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Article(id=1311349831377969668, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202511054, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1762272000000, receivedDateStr=2025-11-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579763502, onlineDateStr=2026-09-28, pubDate=1783612800000, pubDateStr=2026-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579763502, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579763502, creator=13701087609, updateTime=1790579763502, updator=13701087609, issue=Issue{id=1311349802038821144, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='1783612800000', pubDateStr='2026-07-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579756507, creator='13701087609', updateTime=1790588376143, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311385955492258162, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311385955496452467, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349802038821144, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2319, endPage=2326, ext={EN=ArticleExt(id=1311349831612850693, articleId=1311349831377969668, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Trends and projections of depressive disorder burden in aging societies of China, Japan, and the United States, 1990—2050, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trends and projections of the burden of depressive disorders in China, Japan, the United States, and globally from 1990 to 2050, and to explore epidemiological characteristics in the context of population aging.

Methods

Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized disability-adjusted life year rate (ASDR), and age-standardized lived years with disability rate (ASYR) for depressive disorders during 1990—2021 were obtained from the Global Burden of Disease (GBD) 2021 database. Trends were stratified by age and sex. The Nordpred model was used for projections to 2050. Differences were examined in relation to the socio-demographic index (SDI).

Results

Global ASIR increased from 1990 to 2021. China showed a slight decline in ASIR but incident cases grew from 30.5 to 42.4 million. The United States had the highest burden, with a 56% increase in ASDR and an accelerated rise after 2010, while Japan remained relatively stable. The projections showed that ASIR and ASDR in the United States would continue to increase by 2050, and aging-driven case expansion in China and Japan. Global ASIR increased from 3 305.96 per 100 000 in 1990 to 4 212.34 per 100 000 in 2021. China showed slight declines in ASIR and ASPR, with ASPR decreasing from 3 071.84 per 100 000 to 2 875.68 per 100 000, but the number of incident cases increased to 42.36 million due to population size. The United States had the highest disease burden, with ASIR increasing to 6 782.80 per 100 000 and ASDR increasing to 1 010.70 per 100 000. Japan’s ASIR increased to 2 992.26 per 100 000. SDI was positively correlated with ASIR (r=0.367, P<0.001). Females consistently exhibited a higher burden, with the largest sex differences in the United States. Age-specific burden was concentrated among those aged 15-49 years in the United States and among those aged ≥70 years in China. In Japan, the burden was characterized by a dual-peak distribution among both young and older populations.

Conclusion

The burden of depressive disorders in China, Japan, and the United States is expected to increase under population aging, with distinct national patterns: rapid escalation in the United States, heavy absolute burden in China, and a dual-risk expansion toward both younger and older generations in Japan. Strengthening primary and community mental health services targeting females, older adults, and young populations is warranted.

, authors=Xiao-lin YE1, 2, Yun TAN3, Han-yue REN1, 2, Li-yang MAO1, 2, Hui-hui GAO1, 2, Li-mei CHEN1, 2, Yan-yan FENG1, 2, Jing-jing LI1, 2, Peng ZHOU1, 2, authorsList=Xiao-lin YE, Yun TAN, Han-yue REN, Li-yang MAO, Hui-hui GAO, Li-mei CHEN, Yan-yan FENG, Jing-jing LI, Peng ZHOU, authorCompany=null, correspAuthors=Peng ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311349834985071126, articleId=1311349831377969668, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2050年中国、日本、美国老龄化社会抑郁障碍疾病负担趋势及预测, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2050年中国、日本、美国及全球抑郁障碍疾病负担变化趋势及预测，探讨老龄化背景下流行病学特征。

方法

基于全球疾病负担研究（2021）数据，评估1990—2021年年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化伤残调整生命年率（age-standardized disabilty-adjusted life year rate，ASDR）及年龄标化伤残生存年率（age-standardized lived years with disability rate，ASYR），按性别与年龄分层分析，并采用Nordpred模型预测至2050年。结合社会人口学指数（socio-demographic index，SDI）探讨差异。

