Objective To understand the disease burden of major depressive disorder (MDD) in children and adolescents in China and in the world from 1990 to 2021 and provide evidence for the development of targeted prevention and control strategies.

Methods The database Global Burden of Disease (GBD) 2021 was used, Joinpoint regression analysis was conducted to evaluate temporal trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life-year rate (ASDR) of MDD. Socio-demographic Index (SDI) was used as a key explanation variable in multivariate regression analysis to evaluate the associations between disability-adjusted life years (DALYs) and SDI. Das Gupta decomposition quantified the contributions of population growth, aging, and epidemiologic changes to DALYs. Time-series changes in MDD-attributed DALYs were calculated by using GBD standard metrics.

Results From 1990 to 2021, the disease burden of MDD in children/adolescents in China and in the world varied. The analysis revealed that the ASIR increased from 3,554.71/100 000 to 4,135.11 /100,000, with average annual percentage change (AAPC) of 19.55%, the ASPR increased from 2,392.51/100 000 to 2,771.64/100,000 , with AAPC of 12.75%, the ASDR increased from 480.62/100 000 to 557.87/100,000, with the AAPC of 2.91% in the world. The analysis on the disease burden of MDD in children/adolescents in China revealed theASIR decreased from 2,412.43/100 000 to 2,129.47/100,000 (AAPC −6.43%); the ASPR decreased from 1,622.13/100 000 to 1,426.49/100,000 (AAPC −4.28%); the ASDR decreased from 330.26/100 000 to 287.48/100,000 (AAPC −1.02%). Girls consistently usually had higher ASIR, ASPR, and ASDR compared with boys both at home and abroad. In the world, DALYs was negatively associated with SDI; In China, the combination of higher SDI and lower ASDR was more obvious. Decomposition analysis revealed that the global DALY increases were mainly driven by population growth and aging, whereas the DALY decline in China was largely attributed to epidemiological changes. The leading risk factors both at home and abroad were intimate partner violence and childhood sexual abuse.

Conclusion This study systematically characterizes the spatiotemporal evolution, sex specific differences, risk factors, and SDI-related gradients of the disease burden of MDD in children and adolescents in China and in the world from 1990 to 2021 to provide more comprehensive evidence for targeted public health interventions and resource allocation.