Study: Anxiety and Depression Drive Global Mental Health Surge to Nearly 1.2 Billion

• The numbers reveal a dramatic rise — Researchers estimated that 1.17 billion people worldwide were living with a mental disorder in 2023, representing a 95.5% increase in total cases since 1990. Even after accounting for population growth and aging, the age-standardized prevalence rate increased by 24.2%, showing that the rise was not simply due to more people being alive today.

This means mental health disorders are becoming more common in everyday life, workplaces, schools and communities around the world. The increase wasn’t limited to a handful of countries. Researchers reported higher mental disorder disability rates in every location studied compared to 1990.

Rates ranged from approximately 1,302 disability-adjusted life years per 100,000 people in Vietnam to more than 3,555 per 100,000 in the Netherlands. Importantly, the burden remained high regardless of a country’s level of economic development, indicating that greater wealth alone does not solve the mental health crisis.

• Mental disorders became one of the world’s biggest health problems — The study found that mental disorders accounted for 171 million disability-adjusted life years, often abbreviated as DALYs, in 2023. DALYs measure years of healthy life lost due to illness or disability.

Mental disorders were responsible for 6.1% of all DALYs worldwide and rose from the twelfth leading cause of health loss in 1990 to the fifth leading cause in 2023. Researchers also found that mental disorders became the leading cause of years lived with disability globally, accounting for 17.3% of all disability-related health loss.

• Anxiety and depression drove much of the increase — Among all mental health conditions studied, anxiety disorders and major depressive disorder contributed the largest share of the burden. Additional reporting on the analysis noted that anxiety cases increased by 158% and depression cases increased by 131% compared to 1990 levels.

Anxiety disorders ranked as the largest contributor to mental health-related disability worldwide, followed by major depression and schizophrenia. These findings suggest that persistent stress, worry and low mood are becoming defining health challenges of modern life.

• Teenagers now carry the heaviest burden — Mental disorder disability rates peaked among individuals ages 15 to 19 years in 2023. Lead author Dr. Damian Santomauro noted that previous Global Burden of Disease reports consistently showed the highest burden during middle age, making this shift historically unusual.⁴

Because adolescence is a period when the brain, emotional regulation skills and social abilities are still developing, disruptions during these years often create effects that continue into adulthood.

• Women experienced a greater overall burden than men — Across the globe, age-standardized disability rates from mental disorders were higher among females than males. Researchers calculated a rate of 2,239.6 disability-adjusted life years per 100,000 females compared to 1,900.2 per 100,000 males.

While some conditions such as ADHD, autism spectrum disorder and conduct disorder occurred more frequently in males, anxiety disorders and depression contributed heavily to the greater overall burden among females.

• Researchers identified several forces behind the trend — The study focused on measuring disease burden rather than proving causes, but the authors and experts commenting on the findings pointed to several likely contributors.

These included economic instability, political conflict, warfare, food insecurity, discrimination, declining social connection, trauma, environmental stressors, and the lingering effects of the COVID-19 pandemic.⁵ Improved awareness and diagnosis also play a role, but they don’t fully explain the scale of the increase.

• Mental health concerns occupied a growing share of primary care — Visits involving any mental health diagnosis increased from 5.9 visits per 100 insured children in early 2014 to 9.7 visits per 100 children by early 2023.

That means pediatricians and family doctors encountered mental health concerns far more frequently than they did a decade earlier. This finding highlights how often emotional and behavioral concerns now surface during routine medical appointments rather than only in specialized mental health offices.

• Anxiety stood out from every other condition — Among all mental health diagnoses tracked, anxiety showed the most dramatic increase. Anxiety-related diagnoses appeared in 1.7% of pediatric primary care visits in 2014 but rose to 6.1% by 2023. Researchers described this as a roughly 300% relative increase over the 10-year period. No other condition came close to matching that rate of growth.

• Other diagnoses also increased steadily — ADHD remained the most common mental health concern encountered in pediatric primary care throughout the study period. ADHD diagnoses increased from 5% of visits to 6.7% of visits.

Autism spectrum disorder rose from 0.5% to 2%, while trauma- and stress-related disorders doubled from 0.8% to 1.6%. Depression diagnoses also increased, rising from 1.2% to 1.6% of visits. The pattern shows that anxiety was not an isolated trend. Multiple mental health concerns became more visible throughout childhood and adolescence.

• The rise occurred despite fewer doctor visits overall — During the same period that mental health-related visits increased, overall pediatric primary care visits declined slightly from 58.9 visits per 100 children to 54.8 visits per 100 children. In practical terms, children were not visiting doctors more frequently overall. Instead, mental health concerns represented a larger share of the healthcare issues discussed during those visits.

The authors suggested that the trend reflects both an increase in underlying mental health needs and greater efforts by health care providers to identify those needs. Screening refers to the use of questionnaires, conversations, and assessments that help doctors recognize concerns before they become severe. As more practices adopted these approaches, more children received diagnoses that previously might have gone unnoticed.

• Pediatric clinics have become a frontline setting for mental health care — Many families first discuss emotional concerns, behavioral struggles, school difficulties or social challenges with a primary care physician rather than a psychiatrist. Routine wellness visits become checkpoints where concerns can be recognized earlier and addressed before they disrupt academic performance, friendships or family relationships.