结果

1990—2021年，全球ASIR持续上升；中国ASIR略有下降，但发病例数由3 050万增至4 240万。美国疾病负担最高，ASDR上升56%，2010年后升幅显著；日本整体较稳定。至2050年，美国ASIR和ASDR将继续上升；中国与日本病例规模将随老龄化持续扩大。1990—2021年，全球ASIR由3 305.96/10万升至4 212.34/10万。中国ASIR与ASPR略有下降，其中ASPR由 3 071.84/10万降至2 875.68/10万，但受人口规模驱动，发病例数增至4 236万。美国疾病负担最高，ASIR升至6 782.80/10万，ASDR升至1 010.70/10万。日本ASIR升至 2 992.26/10万。SDI与ASIR呈正相关（r=0.367，P<0.001）。女性负担普遍高于男性，美国性别差异最明显。年龄分布上，美国集中于15～49岁，中国以≥70岁为主，日本呈青年与老年“双峰”。

结论

中国、日本、美国抑郁障碍疾病负担在老龄化背景下持续增加。美国上升最快，中国绝对病例数最大，日本需警惕负担向年轻化与高龄化两极扩张的风险。未来需关注女性、老年与青年重点人群，加强基层与社区心理卫生服务体系建设。

, authors=叶小琳1, 2, 谭云3, 任涵月1, 2, 毛李炀1, 2, 高慧惠1, 2, 陈丽梅1, 2, 封艳艳1, 2, 李晶晶1, 2, 周鹏1, 2, authorsList=叶小琳, 谭云, 任涵月, 毛李炀, 高慧惠, 陈丽梅, 封艳艳, 李晶晶, 周鹏, authorCompany=null, correspAuthors=周鹏, authorNote=

叶小琳（1998—），女，博士，中医师，研究方向：中医防治心身情志疾病

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周鹏，E-mail：
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The burden of depressive disorders in China, Japan, the United States and global, 1990—2021

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国家性别发病（人年）标化发病率（1/10万）患病（人年）标化患病率（1/10万）
1990年2021年1990年2021年1990年2021年1990年2021年
中国男性10 775 71415 901 9781 838.071 765.3712 935 41420 610 5892 277.122 222.58
女性19 715 32226 458 2023 449.632 934.5521 543 97632 504 0673 900.993 543.44
总体30 491 03642 360 1812 628.672 345.0834 479 39053 114 6563 071.842 875.68
日本男性1 259 7971 602 4141 850.932 394.111 290 0631 565 0431 864.832 226.10
女性1 952 9122 587 4962 734.583 594.961 793 1132 266 3792 484.593 059.01
总体3 212 7084 189 9092 303.892 992.263 083 1763 831 4222 181.892 640.69
美国男性3 759 4867 909 6352 846.684 708.043 797 0476 799 3372 843.583 948.69
女性6 855 54114 867 4385 025.828 866.236 737 22612 367 4544 857.967 150.18
总体10 615 02822 777 0723 947.296 782.8010 534 27319 166 7913 863.405 549.07
全球男性68 651 829.20131 144 081.822 556.162 394.1169 855 599.41137 840 474.822 600.983 481.36
女性107 675 384.54201 266 251.454 066.473 594.96115 660 529.03219 598 254.814 368.045 584.95
总体176 327 213.74332 410 333.273 305.964 212.34185 516 128.43357 438 729.633 478.244 529.5
国家性别DALYs（人年）标化DALYs率（1/10万）YLDs（人年）标化YLDs率（1/10万）
1990年2021年1990年2021年1990年2021年1990年2021年
中国男性1 994 3523 028 508343.83330.6019 943.5230 285.08343.83330.60
女性3 432 3174 837 434608.67533.0434 323.1748 374.34608.67533.04
总体5 426 6697 865 943473.32430.6154 266.6978 659.43473.32430.61
日本男性213 127262 058310.44387.662 131.272 620.58310.44387.66
女性307 756393 454430.66551.393 077.563 934.54430.66551.39
总体520 883655 512371.90469.105 208.836 555.12430.66469.10
美国男性630 3561 209 235473.47714.596 303.5612 092.35473.47714.59
女性1 124 5382 213 941818.501 307.8111 245.3822 139.41818.501 307.81
总体1 754 8933 423 176647.841 010.7017 548.9334 231.76647.841 010.70
全球男性11 464 941.6322 210 938.94426.88560.9711 464 941.6322 210 938.94426.88560.97
女性18 209 724.1734 119 422.20687.71867.7518 209 724.1734 119 422.20687.71867.75
总体29 674 665.8056 330 361.15556.37713.8229 674 665.8056 330 361.15556.37713.82
), ArticleFig(id=1311349845294670445, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311349831377969668, language=CN, label=表1, caption=

