Depressive disorders, defined by enduring low mood, diminished interest, and pervasive hopelessness, have emerged as a significant global public health issue (Barnett, 2019; WHO, 2023). The incidence of depressive disorders has increased in recent decades, impacting approximately 332 million individuals worldwide (IHME, 2024). The Global Burden of Disease (GBD) 2021 study estimates over 300 million cases of depressive disorders worldwide, with a prevalence rate of approximately 4,006.82 per 100,000 individuals, thereby placing a substantial segment of the global population at immediate risk of developing these disorders (Rong et al., 2025). This imposes significant pressure on healthcare systems and society at large. From 2010 to 2021, the age-standardized disability-adjusted life years (DALY) for depressive disorders rose by 16.4% (95% uncertainty interval [UI]: 11.9–21.3), marking the second most significant increase among the 25 primary tertiary causes (GBD 2021 Diseases and Injuries Collaborators, 2024). Depressive disorders are more common in women, particularly those of childbearing age (Sassarini, 2016; Gao et al., 2024). A previous study noted that the age-standardized DALY rate (ASDALYR) among middle-aged and older adults in China rose by 3.99%, with women consistently showing a higher ASDALYR than men (Xiao et al., 2025). The global incidence of depressive disorders among women has risen over the past 30 years, with the 15–49 age demographic representing the highest percentage of new cases (Gao et al., 2024). Research indicates that the prevalence of depressive disorders among women of childbearing age (WCBA) in rural China is 30.7 percent (Cao et al., 2015). A meta-analysis indicated that the prevalence of perinatal depression in low- and middle-income countries was 13.1%, highlighting a significant burden (Woody et al., 2017).

The probability of developing depressive disorders is nearly twice as high in women as in men, a disparity that persists throughout the reproductive years (Sassarini, 2016). Women experience distinct life stages, including menstruation, pregnancy, childbirth, and menopause, marked by substantial hormonal variations that increase their susceptibility to depressive disorders (Zeng et al., 2019). Depressive disorders in WCBA may manifest at various phases of the reproductive cycle, including premenstrual anxiety, maternal depression, and menopausal depression (Noble, 2005). Reproductive health events, such as oral contraceptive use, miscarriage, infertility, and hormone replacement therapy, have been shown to impact the mental health of WCBA and to induce depression (Noble, 2005; Montagnoli et al., 2020). Previous research indicated that depression during childbearing years is associated with adverse pregnancy outcomes, such as preterm birth, and low birth weight, as well as increased risk of severe maternal health complications and adverse maternal mortality (Miller et al., 2022; Masters et al., 2019; Nisar et al., 2020a). Moreover, economic disparities (such as economic discrimination and employment inequality) and the necessity for WCBA to undertake primary responsibilities for both household and childcare can result in role conflict and role overload, adversely impacting mental health (Piccinelli and Wilkinson, 2000). The social distancing restrictions and other psychosocial factors that intensified during the 2019 coronavirus disease pandemic contributed to a 27.6% global rise in depressive disorders (COVID-19 Mental Disorders Collaborators, 2021; Zhu et al., 2023). Therefore, it is essential to synthesize epidemiological indicators of depressive disorders among WCBA globally to inform targeted intervention strategies on an international level.

Multiple studies have investigated the incidence and trends of depressive disorders among Chinese women (Bao et al., 2024; Xiyuan and Chao, 2024; He et al., 2021), and a thorough evaluation of the global burden of depression in WCBA remains largely ambiguous or unreported. Considering that WCBA represent a key population group for family planning and maternal health, it is essential to conduct an in-depth analysis of the trends of depressive disorders among WCBA. Employing the latest data from GBD 2021, we performed an extensive analysis of the incidence, prevalence, and DALYs of depressive disorders among WCBA from 1990 to 2021, with projections extending to 2046.

In this study, to the best of our knowledge, we reported the incidence, prevalence, and DALY burden of depression in WCBA at global, regional, and national levels using the GBD 2021 and projected the burden of depression in this population in 2046. Key findings include: first, the global prevalent cases of depressive disorders in WCBA showed an increasing trend since 1990. Second, there was significant regional variation in depressive disorders among WCBA. At the SDI level, high SDI region had the highest ASIR, ASPR, and ASDALYR. Regarding 21 GBD regions, most regions showed an upward trend in ASIR. Among them, high-income North America had the highest ASIR, ASPR, and ASDALYR. At the country level, the country with the highest ASIR, ASPR, and ASDALYR was Greenland. Third, joinpoint regression analysis showed a sharp increase in ASIR for WCBA depression after 2019. Finally, we found that globally, the highest incidence of WCBA was found in the 40–44 age group, which may be related to hormonal fluctuations, as this is when women enter perimenopause and menopause (Gyllstrom et al., 2007).

