Major Depressive Disorders in Children Aged 5–14 Years: A Global Burden of Disease Analysis from the Perspective of Exercise Psychology

Wei Wei¹Yongsheng Sun²Shuting Yin³Wei Lyu⁴Rui Liang^5*

• ¹Zhengzhou College of Finance and Economics, Zhenzhou, China
• ²Capital University of Physical Education and Sports, Beijing, China
• ³Kangning Primary School of Zhengdong New District, zhengzhou, China
• ⁴Faculty of Medicine and Health, Al-Farabi Kazakh National University, Almaty, Kazakhstan
• ⁵Henan Institute of Science and Technology, Xinxiang, China

Background: Major depressive disorder (MDD) is an increasingly recognized contributor to morbidity and disability among children globally. While adolescent mental health has received growing attention, the burden and drivers of MDD in children aged 5–14 years remain inadequately characterized at the global level. Methods: We conducted a comprehensive analysis using Global Burden of Disease (GBD) 2021 data to quantify trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of MDD in children aged 5–14 years across 204 countries and territories from 1990 to 2021. Estimates were stratified by age, sex, region, and Socio-demographic Index (SDI). Key behavioral and psychosocial risk factors were evaluated, and projections to 2035 were generated. Policy and intervention recommendations were developed based on evidence from the literature and global health frameworks. Findings: Between 1990 and 2021, the global burden of childhood MDD increased substantially, with sharp rises in prevalence and DALY rates, especially among girls and children aged 10–14 years. High-SDI regions exhibited the highest age-standardized rates, while low-and middle-SDI regions showed rapid relative increases. Bullying victimization, physical inactivity, and other modifiable behavioral factors emerged as leading risk factors for childhood MDD. The COVID-19 pandemic acted as a significant accelerant but was not the sole driver of burden growth. Profound disparities in access to mental health services persist, particularly in low-resource settings. Interpretation: Childhood MDD poses a significant global public health challenge, with profound consequences for lifelong well-being and social functioning. Effective prevention requires school-based mental health initiatives, physical activity interventions, anti-bullying measures, and enhanced community care systems. Mental health policies must ensure equitable resource distribution, robust data infrastructure, and cross-sectoral coordination following WHO and UNICEF guidelines. Improving early identification, mitigating behavioral risks, and guaranteeing universal access to youth mental health services remain crucial for reversing current trajectories and fostering healthy child development.