Burden of 10 mental disorders in low- and middle-income countries, 1990-2023, with forecasts to 2050: a Global Burden of Disease Study

BACKGROUND: Mental disorders impose a disproportionate burden on populations in low- to middle-income countries (LMICs) and low-income countries (LICs), yet longitudinal assessments across these settings remain limited. METHODS: Using the Global Burden of Disease Study 2023, we investigated prevalence and disability-adjusted life years (DALYs) for 10 mental disorder subcategories across 76 LMICs and LICs from 1990 to 2023 and projected trends through 2050 via a generalized ensemble modeling approach. FINDINGS: Age-standardized prevalence rose markedly between 1990 and 2023, from 10,759.9 (95% uncertainty interval, 9,560.1-12,088.6) to 13,929.3 (12,512.5-15,829.0) per 100,000 in LMICs and from 11,723.6 (10,577.7-12,987.5) to 14,979.1 (13,512.9-16,770.7) in LICs, accompanied by corresponding increases in age-standardized DALY rates. The most pronounced increases in both age-standardized prevalence and DALYs were observed during the COVID-19 pandemic. Anxiety disorders (total percentage change: 102.3% in LMICs; 67.3% in LICs), eating disorders (40.7% in LMICs; 4.8% in LICs), depressive disorders (28.6% in LMICs; 29.8% in LICs), and autism spectrum disorders (14.9% in LMICs; 22.5% in LICs) showed the largest increases in prevalence. Under a reference scenario where past trends persist, age-standardized prevalence is projected to reach 17,155.8 (14,449.5-20,212.5) per 100,000 in LMICs and 17,968.4 (15,109.8-21,090.9) in LICs by 2050. CONCLUSIONS: These findings reveal persistent and widening disparities in mental health burden across resource-limited settings, substantially exacerbated by the pandemic. Without targeted, scalable, and sustained policy interventions, the burden in LMICs and LICs will continue to worsen, underscoring the critical need for context-specific public health action. FUNDING: This study was funded by the Gates Foundation.