1990—2021年中国、日本、美国与全球抑郁障碍疾病负担状况

, figureFileSmall=null, figureFileBig=null, tableContent=
国家性别发病（人年）标化发病率（1/10万）患病（人年）标化患病率（1/10万）
1990年2021年1990年2021年1990年2021年1990年2021年
中国男性10 775 71415 901 9781 838.071 765.3712 935 41420 610 5892 277.122 222.58
女性19 715 32226 458 2023 449.632 934.5521 543 97632 504 0673 900.993 543.44
总体30 491 03642 360 1812 628.672 345.0834 479 39053 114 6563 071.842 875.68
日本男性1 259 7971 602 4141 850.932 394.111 290 0631 565 0431 864.832 226.10
女性1 952 9122 587 4962 734.583 594.961 793 1132 266 3792 484.593 059.01
总体3 212 7084 189 9092 303.892 992.263 083 1763 831 4222 181.892 640.69
美国男性3 759 4867 909 6352 846.684 708.043 797 0476 799 3372 843.583 948.69
女性6 855 54114 867 4385 025.828 866.236 737 22612 367 4544 857.967 150.18
总体10 615 02822 777 0723 947.296 782.8010 534 27319 166 7913 863.405 549.07
全球男性68 651 829.20131 144 081.822 556.162 394.1169 855 599.41137 840 474.822 600.983 481.36
女性107 675 384.54201 266 251.454 066.473 594.96115 660 529.03219 598 254.814 368.045 584.95
总体176 327 213.74332 410 333.273 305.964 212.34185 516 128.43357 438 729.633 478.244 529.5
国家性别DALYs（人年）标化DALYs率（1/10万）YLDs（人年）标化YLDs率（1/10万）
1990年2021年1990年2021年1990年2021年1990年2021年
中国男性1 994 3523 028 508343.83330.6019 943.5230 285.08343.83330.60
女性3 432 3174 837 434608.67533.0434 323.1748 374.34608.67533.04
总体5 426 6697 865 943473.32430.6154 266.6978 659.43473.32430.61
日本男性213 127262 058310.44387.662 131.272 620.58310.44387.66
女性307 756393 454430.66551.393 077.563 934.54430.66551.39
总体520 883655 512371.90469.105 208.836 555.12430.66469.10
美国男性630 3561 209 235473.47714.596 303.5612 092.35473.47714.59
女性1 124 5382 213 941818.501 307.8111 245.3822 139.41818.501 307.81
总体1 754 8933 423 176647.841 010.7017 548.9334 231.76647.841 010.70
全球男性11 464 941.6322 210 938.94426.88560.9711 464 941.6322 210 938.94426.88560.97
女性18 209 724.1734 119 422.20687.71867.7518 209 724.1734 119 422.20687.71867.75
总体29 674 665.8056 330 361.15556.37713.8229 674 665.8056 330 361.15556.37713.82
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1990—2050年中国、日本、美国老龄化社会抑郁障碍疾病负担趋势及预测
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叶小琳 1, 2 , 谭云 3 , 任涵月 1, 2 , 毛李炀 1, 2 , 高慧惠 1, 2 , 陈丽梅 1, 2 , 封艳艳 1, 2 , 李晶晶 1, 2 , 周鹏 1, 2
现代预防医学 | 流行病与统计方法 2026,53(13): 2319-2326
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现代预防医学 |流行病与统计方法 2026 , 53 (13) : 2319 -2326
1990—2050年中国、日本、美国老龄化社会抑郁障碍疾病负担趋势及预测
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叶小琳（1998—），女，博士，中医师，研究方向：中医防治心身情志疾病

