According to the latest Global Burden of Disease (GBD) studies, mental disorders are the second leading cause of years lived with disability (YLDs) worldwide and the seventh leading cause of disability-adjusted life years (DALYs) globally. They are also strongly associated with high suicide rates (Vigo et al., 2016; Bachmann, 2018; WHO, 2024). Depression, anxiety disorders, bipolar disorder, and schizophrenia are among the most prevalent and impactful mental illnesses. Of these, depression and anxiety disorders account for 37.3% and 22.9% of mental disorder-related DALYs, respectively. Both conditions frequently co-occur, and recent epidemiological data indicate a significant rise in their prevalence over the past decades (GBD 2019 Mental Disorders Collaborators, 2022). Although bipolar disorder and schizophrenia have relatively lower global prevalence rates, their substantial socioeconomic burden—due to prolonged duration, high treatment costs, and frequent relapses—cannot be overlooked (Grande et al., 2016; Jauhar et al., 2022). These disorders not only directly impair patients' quality of life, leading to significant losses in work capacity and daily functioning, but also negatively affect their families, workplaces, and social interactions. Recognizing mental health as a fundamental human right, the World Health Organization continues to prioritize this issue.

While numerous epidemiological studies have assessed the global burden of mental disorders, most have focused on specific countries, regions, or individual diseases, lacking comprehensive cross-border, cross-cultural, and multi-disease comparisons (Tian et al., 2025; Safiri et al., 2024; Iran Subnational Mental Health GBD Collaborators, 2024; Zhang et al., 2025). Additionally, existing research often emphasizes disease prevalence and mortality, with less attention given to the socioeconomic impacts and disparities across age, gender, and social groups (Opio et al., 2022; Lauron et al., 2023; Pai et al., 2022). Furthermore, studies have frequently overlooked women of reproductive age, a population experiencing heightened physical and psychological stress due to childbirth and child-rearing. This critical life stage increases vulnerability to mental disorders, particularly during pregnancy, childbirth, and the postpartum period, when mental health issues are especially pronounced and may adversely affect both maternal and neonatal outcomes (Cantwell et al., 2021; Jones et al., 2014).

The GBD 2021 dataset provides comprehensive data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) for 371 diseases and injuries, as well as 88 behavioral, environmental, occupational, and metabolic risk factors across 204 countries worldwide (GBD 2021 Diseases and Injuries Collaborators, 2024). A key strength of this dataset is its use of harmonized diagnostic criteria and methodologies, ensuring high-quality, comparable data. Additionally, it enables a systematic assessment of global and regional disease burdens by tracking health status across different countries and regions. Building on this dataset, the present study will conduct an in-depth analysis of the global burden of depression, anxiety disorders, bipolar disorder, and schizophrenia among women of reproductive age. It will evaluate regional, socioeconomic, and age-related differences in disease burden, examine trends over time, explore potential influencing factors, and project future trajectories. The findings aim to provide a scientific basis for global mental health policy development, supporting more effective and targeted interventions.

Methods

This study used the Global Burden of Disease (GBD) 2021 data to assess the global impact of anxiety, depression, bipolar disorder, and schizophrenia among women of reproductive age. The GBD 2021 dataset is accessible through the Global Health Data Exchange (GHDx) Results Tool(http://ghdx.healthdata.org/). It provides open access to detailed global and regional health metrics. The dataset estimates 371 diseases and injuries, covering incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs). Additionally, it includes 88 risk factors pertaining to behavioral, environmental, occupational, and metabolic domains. This analysis focused on the mortality and DALYs associated with anxiety, depression, bipolar disorder, and schizophrenia among women of reproductive age in the worldwide. DALYs, which combine years lived with disability (YLDs) and years of life lost (YLLs) due to early death, serve as a measure for evaluating both fatal and nonfatal disease impacts. The Socio-population Index (SDI) is a composite measure of socioeconomic development that combines total fertility rates, mean years of education, and lagged per capita income for individuals aged 15 and older across various regions. The SDI ranges from 0 to 1, classifying countries into five tiers: low, low-middle, middle, high-middle, and high. The study analyzed data from 204 countries and territories from 1990 to 2021. It provided a comprehensive trend analysis and an in-depth evaluation of the global burden of anxiety, depression, bipolar disorder, and schizophrenia among women of reproductive age. Ethical approval and informed consent were not necessary since this study utilized publicly available data. The research adhered to guidelines for accurate and transparent reporting in health assessments.