The current study indicated that the global ASIR for depressive disorders among WCBA has risen over the past three decades, underscoring the necessity for increased focus on age-specific populations affected by depression. Research indicates that adolescent depression impacts fewer than half as many males as females (Bouma et al., 2008). Sex hormones are crucial in their function. The dysregulation of the HPA axis, a principal stress management system in the body, indicates vulnerability to depression (Burke et al., 2005). Prior research has demonstrated that the HPA axis is markedly affected by female sex hormones, particularly estrogen and progesterone (Bangasser et al., 2010). Conversely, sex hormones induce alterations in body shape in girls during puberty, and heightened self-awareness amplified by modern social contexts such as social media comparisons renders them more susceptible to adverse assessments of these changes, thereby elevating the risk of depression (Woods and Scott, 2016; Ivie et al., 2020). Cyranowski et al.'s model posits that adolescent girls exhibit heightened susceptibility to interpersonal stress. As the demand for gendered role conformity (e.g., subordination) escalates during puberty, their sensitivity to interpersonal dynamics, such as evaluative scrutiny from peers, intensifies (Cyranowski et al., 2000). This susceptibility is further shaped by structural factors: Kuehner noted that macro-level gender inequity, including limited access to resources and societal gender discrimination, exacerbates women's exposure to stressors and their vulnerability to depression (Kuehner, 2017).

Depressive disorders is a significant occurrence for women, particularly during pregnancy. A study revealed that the prevalence of maternal depression was 26.3% (Worku et al., 2025), with its elevated occurrence linked to both general psychosocial factors (e.g., domestic violence, unemployment, life stress) and pregnancy-specific factors. Research indicated that exposure to spousal violence during pregnancy increases the risk of maternal depression threefold (Howard et al., 2013). A study involving nearly 200 pregnant women revealed that smoking and the consumption of sleeping pills, analgesics, and antiemetics were significantly associated with an increased risk of depression during pregnancy (Newport et al., 2012). Additionally, several physical and physiological determinants specific to pregnancy are associated with this risk. A systematic review of 20 studies examined the correlation between depression during pregnancy and maternal sleep deprivation, dysregulated HPA function, and disturbances in the immune-inflammatory response (Palagini et al., 2014), which warrants attention from researchers. Cortisol, a hormone linked to stress, is significantly correlated with stress levels. A study of blood samples from 105 pregnant women revealed a negative correlation between depressive symptoms and pro-inflammatory cytokines (e.g., IL-1β, TNF, and IL-7), as well as a negative association between cortisol and these inflammatory factors (Field, 2017). This indicates that an immune system imbalance may, to a degree, be associated with an increased risk of depression in maternal women.

WCBA depressive disorders were more prevalent in higher-economic regions, with the highest ASIR in High SDI regions and it is the only SDI region with an upward trend. This pattern can be explained through a bio-social interaction framework that connects social, structural, and biological factors specific to high-SDI contexts. In high-SDI regions, WCBA face elevated career expectations driven by advances in education and gender equality awareness (Aulia, 2024), yet they still bear disproportionate caregiving burdens; this mismatch between heightened role demands and persistent traditional responsibilities creates social role strain, a key source of chronic stress. Additionally, the abundant medical resources (Jorm et al., 2017; Richardson et al., 2024) and rapid spread of mental health information high-SDI regions (Fan et al., 2025a) enhance detection and diagnosis of depressive symptoms. Moreover, documented heightened reactivity of WCBA to stress interacts with these contextual pressures: in high-SDI settings where self-esteem is closely tied to role fulfillment (Kim and Moore, 2019; Wang et al., 2025), stress from unmet expectations triggers self-critical responses that further increase depression risk (Hyde and Mezulis, 2020). Our findings also indicated that the percentage change in depression cases is the largest in low SDI regions, which may be associated with limited mental health services (Lopes et al., 2016) and economic instability. Studies have found that women are more vulnerable to the pandemic than men due to lower wages, job loss and caregiving burdens (Arcand et al., 2023), which may contribute to a higher incidence of depression. This contrast, which involves highest ASIR in high SDI regions alongside the steepest case growth in low SDI regions, highlights a critical dynamic in global mental health disparities. This disparity stems from unequal resource access: low SDI regions, with underfunded and fragmented mental health systems, cannot keep pace with rising burdens, while high SDI regions leverage stronger infrastructure to mitigate risks. Such gaps, often widened by crises like the pandemic, entrench health inequities by leaving the most affected populations with the least support (De Sousa et al., 2020; Abas et al., 2021).

Our research indicated that, among the 21 GBD regions, High-income North America exhibited the highest ASIR burden of WCBA depressive disorders. This may pertain to socioeconomic status and life stressors. Greenland holds the top position in the ASIR at the national level. The nation is sparsely populated, and the WCBA demographic has limited opportunities for social interaction, resulting in a markedly elevated risk of depressive disorders among WCBA (Ingemann et al., 2021). Moreover, the island's severe working conditions, occupational uniformity, and limited labor force are substantial risk factors for depression among the WCBA population (Christiansen et al., 2021). The severe living conditions and perpetual darkness significantly intensify the psychological distress of WCBA, which indirectly leads to an increase in ASIR (Timlin et al., 2021).