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叶小琳（1998—），女，博士，中医师，研究方向：中医防治心身情志疾病

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叶小琳1, 2, 谭云3, 任涵月1, 2, 毛李炀1, 2, 高慧惠1, 2, 陈丽梅1, 2, 封艳艳1, 2, 李晶晶1, 2, 周鹏1, 2
作者信息
  • 1.广州中医药大学第七临床医学院，广东 深圳 518133
  • 2.深圳市宝安区中医院，广东 深圳 518133
  • 3.广州中医药大学
通讯作者:
周鹏，E-mail：
作者简介:

叶小琳（1998—），女，博士，中医师，研究方向：中医防治心身情志疾病

Trends and projections of depressive disorder burden in aging societies of China, Japan, and the United States, 1990—2050
Xiao-lin YE1, 2, Yun TAN3, Han-yue REN1, 2, Li-yang MAO1, 2, Hui-hui GAO1, 2, Li-mei CHEN1, 2, Yan-yan FENG1, 2, Jing-jing LI1, 2, Peng ZHOU1, 2
Affiliations
  • The Seventh Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518133, China
出版时间: 2026-07-10 doi: 10.20043/j.cnki.MPM.202511054
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摘要
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目的

分析1990—2050年中国、日本、美国及全球抑郁障碍疾病负担变化趋势及预测，探讨老龄化背景下流行病学特征。

方法

基于全球疾病负担研究（2021）数据，评估1990—2021年年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化伤残调整生命年率（age-standardized disabilty-adjusted life year rate，ASDR）及年龄标化伤残生存年率（age-standardized lived years with disability rate，ASYR），按性别与年龄分层分析，并采用Nordpred模型预测至2050年。结合社会人口学指数（socio-demographic index，SDI）探讨差异。

结果

1990—2021年，全球ASIR持续上升；中国ASIR略有下降，但发病例数由3 050万增至4 240万。美国疾病负担最高，ASDR上升56%，2010年后升幅显著；日本整体较稳定。至2050年，美国ASIR和ASDR将继续上升；中国与日本病例规模将随老龄化持续扩大。1990—2021年，全球ASIR由3 305.96/10万升至4 212.34/10万。中国ASIR与ASPR略有下降，其中ASPR由 3 071.84/10万降至2 875.68/10万，但受人口规模驱动，发病例数增至4 236万。美国疾病负担最高，ASIR升至6 782.80/10万，ASDR升至1 010.70/10万。日本ASIR升至 2 992.26/10万。SDI与ASIR呈正相关（r=0.367，P<0.001）。女性负担普遍高于男性，美国性别差异最明显。年龄分布上，美国集中于15～49岁，中国以≥70岁为主，日本呈青年与老年“双峰”。

结论

中国、日本、美国抑郁障碍疾病负担在老龄化背景下持续增加。美国上升最快，中国绝对病例数最大，日本需警惕负担向年轻化与高龄化两极扩张的风险。未来需关注女性、老年与青年重点人群，加强基层与社区心理卫生服务体系建设。

抑郁障碍  /  疾病负担  /  老龄化社会  /  Nordpred预测模型
Objective

To analyze the trends and projections of the burden of depressive disorders in China, Japan, the United States, and globally from 1990 to 2050, and to explore epidemiological characteristics in the context of population aging.

Methods

Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized disability-adjusted life year rate (ASDR), and age-standardized lived years with disability rate (ASYR) for depressive disorders during 1990—2021 were obtained from the Global Burden of Disease (GBD) 2021 database. Trends were stratified by age and sex. The Nordpred model was used for projections to 2050. Differences were examined in relation to the socio-demographic index (SDI).