We analyzed age-standardized incidence, DALYs, and their 95% uncertainty intervals for anxiety, depression, bipolar disorder, and schizophrenia among women of reproductive age using data from the GBD 2021 study, which included 204 countries, 21 GBD regions, and 5 Socio-Demographic Index (SDI) quintiles. Additionally, we stratified the prevalence, incidence, death and DALYs by sex into two groups. We then divided the population into 4 age groups (15–19 years, 20–24 years…45–49 years) based on a 5-year cycle. The study utilized high-resolution maps to visualize the global burden of tuberculosis, emphasizing disparities across socio-demographic and geographic contexts. his spatial representation provided valuable insights into the patterns of anxiety, depression, bipolar disorder, and schizophrenia among women ages 15 to 49 worldwide.

We used decomposition analysis to measure how population growth, aging, and epidemiological changes contributed to trends in total incidence, prevalence, mortality and DALYs. This approach provided clearer insights into how demographic and health system factors influence the disease burden. This study uses a method consistent with the analytical framework of previous Global Burden of Disease (GBD) studies. These studies estimate how changes in population structure and risk factors affect shifts in disease outcomes.

Health inequality analysis examines disparities in disease burden across countries and regions, helping to shape public health policies. This analysis employs the slope index of inequality (SII) and the concentration index (CII) to measure health inequalities. The SII illustrates the relationship between health indicators and socioeconomic status. It utilizes the Sociodemographic Index (SDI) in a linear regression analysis. The CI ranges from − 1 to 1 and indicates the variation of health outcomes based on economic status. Values closer to 0 reflect less inequality, positive values favor the wealthy, and negative values favor the impoverished. This study calculated the SII and CI for the Mortality and DALYs of caries in anxiety, depression, bipolar disorder, and schizophrenia between 1990 and 2021. It emphasizes health inequalities in a global context, across various regions, and among 204 countries.

To better formulate public health policies and allocate medical resources, we divided the population into gender-based subgroups (females and males) and used the Bayesian-Aperiodic-People-Cohort (BAPC) model to predict trends in the incidence and prevalence of anxiety, depression, bipolar disorder, and schizophrenia among women of reproductive age over the next 15 years. By considering temporal variations and age-specific trends, these models provide a reliable and comprehensive outlook on the future burden of tooth decay. Studies have shown that combining the Integrated Nested Laplace Approximation (INLA) with the BAPC model effectively approximates marginal posterior distributions, thereby avoiding the mixing and convergence issues typically associated with the Markov Chain Monte Carlo (MCMC) sampling technique used in traditional methods.

All statistical analyses were conducted using R (version 4.3.3) and Stata 18 (StataCorp, College Station, TX). We created custom scripts to perform decomposition and sensitivity analyses. We performed Bayesian analysis using WinBUGS (version 1.4) as part of our analytical process. Geographic and spatial analyses were conducted with ArcGIS Pro and QGIS (version 3.16), allowing for the creation of high-resolution maps that visualize the TBL burden and disparities. We generated data visualizations, including bi-lateral and two-axis plots, using the 'ggplot2' and 'Benchmarking' packages in R.

In this study, we set the p < 0.05 threshold for all analyses to determine statistical significance. This approach aligns with standard practices in epidemiological and public health research, especially concerning studies on the Global Burden of Disease.

1. Analysis of the Current Status and Trends in the Burden of Psychiatric Disorders Among Women of Reproductive Age Globally (1990–2021)