Our Joinpoint regression analyses revealed a significant reversal and marked increase in the ASIR for depressive disorders among WCBA post-2019. Prior research indicates that the worldwide incidence of depressive disorders significantly rose during the initial year of the COVID-19 pandemic (Hawes et al., 2022). The increased ASIR for depression in the WCBA resulted from a multifactorial combination of elements. The COVID-19 pandemic resulted in a deterioration of socioeconomic performance, with women of childbearing age experiencing higher unemployment rates, and unstable household income exacerbating psychological distress (Montenovo et al., 2022). Conversely, marital and familial status constituted a significant factor: numerous WCBA experienced the loss of relatives or spouses during the epidemic, intensifying their distress. Moreover, stringent social distancing measures during the epidemic diminished the social networks of WCBA, heightening feelings of isolation and the likelihood of depressive disorders. Health apprehensions regarding the novel coronavirus and anxieties surrounding vaccine safety were significant contributors to the increased ASIR for depression among WCBA (Jiang et al., 2025). In the decomposition analysis, swift population growth significantly impacts WCBA, resulting in a rise in the number of WCBA populations, which subsequently elevates the absolute counts of prevalence and DALYs. However, this does not indicate worsening epidemiology, as the ASRs showed a slight decline. The epidemiological proportion ranks second highest, signifying considerable potential for enhancement in public health. In the future, to effectively manage the incidence, prevalence, and DALYs of depressive disorders among WCBA, it is essential to strategically allocate public health resources and regulate epidemiological trends within a large population. However, decomposition analysis has its limitations. It isolates factors, missing interactive effects like how urbanization-linked population surges might strain mental health resources. Aggregated data may conceal subgroup differences. Unmeasured confounders, such as regional mental health service disparities, could also affect results. Critically, focusing on population growth doesn't negate the importance of addressing epidemiological drivers like social stressors. Future strategies should scale mental health services and target specific risk factors.

Maternal depression has become a critical global public health issue, with the WHO emphasizing its priority in the Global Action Plan for Mental Health 2013–2030 and promoting interventions like the Thinking Healthy Manual to address it (Nisar et al., 2020b). To effectively tackle this challenge, the government should incorporate the prevention and treatment of depressive disorders in WCBA into the public health policy framework and develop targeted interventions. In high-SDI regions, more refined mental health services should be provided, with a particular focus on the impact of social and environmental stressors on WCBA (Fan et al., 2025b). For example, a dedicated mental health service platform for WCBA could be established to offer convenient psychological support. Regarding low-SDI regions, priority should be given to strengthening the development of basic mental health services. For example, the coverage of mental health service points should be increased, especially in remote areas. In addition, anti-stigma campaigns should be promoted to address workplace inequalities, and digital health monitoring systems and regional registration systems should be implemented to enhance surveillance (Howard et al., 2025). At the same time, treatment subsidy initiatives should be introduced for WCBA in low-income regions, while integrating routine mental health screening into prenatal and postnatal care. To effectively manage depression among WCBA, it is essential to implement stratified interventions based on age groups. For adolescents, mental health education and early screening should be conducted to disseminate knowledge and provide psychological counseling services. For maternal women, enhanced psychological interventions should be provided, focusing on depression during maternal period, along with emotional support (Żyrek et al., 2024). For women in perimenopause, hormone replacement therapy and psychological support should be offered to help them transition smoothly.

This research possesses the subsequent limitations: initially, employing GBD 2021 to assess the global burden of disease for depressive disorders among WCBA may reveal discrepancies in data quality attributable to varying data collection methodologies across countries, particularly in remote and impoverished regions where data gathering poses significant challenges, thereby indirectly influencing the reliability of the data. Secondly, the use of different diagnostic criteria (ICD-10 and DSM-IV-TR) and the transition to DSM-5 could introduce further inconsistencies, especially in settings where diagnostic standards are not uniformly applied. Moreover, in low-resource settings, underreporting and misdiagnosis are likely due to limited access to mental health services and inadequate diagnostic infrastructure. Future work should focus on harmonizing diagnostic criteria and improving data collection in low-resource settings using digital health technologies and community-based surveys. Third, the GBD may have neglected potential influences, including genetic and environmental factors, in forecasting disease burden, thereby compromising the accuracy of the findings. Fourth, population groups across regions and nations may differ in age structure, which could affect the comparability of depressive disorder burden estimates. While ASRs were calculated to mitigate this by aligning with a standard age distribution, residual impacts of age structure disparities may still exist. Fifth, the Nordpred model relies on the assumption that pre-existing epidemiological trends continue unchanged. This assumption may be challenged by unexpected events such as the COVID-19 pandemic, which has disrupted established trends in some health outcomes, and by unforeseen future factors including policy changes (e.g., new mental health intervention policies), both of which could potentially affect the predictive validity of Nordpred model. Ultimately, while we analyzed the incidence, prevalence, and DALYs of depressive disorders among WCBA in the 15–49 age demographic, we did not further delineate its risk factors, which may constrain a thorough comprehension of WCBA depressive disorders.

This study illustrated the rising trends in ASIR, ASPR, and ASDALYR among WCBA globally from 1990 to 2021, emphasizing the significance of geographical and age-related factors. Governments must urgently implement targeted interventions to alleviate the burden of depressive disorders among WCBA globally.