Results

Global ASIR increased from 1990 to 2021. China showed a slight decline in ASIR but incident cases grew from 30.5 to 42.4 million. The United States had the highest burden, with a 56% increase in ASDR and an accelerated rise after 2010, while Japan remained relatively stable. The projections showed that ASIR and ASDR in the United States would continue to increase by 2050, and aging-driven case expansion in China and Japan. Global ASIR increased from 3 305.96 per 100 000 in 1990 to 4 212.34 per 100 000 in 2021. China showed slight declines in ASIR and ASPR, with ASPR decreasing from 3 071.84 per 100 000 to 2 875.68 per 100 000, but the number of incident cases increased to 42.36 million due to population size. The United States had the highest disease burden, with ASIR increasing to 6 782.80 per 100 000 and ASDR increasing to 1 010.70 per 100 000. Japan’s ASIR increased to 2 992.26 per 100 000. SDI was positively correlated with ASIR (r=0.367, P<0.001). Females consistently exhibited a higher burden, with the largest sex differences in the United States. Age-specific burden was concentrated among those aged 15-49 years in the United States and among those aged ≥70 years in China. In Japan, the burden was characterized by a dual-peak distribution among both young and older populations.

Conclusion

The burden of depressive disorders in China, Japan, and the United States is expected to increase under population aging, with distinct national patterns: rapid escalation in the United States, heavy absolute burden in China, and a dual-risk expansion toward both younger and older generations in Japan. Strengthening primary and community mental health services targeting females, older adults, and young populations is warranted.