From 1990 to 2021, there was no significant global increase in the incidence of anxiety, depression, bipolar disorder, or schizophrenia, nor in the age-standardized rates (ASRs) of DALYs among women of reproductive age. However, the absolute number of cases continued to rise, particularly for anxiety and depression, which saw substantial increases in 2020. Specifically, the incidence of anxiety disorders and the number of associated DALYs increased by 18.3% and 17.5%, respectively, while depression saw increases of 22.8% and 19.1%. The corresponding ASRs for these disorders increased nearly 1.2-fold.By 2021, the incidence and DALY counts for anxiety disorders were 18,962,131 (95% uncertainty interval [UI]: 12,660,029–26,295,396) and 16,448,344 (95% UI: 10,383,333–24,009,992), respectively. For depression, these numbers were 133,248,593 (95% UI: 99,032,450–177,876,463) and 21,042,424 (95% UI: 13,468,194–30,593,481). For bipolar disorder, they were 826,397 (95% UI: 484,408–1,270,443) and 2,806,894 (95% UI: 1,740,129–4,226,051), while schizophrenia had corresponding values of 513,255 (95% UI: 302,798–767,916) and 4,836,703 (95% UI: 3,318,473–6,567,286). The respective ASRs were 976.14 per 100,000 (95% UI: 650.09–1,355.11) and 844.05 per 100,000 (95% UI: 532.79–1,232.57) for anxiety disorders, 6,808.01 per 100,000 (95% UI: 5,049.99–9,106.66) and 1,073.5 per 100,000 (95% UI: 686.73–1,562.48) for depression, 43.16 per 100,000 (95% UI: 25.43–66.23) and 143.77 per 100,000 (95% UI: 89.11–216.63) for bipolar disorder, and 26.71 per 100,000 (95% UI: 15.76–39.94) and 243.46 per 100,000 (95% UI: 166.79–331.29) for schizophrenia. Compared to 1990, these figures represent increases of 76.7% and 76.3% for anxiety disorders, 71.4% and 69.1% for depression, 43.6% and 48.5% for bipolar disorder, and 35.7% and 55.3% for schizophrenia in terms of incidence and DALYs, respectively. The estimated annual percentage changes (EAPCs) of ASRs were 0.24 (95% confidence interval [CI]: 0.08–0.39) and 0.16 (95% CI: 0.01–0.32) for anxiety disorders, -0.18 (95% CI: -0.39–0.04) and − 0.14 (95% CI: -0.32–0.04) for depression, 0.09 (95% CI: 0.07–0.11) and 0.03 (95% CI: 0.02–0.04) for bipolar disorder, and − 0.02 (95% CI: -0.03– -0.01) and 0 (95% CI: 0–0.01) for schizophrenia (Fig. 1, Tables 1–8).

2. Global Burden of Disease and Trends in Psychiatric Disorders Among Women of Reproductive Age Across Subgroups (Age, SDI, Region, and Country)

Globally, the incidence of psychiatric disorders and DALYs increased significantly across all disease types and age groups from 1990 to 2021. However, the overall trends in disease burden remained consistent across age groups and aligned with broader age-related patterns (Fig. 2, Fig. S1).The 15–19 age group exhibited the highest number of anxiety and bipolar disorder cases, as well as the highest ASRs, with bipolar disorder being particularly prevalent in this group. However, this age group had the lowest incidence and ASRs of depression and the smallest DALY burden among the four psychiatric disorders. In contrast, the 45–49 age group had the highest incidence and DALY burden of depression, with the fastest-growing ASRs. The 20–24 age group had the highest incidence and ASRs of schizophrenia, although its DALY burden remained relatively limited, only slightly exceeding that of the 15–19 age group (Fig. S1).

Across all Socio-Demographic Index (SDI) regions, the burden of psychiatric disorders increased significantly from 1990. Depression and anxiety disorders were the most prevalent, while bipolar disorder and schizophrenia exhibited relatively stable incidence rates across SDI regions. However, schizophrenia contributed to a considerably greater disease burden (Fig. 3).With the exception of high-SDI regions, which exhibited higher ASRs, the ASRs of psychiatric disorders varied only slightly across SDI regions. However, middle- and low-middle-SDI regions had the highest absolute number of cases and DALYs (Fig. 3). Over time, the trends in psychiatric disorder burden remained consistent across all SDI regions (Fig. S2).

Across the 21 GBD regions, from 1990 to 2021, the incidence and DALY burden of all four psychiatric disorders increased most rapidly in South Asia, Southeast Asia, North Africa and the Middle East, Western Sub-Saharan Africa, Eastern Sub-Saharan Africa, Tropical Latin America, and Central Latin America. These regions accounted for a growing proportion of the global burden. In contrast, densely populated East Asia experienced a decline in the incidence and DALYs of most psychiatric disorders, except for bipolar disorder and schizophrenia, where DALYs continued to rise.

Regarding ASRs, the age-standardized incidence rate (ASIR) and age-standardized disability-adjusted life year rate (ASDR) for bipolar disorder and schizophrenia remained relatively stable across all 21 regions. However, Tropical Latin America and Australasia recorded the highest ASIRs and ASDRs for bipolar disorder, while East Asia had the lowest. Schizophrenia ASIRs and ASDRs were highest in East Asia, Australasia, and High-income North America.

