Global Burden of Mental Disorders Among Female Children and Adolescents Compared with Males: Findings from the Global Burden of Disease Study 1990 to 2021

Background: This study describes the global burden of mental disorders among female children and adolescents, with particular attention to temporal trends, regional patterns, and attributable risk factors from 1990 to 2021. Methods: Using Global Burden of Disease 2021 data, we analyzed age-standardized DALY rates, prevalence, and incidence among children and adolescents aged 0– 19 across 204 countries. Estimates for males were included as a comparator to contextualize the burden among females. Results: The prevalence of mental disorders among children and adolescents increased modestly overall from 1990 to 2021, with a more pronounced increase between 2020 and 2021. In 2021, males had higher overall age-standardized prevalence, while females had higher age-standardized DALY rates per 100,000 population, at 1073.64 (95% Confidence Interval (CI) 1073.08 to 1074.20) compared with 1027.13 (95% CI 1026.60 to 1027.67) in males. Females bear a more significant burden of emotional disorders, and males are more affected by behavioral and developmental disorders. Neurodevelopmental disorders predominated at ages 0 to 4, depression and anxiety were more prominent in older children and adolescents. Among females in high SDI countries, the age-standardized DALY rate reached 1579.02 per 100,000 people (95% CI 1576.8– 1581.26). GBD estimates indicated higher proportions of DALYs attributable to behavioral risks and childhood sexual abuse in high SDI countries, while proportions attributable to lead exposure and environmental risks were higher in low and low-middle SDI countries. Conclusion: Mental disorders impose a substantial burden on female children and adolescents worldwide, with the higher DALY burden relative to males particularly evident during adolescence. These findings may inform prevention priorities and public health strategies tailored to females across age groups and socioeconomic contexts.