Depressive disorders  /  Disease burden  /  Aging society  /  Nordpred prediction model
叶小琳, 谭云, 任涵月, 毛李炀, 高慧惠, 陈丽梅, 封艳艳, 李晶晶, 周鹏. 1990—2050年中国、日本、美国老龄化社会抑郁障碍疾病负担趋势及预测. 现代预防医学, 2026 , 53 (13) : 2319 -2326 . DOI: 10.20043/j.cnki.MPM.202511054
Xiao-lin YE, Yun TAN, Han-yue REN, Li-yang MAO, Hui-hui GAO, Li-mei CHEN, Yan-yan FENG, Jing-jing LI, Peng ZHOU. Trends and projections of depressive disorder burden in aging societies of China, Japan, and the United States, 1990—2050[J]. Modern Preventive Medicine, 2026 , 53 (13) : 2319 -2326 . DOI: 10.20043/j.cnki.MPM.202511054
正文
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抑郁障碍（depressive disorders）是一类以持续性情绪低落、兴趣丧失及认知功能受损为主要特征的精神障碍，其发病机制涉及神经递质系统紊乱及下丘脑-垂体-肾上腺轴功能异常，并与遗传及社会应激等多因素相互作用有关[1-3]。该疾病不仅显著影响个体情绪与社会功能，还与心血管疾病、糖尿病等慢性病存在双向关联，可导致长期残疾并增加过早死亡风险，对公共卫生系统造成沉重负担[4]。近年来，抑郁障碍已成为全球主要致残性精神疾病之一，其发病率与患病率在多地区持续上升[5]。从区域分布看，抑郁障碍负担呈明显差异。在高收入国家如美国，青年及女性群体负担较重，提示社会心理压力累积及卫生服务体系面临挑战[6]；在东亚地区，中国年龄标化发病率相对稳定，但受人口老龄化驱动，患病人数和健康损失持续增加；日本整体水平较低，但青年群体风险呈上升趋势[7]。上述差异反映了社会经济发展、人口结构及医疗体系等多重因素的综合影响。
尽管已有研究报道抑郁障碍负担及其变化趋势[8]，但针对跨国差异、年龄结构特征及老龄化背景下长期预测的系统分析仍较为有限。中国、日本与美国分别代表不同发展阶段和人口结构特征，均面临老龄化加速及心理健康服务需求增长的共同挑战，同时在社会经济水平及卫生体系方面存在显著差异，具有重要的比较研究价值。因此，本研究基于全球疾病负担研究（Global Burden of Disease，GBD 2021）数据，系统分析1990—2021年中国、日本、美国抑郁障碍疾病负担变化趋势，并预测至2050年的发展格局。通过评价年龄标化发病率（age-standardized incidence rate，ASIR）、年龄标化患病率（age-standardized prevalence rate，ASPR）、年龄标化伤残调整生命年率（age-standardized disability-adjusted life-years rate，ASDR）及年龄标化伤残生存年率（age-standardized years lived with disability rate，ASYR），结合性别、年龄分布及社会人口学因素，旨在揭示老龄化背景下抑郁障碍负担的流行特征，为制定分层分人群的精神卫生防控策略提供依据。
1　资料与方法
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1.1　资料来源
本研究的数据来源于GBD 2021数据库（https://ghdx.healthdata.org/gbd-results-tool）。通过GHDx查询工具筛选指标为“Incidence”“Prevalence”“DALYs”“YLDs”，疾病选择“Depressive disorders”，按国际疾病分类第十版（ICD-10）F32-F33编码进行定义。提取1990—2021年中国、日本、美国及全球人群的ASIR、ASPR、ASDR和ASYR，并按年龄（5岁分层）、性别（男、女）与地区分层整理。
1.2　评价指标
选取ASIR、ASPR、ASDR和ASYR用于评估抑郁障碍疾病负担，均基于GBD 2021全球标准人口进行年龄标准化。其中，ASDR用于衡量抑郁障碍所致的总体健康损失水平，ASYR用于反映非致死性健康损失水平。本研究同时提取社会人口学指数（socio-demographic index，SDI）、人口老龄化比例与城镇化率，用于跨国差异解释与社会决定因素分析。其中，SDI为GBD研究提出的综合发展指标，由人均收入、受教育年限和总生育率标准化计算，取值范围为0～1，数值越高表示社会经济发展水平越高。
1.3　统计学方法
