Int J Equity Health. 2026 Feb 7. doi: 10.1186/s12939-026-02775-5. Online ahead of print.
ABSTRACT
BACKGROUND: Major depressive disorder (MDD) is a leading cause of global disability, yet systematic evaluations of quality of care disparities across regions are sparse. Leveraging data from the Global Burden of Disease (GBD) Study 2021, this study quantified the quality of care for MDD from 1990 to 2021 and examined socio-demographic inequities by age and sex.
METHODS: Data on MDD were extracted from the GBD 2021 study for the globe, 5 socio-demographic index (SDI) regions and 21 GBD regions. The quality of care index (QCI) is a composite, dimensionless index scaling from 0 to 100, with higher values indicating better quality of care. The age-standardized QCI was calculated using the Principal Component Analysis (PCA) method and further stratified by sex, age, and region. The gender disparity ratio (GDR) was used to characterize the sex disparities. The temporal trend of QCI and GDR by sex and age across SDI regions was further calculated.
RESULTS: Globally, the QCI of MDD increased from 56.26 (1990) to 62.95 (2021), with low SDI regions consistently exhibiting the highest QCI (71.90 in 1990; 71.19 in 2021) and high SDI regions the lowest (40.28 to 51.55). Sex disparities widened as female QCI rose by 14.0% (vs. 7.6% in males) and GDR increased from 1.02 to 1.08. The highest GDR (1.27) persisted in Oceania, while Tropical Latin America had the lowest (0.94 in 2021). Age-specific QCI peaked in adolescents (10-14 years) and declined with age, with notable improvements post-2019. Older adults (> 80 years) in high SDI regions saw higher QCI versus low-middle SDI regions. Trend analysis revealed that high and high-middle SDI regions maintained a lower QCI of MDD than the global average level but narrower sex gaps (GDR 1.04 in 2021) compared to low SDI regions (GDR 1.15).
CONCLUSIONS: While global quality of care for MDD improved, socioeconomic development inversely correlated with QCI, potentially reflecting systemic under-reporting in low-resource settings and overburdened systems in high-income regions. Persistent gender and age disparities necessitate targeted and equal policies, including sex-sensitive care models and geriatric mental health integration.
PMID:41654951 | DOI:10.1186/s12939-026-02775-5