For depression, Central Latin America, High-income North America, and Central Sub-Saharan Africa had the highest and increasing ASIRs and ASDRs. The fastest-growing ASDRs were observed in Tropical Latin America, Central Latin America, Andean Latin America, and High-income North America, while East Asia experienced the largest and fastest-growing ASIRs and ASDRs for depression. The estimated annual percentage change (EAPC) for depression was − 1.4 (95% CI: -1.65 to -1.16) for ASIRs and − 1.15 (95% CI: -1.34 to -0.95) for ASDRs, making East Asia the region with the most rapid decline. A more modest decline in ASIRs and ASDRs for depression was also observed in Oceania (Fig. 4).

Figure 5–6 illustrates the global trend of psychiatric disorder burden over time in relation to SDI across countries. The prevalence of anxiety disorders increased worldwide, with DALYs rising in nearly all countries, except for a few. The most rapid increases occurred in countries with SDI > 0.6, particularly Brazil, Portugal, and Paraguay. A similar trend was observed for depression, with incidence and DALYs increasing globally, peaking in Greenland. Compared to anxiety disorders, depression showed a weaker correlation between disease burden and SDI.For bipolar disorder and schizophrenia, ASRs remained largely unchanged across countries. Bipolar disorder prevalence increased, while DALY rates declined, particularly in high-SDI countries, with New Zealand exhibiting the fastest rise in both prevalence and DALYs. The burden of schizophrenia varied across countries, with high-SDI nations such as the Netherlands, the United States, and Denmark experiencing the most significant changes.

Overall, the incidence and DALYs of the four aforementioned mental disorders were positively correlated with the SDI, increasing with higher SDI levels, particularly for anxiety disorders. At the regional level, the relationship between the incidence and DALYs of bipolar disorder and SDI followed a "W" pattern, with a significant decline at SDI < 0.4, followed by a notable increase as SDI continued to rise. In contrast, schizophrenia exhibited a "U"-shaped relationship with SDI, with the lowest prevalence and DALYs observed at an SDI of 0.6. The disease burden of anxiety disorders steadily increased with SDI, whereas the burden of depression remained relatively stable at SDI < 0.6 before rising sharply thereafter. At the national level, the incidence and DALY rates of all four disorders increased with SDI growth, with more pronounced increases observed at SDI > 0.75(Fig. 7).

From 1990 to 2021, the slope indices for all four psychiatric disorders showed an upward trend, while the concentration indices declined (Fig. 8A/B). Specifically, the slope index for schizophrenia incidence increased from − 2.90 (95% CI: -4.26 to -1.55) in 1990 to -2.16 (95% CI: -3.55 to -0.78) in 2021, while the corresponding slope index for DALYs rose from 3.14 (95% CI: -7.60 to 13.88) to 5.84 (95% CI: -5.34 to 17.01). Similarly, the slope indices for the incidence of bipolar disorder, depression, and anxiety increased from 16.85 (95% CI: 9.00 to 24.69), -842.74 (95% CI: -1866.14 to 180.66), and 196.96 (95% CI: 131.14 to 262.78) to 17.97 (95% CI: 10.44 to 25.49), 465.39 (95% CI: -736.83 to 1667.60), and 330.90 (95% CI: 247.18 to 414.61), respectively. The corresponding slope indices for DALYs increased from 87.25 (95% CI: 54.75 to 119.75), -138.47 (95% CI: -276.91 to -0.03), and − 138.47 (95% CI: -276.91 to -0.03) to 88.51 (95% CI: 57.70 to 119.31), 39.84 (95% CI: -122.73 to 202.41), and 432.21 (95% CI: 329.22 to 535.21), respectively.Meanwhile, the concentration indices for the incidence of these four disorders decreased from − 0.08 (95% CI: -0.23 to 0.16), 0.02 (95% CI: -0.15 to 0.21), 0.15 (95% CI: -0.15 to 0.21), and 0.21 (95% CI: -0.15 to 0.21) to -0.10 (95% CI: -0.28 to 0.06), -0.09 (95% CI: -0.22 to 0.05), -0.06 (95% CI: -0.25 to 0.12), and − 0.08 (95% CI: -0.22 to 0.12), respectively. Likewise, the concentration index for DALYs also showed a downward trend, with schizophrenia decreasing from − 0.03 (95% CI: -0.21 to 0.26) to -0.04 (95% CI: -0.24 to 0.13), bipolar disorder from 0.09 (95% CI: -0.09 to 0.27) to -0.03 (95% CI: -0.16 to 0.11), depression from − 0.05 (95% CI: -0.23 to 0.20) to -0.08 (95% CI: -0.25 to 0.11), and anxiety disorders from 0.02 (95% CI: -0.16 to 0.26) to -0.02 (95% CI: -0.19 to 0.14).These findings highlight the complex changes in the global burden of mental disorders in the context of socioeconomic development, indicating that global health inequities have worsened over time and underscoring the urgent need to strengthen mental health services in low-SDI regions.

