinder the understanding of anxiety disorders burden among adolescents globally, particularly in low-income and middle-income countries.18 These countries account for 90% of the global adolescent population,19 and often provide severely limited healthcare services for children and adolescents.17 ,20 Only 44.2% of children with mental disorders received any form of healthcare service even in high-income countries.13 The Lancet has urged the global community to expand mental health services, especially in low-income and middle-income countries.21 However, services for anxiety disorders are not given global health priority due to insufficient information on global or regional time trends, and few countries have collected and reported data using the same instrument over the years.
Regional variations in adolescent anxiety disorders might stem from national disparities, including healthcare resources and the overall national environment. Research indicates that limited access to psychiatrists contributes to delayed treatment for adolescents with anxiety disorders.22 23 Moreover, the Environmental, Social and Governance (ESG) Index reveals the societal contexts, environmental stressors and governance structures that may exacerbate or alleviate anxiety levels among adolescents. The quality of life (QoL) Index serves as a comprehensive measure of the overall well-being and life satisfaction of adolescents. Previous research has found that adverse living environments characterised by insecurity and conflict may decrease the QoL and elevate anxiety levels among adolescents.24 To substantiate the divergence in adolescent anxiety across nations, we investigated the interplay between healthcare accessibility, the ESG Index, the QoL Index and anxiety disorders.
This study presents the prevalence of anxiety disorders among adolescents and the associated DALYs in 1990 and 2019, along with global and national trends. DALY is the age loss caused by certain diseases; one DALY can be regarded as the loss of one year in full health. DALYs are used to assess health status and understand the impact of diseases or social environments on patient health. DALYs also provide important reference for health resource allocation and disease prevention policies.
We aimed to (1) Estimate the incidence trends of anxiety disorders in 204 countries from 1990 to 2019 among children and adolescents aged 10–19 years, (2) Compare the incidence and disease burden of anxiety disorders across different countries or different historical periods in the same region, and (3) Examine the association between healthcare access, the ESG Index and the QoL Index and the incidence of anxiety disorders. This research aims to facilitate the assessment and interpretation of Global Burden of Disease (GBD) 2019 estimates for stakeholders, including governments and international agencies, researchers and clinicians engaged in the identification, management and prevention of adolescent mental health, and highlight priority areas for improvement in the mental disorder burden estimation methodology.