To analyze the trends in the disease burden of schizophrenia among Chinese adolescents aged 10-24 years from 1990 to 2021, reveal age, period, and cohort effects, and predict the disease burden trend from 2022 to 2030, providing a basis for formulating targeted prevention and control strategies.

Based on data from the Global Burden of Disease study, Joinpoint regression was used to analyze trends in age-standardized rates, an age-period-cohort model was applied to interpret age, period, and cohort effects on incidence and prevalence.

From 1990 to 2021, the incidence rate, prevalence rate, and disability-adjusted life year (DALY) rate of schizophrenia among Chinese adolescents showed a downward trend, decreasing from 33.64/100 000, 145.77/100 000, and 98.69/100 000 to 31.51/100 000, 133.55/100 000, and 90.80/100 000, with decline rates of 6.33%, 8.38%, and 8.00%, respectively. In contrast, the age-standardized incidence rate, prevalence rate, and DALY rate increased slowly at average annual growth rates of 0.05%, 0.13%, and 0.14%, respectively. The trend of age-standardized incidence rate could be divided into three periods: 1990-2008 (APC=-0.02%), 2005-2016 (APC=-0.28%), and 2016-2021 (APC=0.77%). The trend of age-standardized prevalence rate was divided into four periods: 1990-2004 (APC=-0.01%), 2004-2010 (APC=0.13%), 2010-2016 (APC=-0.14%), and 2016-2021 (APC=0.84%). The trend of age-standardized DALY rate was divided into four periods: 1990-2005 (APC=0.02%), 2005-2010 (APC=0.20%), 2010-2016 (APC=-0.16%), and 2016-2021 (APC=0.81%). The age-period-cohort model revealed that the risks of incidence and prevalence increased significantly with age (RR values for the 20-24-year-old group were 2.37 and 4.41, respectively, significantly higher than 0.30 and 0.17 in the 10-14-year-old group), showed a mild upward trend over time (RR values increased from 0.94 and 0.91 in 1990-1994 to 1.08 and 1.11 in 2020—2021), and decreased with later birth cohorts (RR values for the 1970-1974 birth cohort were 1.07 and 1.11, dropping to 0.96 and 0.92 in the 2010-2014 cohort).

From 1990 to 2021, the incidence, prevalence, and DALY rates of schizophrenia among Chinese adolescents showed a downward trend, while the standardized rates exhibited a slow upward trend. Age growth and temporal trends were key factors in risk elevation, while younger birth cohorts exhibited lower risks. Dynamic intervention strategies targeting adolescents are needed in the future, with particular attention to the rising age-standardized burden.