Globally, and particularly in low-SDI regions such as Africa, Latin America, South Asia, and Southeast Asia, population growth is the primary driver of the increasing burden of psychiatric disorders, excluding anxiety disorders. In East Asia, however, aging is the key factor, especially for schizophrenia and bipolar disorder. Aging has a negative impact on morbidity, contributing 112.57% and 91.72%, respectively, while positively influencing DALYs, with contributions of 76.3% and 139.99%.Regarding anxiety disorders, the global increase in both incidence and DALYs is largely attributed to population growth, which contributes 66% and 62.23%, respectively. However, epidemiological changes also play a significant role, contributing 35.85% and 33.75%, respectively. The impact of these changes becomes more pronounced as SDI increases, particularly in high-SDI areas, where epidemiological changes contribute 83.15% and 78.14%, respectively, and in high-middle-SDI regions, contributing 74.18% and 72.4%. In these regions, the contribution of population growth and aging is far less significant (Fig. 9).

Figure 9 illustrates that the incidence and DALYs of anxiety disorders and depression are projected to increase significantly over the next decade, with a particularly sharp rise expected from 2030 onward. This trend suggests that anxiety disorders and depression will become increasingly prominent public health challenges. In contrast, although bipolar disorder and schizophrenia are also projected to rise, their growth will be more moderate, indicating that the burden from these disorders will increase at a slower pace. Overall, the burden of mental illness, particularly among women, is expected to continue rising, with anxiety and depression being of particular concern. This could have important implications for public health policy and resource allocation (Fig. 10).

To the best of our knowledge, our study is the first to analyze and compare the four most common or impactful psychiatric disorders in women of reproductive age globally. Our findings show that while the incidence and DALYs for anxiety, depression, bipolar disorder, and schizophrenia in women of childbearing age have all increased modestly at the global level from 1990 to 2021, and the corresponding ASRs have generally trended downward, anxiety disorders have shown rising rates of episodes and DALYs in nearly all countries, and depression has followed a similar pattern in most countries, particularly in higher-SDI regions. Furthermore, there are significant differences in the burden of these four mental disorders across age groups, regions, and countries, with varying influencing factors in each region.

In 2021, our study found that anxiety, depression, bipolar disorder, and schizophrenia together accounted for 45,134,365 DALYs among women of childbearing age globally, with the respective proportions being 36.4%, 46.6%, 6.2%, and 10.7%. These findings suggest that depression and anxiety disorders continue to be the most prevalent psychiatric disorders among women of childbearing age, consistent with previous population-wide studies. Additionally, both depression and anxiety disorders showed a significant increase in 2020, a trend confirmed by two recent studies. The COVID-19 pandemic in 2020, combined with increased uncertainty about health risks, rising unemployment, economic downturns, geographic lockdowns, and shifts in lifestyles, all contributed to heightened feelings of despair, loneliness, anxiety, and even depression.

Our study revealed distinct age-dependent patterns in psychiatric disorder prevalence: depression predominated in older adults, anxiety and bipolar disorders were more prevalent among adolescents (15–19 years), whereas schizophrenia incidence peaked in the 20–24 age cohort. These distributions likely stem from multifactorial interactions involving neurotransmitter imbalances, genetic predispositions, regional brain dysfunction, and environmental stressors (Sullivan et al., 2003; Alexopoulos, 2005; Casey et al., 2008; Stein and Stein, 2008; Katon, 2011; Diniz et al., 2013; American Psychological Association, 2018; Cale et al., 2024). Mechanistically, age-related central nervous system decline in older adults reduces serotonin (5-HT), dopamine (DA), and norepinephrine (NE) levels, impairing mood regulation and elevating depression risk (Alexopoulos, 2005). In adolescents, neurodevelopmental immaturity—particularly in frontal/temporal lobes and hippocampal volumes—coupled with dysregulated 5-HT, γ-aminobutyric acid (GABA), and cortisol levels, compromises emotional stability, predisposing to anxiety and bipolar disorders (Casey et al., 2008; Stein and Stein, 2008). Concurrent psychosocial stressors differentially affect age groups: older adults face elevated depression risks due to social isolation (post-retirement, widowhood, or "empty nest" syndrome) and comorbidities with neurodegenerative (e.g., Alzheimer’s, Parkinson’s) and chronic metabolic diseases (e.g., hypertension, diabetes) (Katon, 2011; Diniz et al., 2013). Conversely, younger populations exhibit heightened anxiety susceptibility attributable to academic pressure, occupational demands, and interpersonal conflicts characteristic of modern fast-paced lifestyles (American Psychological Association, 2018).

