Temporal Patterns and Predictive Factors of Childhood Depressive Disorders Across Asia

Childhood depressive disorders represent a growing mental health concern, yet region-specific evidence in Asia remains limited. Asia hosts more than half of the global child population and has experienced rapid social and environmental changes that may heighten psychosocial stress. This study assessed the burden, temporal trends, geographic variation, and determinants of childhood depressive disorders across Asia from 1990 to 2023.

Data for children aged 0-14 years were obtained from the Global Burden of Disease (GBD) 2023 study. Incidence and disability-adjusted life years (DALYs) were analyzed by age, sex, region, and country. Joinpoint regression quantified annual and long-term temporal trends. Bullying victimization was evaluated as a behavioral risk factor. Extreme Gradient Boosting (XGBoost) models with Shapley Additive Explanations (SHAP), which show how each variable influences model predictions, were used to identify the major predictors of incidence and DALYs.

In 2023, South Asia showed the highest incidence rate (1099 per 100,000) and DALYs rate (119 per 100,000). Across all regions, children aged 10-14 years and girls had the greatest incidence and DALYs rates. India, China, and Pakistan contributed the largest absolute numbers of cases and DALYs, while Mauritius, Bangladesh, and Pakistan recorded the highest rates. Pakistan demonstrated the steepest long-term increases in both incidence and DALYs. Bullying-attributable DALYs increased across all regions, with the largest growth in South and Southeast Asia. SHAP analyses identified age, sex, calendar year, and population size as the strongest predictors, with older children and girls showing markedly higher predicted burdens.

Childhood depressive disorders have increased steadily across Asia over the past three decades, with clear demographic and geographic disparities. These findings highlight the urgency of early detection, school-based mental health programs, antibullying interventions, and gender-responsive services. Strengthening child mental health systems in Asia is critical for improving developmental outcomes.