Global, Regional, and National Trends in the Burden of Bipolar Disorder Among Women of Reproductive Age from 1990 to 2021, and Projections to 2041: A Systematic Analysis from the Global Burden of Disease Study 2021

Feihu Hu¹Huaichen Zhang²Qin He¹Jing Zhang²Jingbei Zhang³Chuanfu Song^3*Cheng Yang^3*

• ¹Second Affiliated Hospital of Nanchang University, Nanchang, China
• ²Daizhuang Hospital, Jining City, Shandong Province, Jining City, Shandong Province, China
• ³The Fourth People's Hospital of Wuhu, Wuhu, China

Background: Bipolar disorder (BD) is a severe psychiatric illness. Women of reproductive age (15–49 years) are at higher risk due to hormonal, reproductive, and social factors. Despite its substantial personal and public health burden, systematic evidence based on recent Global Burden of Disease (GBD) data remains limited. Methods:This study used GBD 2021 data to assess incidence, prevalence, and DALYs of BD among women aged 15–49 globally, regionally, and nationally from 1990–2021. We calculated age-standardized incidence rate (ASIR), prevalence rate (ASPR), and DALYs rate (ASDR), along with the estimated annual percentage change (EAPC) , evaluated health inequality, and projected trends to 2041 using a Bayesian age–period–cohort model. Results:From 1990 to 2021, the burden of BD among women aged 15–49 years increased significantly worldwide. In 2021, the numbers of new cases, prevalent cases, and DALYs were all higher than in 1990. Although the ASIR slightly declined (EAPC=−0.07), both the ASPR and ASDR continued to rise (EAPC=0.06 and 0.05, respectively). Across SDI quintiles, high-SDI regions ranked highest in all three indicators; middle-high SDI regions had the lowest ASIR and ASPR, while middle-low SDI regions had the lowest ASDR. Regionally, Tropical Latin America recorded the highest ASIR, while Oceania reported the highest ASPR and ASDR; East Asia showed the lowest values across all three indicators. At the national level, New Zealand had the highest ASIR, ASPR, and ASDR; China reported the lowest ASIR, and the Democratic People’s Republic of Korea had the lowest ASPR and ASDR. The burden was positively correlated with SDI, particularly for ASPR and ASDR. By age group, the greatest increase in incidence was observed among women aged 35–39 years, while the 45–49 age group showed the largest rises in prevalence and DALYs. Over the past three decades, health inequalities have shown little improvement. Projections suggest that by 2041, ASIR, ASPR, and ASDR may slightly decline, but the overall burden will remain high Conclusion: From 1990 to 2021, the global burden of bipolar disorder among women of reproductive age rose markedly, with significant disparities. Context-specific strategies, including early screening and long-term management, are essential to reduce burden and improve mental health.