Our study highlights significant regional and global disparities in psychiatric disorders among women of childbearing age. Notably, high-income North America, Latin America, and Australasia exhibit the highest and most rapidly increasing burden of psychiatric disorders, a trend identified and prioritized in public health agendas two decades ago (Kohn et al., 2005). Conversely, East Asia reports the lowest rates of anxiety, depression, and bipolar disorder, as well as the lowest DALYs. Specifically, depression prevalence in East Asia has declined significantly since 1990, driven largely by a > 12% reduction in major depressive disorder cases in China (Tian et al., 2025). While direct evidence for these regional differences is limited, contextual factors provide plausible explanations. For instance, Japan’s mental health policies—such as capping out-of-pocket costs for psychiatric care at 10% of total expenses and including transcranial magnetic stimulation therapy in public healthcare—have significantly improved access to treatment. Consequently, according to Kawakami (2014) and the Japan Local Life Support Association (JLSA, 2018), consultation rates for major depression have more than doubled in Japan. Moreover, depression is increasingly recognized as a societal indicator in Japanese media, fostering greater public awareness and resilience. Similarly, China and South Korea demonstrate elevated psychological resilience, potentially contributing to lower mental health burdens (Qin et al., 2025). In contrast, North America’s economic prosperity masks stark social inequalities, where mental health issues are exacerbated by high living costs, healthcare expenses, and inadequate social support for low-income populations (Sareen et al., 2011). Latin America faces distinct challenges, including economic instability, poverty, and unemployment, which elevate anxiety and depression rates (Lund et al., 2010). Cultural norms, such as “machismo,” further hinder timely mental health interventions, particularly among men. Compounding these issues are pervasive social stressors, including political unrest, over-urbanization, gang violence, high crime rates, drug trade, and child abuse, which collectively sustain high psychiatric disorder prevalence in the region (Sapag et al., 2018; Mascayano et al., 2016; Peen et al., 2010; Libby et al., 2005). The global burden of anxiety and depression among women of childbearing age is rising rapidly, particularly in high-income regions of North America, Latin America, and parts of Africa. To address this growing issue, effective public health policies must be developed urgently. East Asian countries offer potential models, providing valuable insights through substantial governmental funding for healthcare, well-established primary mental health care systems, and a supportive social environment.Additionally, special attention is needed for adolescents and older adults, who are particularly vulnerable to psychiatric disorders due to neurodevelopmental changes, cognitive decline, and multidimensional social disadvantages. For these populations, fostering a supportive and engaging environment, along with adequate social support, is crucial in mitigating exposure to harmful external stressors.

While our study highlights the importance of psychosomatic health in women of reproductive age, it has several limitations. First, our analysis primarily accounts for health-related losses, while broader welfare losses associated with mental illness are not included due to the complexity of quantification. Second, diagnosing and categorizing mental disorders remains a clinical challenge, particularly in low-SDI regions, where data quality may be inconsistent. Additionally, economic and cultural barriers often prevent individuals in these areas from seeking medical treatment, further complicating accurate assessment.

In conclusion, our study underscores the persistent and increasing burden of psychiatric disorders among women of reproductive age worldwide, with notable regional disparities, especially in anxiety and depression. The lack of significant improvement over time suggests that current prevention and treatment strategies have yet to yield substantial real-world benefits. However, by leveraging big data, our study offers a comprehensive analysis of the factors contributing to these regional variations. Identifying these key determinants can serve as a foundation for targeted interventions aimed at reducing the global impact of psychiatric disorders in this vulnerable population.

The data used in this study can be derived from the GBD 2021 (Available at: https://vizhub.healthdata.org/gbd-results/).

Clinical trial number: not applicable.