The researchers concluded that pediatric practices require additional training, resources and integrated mental health services to meet rising demand. Integrated care means mental health professionals work alongside primary care providers within the same health care system, making support easier to access.

As anxiety and other mental health concerns continue to appear more frequently in routine medical visits, the ability to identify and address problems early becomes increasingly important for long-term emotional well-being.

• The reduction was both consistent and significant — Across the studies, cortical choline levels were about 8% lower in people with anxiety disorders than in healthy controls. The finding became even stronger in studies with the highest-quality measurements, suggesting this was not a statistical fluke or isolated observation.

Researchers described reduced choline-containing compounds as a “consistent, transdiagnostic abnormality,” meaning it appeared across multiple anxiety disorders rather than being limited to one specific diagnosis.

• The affected brain regions help regulate thoughts and emotions — The largest changes appeared in cortical regions of the brain, particularly areas involved in executive function. Executive function refers to your brain’s ability to plan, organize, focus attention, and regulate emotional responses. Researchers noted that anxiety disorders are often associated with difficulty controlling worry and threat-related thoughts, making abnormalities in these regions especially relevant.

• Chronic stress appears to increase demand for choline — Persistent activation of the brain’s threat and arousal systems creates increased demand for choline-containing compounds. Over time, the brain appears to consume these compounds faster than it replenishes them. Researchers suggested that chronically elevated arousal alters membrane phospholipid metabolism — the process your brain uses to build, repair and recycle the fatty structures that make up cell membranes.

• Another marker suggested reduced neuronal health — Researchers also found lower levels of N-acetylaspartate, or NAA, across cortical regions. NAA is often used as a marker of neuronal integrity, meaning the overall health and function of brain cells. Lower levels suggest that chronic anxiety is associated not only with altered choline metabolism but also with broader changes in neuronal function.

• The findings point to a biological component of anxiety — One of the most important takeaways is that anxiety disorders are associated with measurable physical changes inside the brain. Researchers concluded that reduced cortical choline levels represent a widespread neurometabolic abnormality in anxiety disorders.

This helps explain why chronic anxiety often feels exhausting and difficult to control. The condition is not simply a pattern of negative thoughts; it’s associated with changes in the brain’s chemistry, structure maintenance and energy demands.

1. Make sleep your first priority — If your sleep is poor, every other strategy becomes harder. Anxiety and sleep disruption fuel each other. Create a consistent bedtime and wake time, even on weekends. Get outside shortly after sunrise to expose your eyes and skin to natural light. This helps regulate your circadian rhythm, which is your body’s internal clock. I also recommend reducing artificial light exposure after sunset so your brain receives a stronger signal that it’s time to rest.

2. Make exercise non-negotiable — Exercise is one of the most powerful tools available for mental health. Research consistently shows that exercise reduces depression symptoms as effectively as antidepressant medications and psychotherapy for many adults, without the burden of prescription side effects.⁸ Physical activity lowers stress hormones, improves sleep quality, supports healthy brain chemistry, and helps your brain adapt more effectively to life’s challenges.

If you’re inactive, start with a daily walk. As your fitness improves, add resistance training two times per week. Think of exercise as a daily investment in your brain’s resilience, not just your physical fitness.

3. Strengthen your social connections — The global mental health research identified declining social connection as one of the major factors associated with worsening mental health trends. Make connection a daily practice rather than an occasional event. Call a friend. Join a group activity. Eat meals with family members.

Aim for one real conversation and, where you can, one shared meal a day. Small interactions add up; give yourself a concrete daily target rather than waiting for the occasional big get-together.

4. Reduce the sources of chronic stress you can control — You can’t eliminate every stressor, but you can lower the number hitting your nervous system at the same time. Review your day like a scorecard. How much time do you spend consuming upsetting news, scrolling social media or multitasking? How often do you build recovery time into your schedule? Identify one source of unnecessary stress and remove it this week. Then repeat the process next week.

5. Give your brain the choline it needs — The brain imaging research found that people with anxiety disorders had significantly lower levels of choline-containing compounds in important brain regions. The best food source of choline is pastured egg yolks, but look for eggs from hens raised on low-polyunsaturated-fat (low-PUFA) feed.

Grass fed beef liver is another excellent option that provides highly absorbable choline. Most adults need roughly 425 to 550 milligrams (mg) of choline daily. A single egg yolk delivers around 115 to 150 mg, so two or three covers most of that target.

If you avoid animal foods, getting enough choline becomes much more difficult. Cruciferous vegetables such as broccoli, cauliflower and Brussels sprouts contain choline, but the amounts are relatively small. You would need to eat very large quantities to meet your needs. In that situation, a choline supplement is often necessary to avoid deficiency.

One underrated option is citicoline. Most products use doses that are too low to have a meaningful effect. At therapeutic doses between 500 mg and 2,500 mg daily, citicoline helps your brain produce acetylcholine while supplying building blocks needed to maintain healthy brain cell membranes. For people dealing with chronic stress, mental fatigue or difficulty concentrating, it’s one of the most targeted nutritional strategies for supporting healthy brain function.