采用Excel 2021进行数据整理，R软件（4.4.0版）完成统计分析与可视化。对各指标进行描述性分析，并按性别与年龄组（0～14岁、15～49岁、50～69岁、≥70岁）分层展示；采用Loess法拟合平滑趋势，并计算变化幅度。基于Nordpred模型预测至2050年变化趋势；采用Pearson相关分析评估SDI与疾病负担指标的关系。检验水准α=0.05。
2　结果
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2.1　全球及中国、日本、美国抑郁障碍疾病负担
1990—2021年，全球及中国、日本、美国抑郁障碍疾病负担总体呈上升趋势。全球ASIR由3 305.96/10万升至4 212.34/10万，病例数增至3.32亿。中国ASIR略有下降（2 628.67/10万降至2 345.08/10万），但病例数由3 049万增至4 236万。美国ASIR由3 947.29/ 10万升至6 782.80/10万，显著高于中国与日本；日本由2 303.89/10万升至2 992.26/10万，整体水平较低。患病方面，美国ASPR由3 863.40/10万升至5 549.07/ 10万，增幅最明显；日本由2 181.89/10万升至2 640.69/10万；中国则由3 071.84/10万降至2 875.68/10万。全球DALYs由2 967万增至5 633万，接近翻倍；美国年龄标化DALYs率由647.84/10万升至1 010.70/10万，上升56%，负担最高。性别差异方面，各国女性发病率与患病率均高于男性。中国2021年女性ASIR为2 934.55/10万，男性为1 765.37/10万。总体来看，美国抑郁障碍负担最高且增长最快，日本处于中等水平，中国标化率较低但患者规模最大。见表1。
2.2　中国、日本、美国抑郁障碍疾病负担的时间趋势及差异
1990—2021年，中国、日本、美国抑郁障碍疾病负担呈现显著跨国差异。美国ASIR、ASPR、ASDR及ASYR始终保持最高水平，并自2000年后持续上升；中国与日本整体水平较低，但近年均呈轻度上升趋势，其中中国总体水平高于日本。见图1。
2.3　中国、日本、美国抑郁障碍疾病负担的趋势及预测
基于Nordpred模型预测，1990—2050年中国、日本、美国抑郁障碍负担呈阶段性变化：1990—2005年相对平稳，2005—2020年增长加快，2020年后持续上升。美国各指标始终居首，2000年后持续攀升，2015年后增速进一步加快。中国标化水平较低，但受人口规模与老龄化驱动，病例数及健康损失将持续扩大。日本总体水平较低且变化平缓，但在老龄化与青年风险增加背景下，未来仍呈上升趋势。见图2。
2.4　中国、日本、美国抑郁障碍疾病负担的性别差异及趋势
2021年，中国、日本和美国抑郁障碍疾病负担均存在显著性别差异，女性在ASIR、ASPR、ASDR及ASYR等指标上均高于男性，见图3。美国女性发病率和患病率最高且明显高于男性；中国与日本亦呈相同趋势。1990—2021年，美国女性相关指标持续上升，男性虽增加但始终较低；中国与日本性别差异总体稳定，2010年后女性略有上升。ASDR与ASYR变化趋势一致，性别差异在整个观察期持续存在，见图4。
2.5　中国、日本、美国抑郁障碍年龄分层疾病负担
年龄分层分析显示，三国抑郁障碍负担重心存在差异：在ASDR、ASYR、ASIR和ASPR上，美国均集中于15～49岁人群，显示抑郁障碍对劳动力人口影响最为严重；中国呈现典型老龄化驱动特征，各指标均以≥70岁组贡献最为突出；日本则表现为“双峰驱动”模式，15～49岁组是ASIR的主要来源，而在ASPR、ASDR和ASYR上，15～49岁与≥70岁组贡献水平接近，呈现青年与老年群体负担双重驱动的特征。见图5。
2.6　中国、日本、美国人口老龄化、经济发展与城市化的比较趋势
1990—2021年，中国、日本、美国在人口老龄化、经济增长和城市化方面差异显著。人口老龄化方面，日本水平最高且持续上升，2020年超过28%；美国缓慢增长；中国起点最低但近十年加速明显，见图6A。经济增长方面，美国GDP长期居首；中国2000年后快速增长并于2010年超过日本；日本增速趋缓，见图6B。城市化方面，日本和美国长期维持在75%～80%高水平，中国由不足30%升至2020年超过60%，转型显著，见图6C。
2.7　中国、日本、美国SDI与抑郁障碍疾病负担的相关性
如图7所示，SDI与抑郁障碍疾病负担呈正相关。ASIR与SDI呈中度正相关（R=0.367，P<0.001），高SDI的美国ASIR水平最高，提示社会发展水平越高，疾病识别与报告率可能越高。年龄标化患病率与SDI相关性不显著（R=0.104，P=0.315）。ASDR和ASYR与SDI呈弱正相关（R=0.261，P<0.05），表明即使在高SDI国家，该病造成的健康损失依然严峻，非致死性负担不容忽视。
3　讨论
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本研究系统分析了1990—2021年全球及中国、日本、美国抑郁障碍疾病负担的变化趋势，并预测至2050年的发展格局。本研究发现，在相似的老龄化趋势下，中、日、美三国抑郁障碍负担轨迹显著分化。既往研究[9-10]与本研究的相关性分析提示，其差异并非单一人口学因素所致，而是由社会心理压力结构、医疗服务体系碎片化或基层覆盖差异，以及不同文化背景下对污名化的应对方式等多重机制共同塑造的结果。美国呈高SDI背景下高负担且快速上升趋势；中国表现为绝对病例数迅速扩张的“规模驱动型”；日本则呈青年与老年风险并存的“结构性转移”。本研究揭示的国家差异、性别差异与年龄分布特征，为制定分层、分人群的精准干预策略提供了重要依据。
全球层面看，1990—2021年抑郁障碍疾病负担持续加重。全球ASIR由3 305.96/10万升至4 212.34/10万，DALYs总量由约2 967万增至5 633万，升幅接近一倍。这不仅反映了抑郁障碍发病风险的普遍上升，更体现了该病所致总体健康损失的剧烈扩张。这种趋势的形成，一方面源于现代社会环境变迁下，人群社会心理压力的长期累积与心理应激事件的增加；另一方面，伤残负担倍增也折射出当前心理卫生服务供给在可及性、连续性及干预效能方面，仍难以应对日益严峻的疾病挑战。新冠疫情暴发后，居家隔离、社会交往受限、医疗服务中断及经济不确定性增加等因素叠加，导致全球抑郁障碍相关指标在短期内明显上升[11-14]。三国呈现显著差异：美国负担高位且持续上升，ASDR升幅达56%，女性尤为突出。其高度专科化、依赖商业保险且基层干预不足的服务体系可能加剧了长期致残负担[15]。中国ASIR微降，但在人口规模与老龄化驱动下，病例数激增至4 240万，易因基层覆盖与老年心理管理体系不完善导致延迟干预[16-18]。日本总体负担低但ASIR上升，青年风险增加，提示社会支持弱化、就业不稳及文化因素共同阻碍了心理问题的早期识别[19]。
性别差异是抑郁障碍的重要流行病学特征。中国、日本、美国女性在发病率、患病率及致残负担方面均高于男性，美国差异最为显著。女性在孕产期及围绝经期等阶段的生物学易感性，加之承担更多照护责任并面临家庭与职场双重压力，使其成为重点防控人群[20-21]。疫情期间照护负担与就业压力叠加，可能进一步扩大性别心理健康差距。年龄分布方面，各国呈现不同模式：美国主要集中于15～49岁人群，对劳动力供给和社会生产力影响显著[22]；中国以≥70岁老年群体为主，应纳入慢病管理体系；日本呈现青年与老年“双峰”特征，反映社会支持弱化与就业压力增加的综合影响[22-23]。预测结果显示，至2050年美国抑郁障碍负担仍将快速上升，而中国与日本虽标准化率变化有限，但受老龄人口规模扩张影响，患者数量和健康损失仍将不断增加。三国抑郁负担差距预计进一步扩大，提示抑郁障碍受社会经济结构、医疗体系响应能力及人口学变化的共同影响[24]。因此，美国应提升抑郁障碍治疗与康复管理的连续性，中国需加强基层精神卫生服务与持续治疗可及性，日本则应警惕负担向年轻人群转移，及早在学校和职场开展心理干预。
本研究存在一定局限：（1）GBD数据可能受诊断实践及污名化影响，限制跨国可比性；（2）未纳入疾病严重程度及治疗差异，影响临床解读；（3）缺乏个体层面数据，无法进行因果推断；（4）同时疫情长期影响可能未被充分反映。此外，各国内部心理健康资源与文化差异未能深入分析。尽管如此，本研究仍为制定与优化心理健康政策提供了重要参考。
本研究揭示中国、日本、美国在老龄化背景下抑郁障碍负担持续上升，并呈现显著国家差异、性别差异与年龄分布特征。结果提示，应强化重点人群识别与持续干预，完善基层与社区心理健康服务体系，提高社会支持与医疗协作能力。未来需关注社会人口学因素与健康行为对负担的共同影响，推动早发现、早治疗与功能康复协同实施，以助力心理健康与健康老龄化目标实现。
基金
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  • 国家自然科学基金青年项目(82405554)
  • 广东省基础与应用基础研究基金会(2022A1515110808)
  • 深圳市医学研究专项(C2501039)
文献
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2026年第53卷第13期
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doi: 10.20043/j.cnki.MPM.202511054
  • 接收时间：2025-11-05
  • 首发时间：2026-09-28
  • 出版时间：2026-07-10
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  • 收稿日期：2025-11-05
基金
国家自然科学基金青年项目(82405554)
广东省基础与应用基础研究基金会(2022A1515110808)
深圳市医学研究专项(C2501039)
作者信息
    1.广州中医药大学第七临床医学院，广东 深圳 518133
    2.深圳市宝安区中医院，广东 深圳 518133
    3.广州中医药大学

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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