China’s Mental Disorder Cases Reach 191 Million, New Lancet Study Finds

A major new study estimates that China had more than 191 million prevalent cases of mental disorders in 2023, a sharp increase over the past three decades and a finding that has renewed discussion about psychological pressure, particularly among young people.

The study, published July 27 in The Lancet Regional Health – Western Pacific, was conducted by researchers from the Chinese Center for Disease Control and Prevention, Beijing Anding Hospital at Capital Medical University, and other institutions. Using data from the Global Burden of Disease Study 2023, researchers examined mental disorders nationally and across provincial-level areas from 1990 through 2023.

The researchers described mental disorders as a “growing public health priority” in China and said the country had experienced a “substantial escalation” in the burden of such conditions over the three-decade period.

Mental disorder cases rise 45.6 percent since 1990

According to the study, China had an estimated 191.2 million prevalent cases of mental disorders in 2023, up 45.6 percent from 1990. The age-standardized prevalence rate rose 14.6 percent to 12,706 cases per 100,000 people.

Mental disorders were also responsible for an estimated 26.4 million disability-adjusted life years, or DALYs—a measure combining years lost to premature death and years lived with disability. The total DALY burden increased 52.7 percent from 1990, while the age-standardized DALY rate rose 18.4 percent.

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Depressive and anxiety disorders were the largest contributors. Depression accounted for 35.6 percent of DALYs associated with mental disorders and affected an estimated 59.6 million people, while anxiety disorders accounted for 26.3 percent and affected about 58.7 million.

The highest age-standardized prevalence rates were recorded in Hong Kong, Gansu, Macao and Shandong. The lowest were in Liaoning, Tianjin, Beijing and Shanghai. Macao recorded the largest percentage increase in prevalence since 1990, followed by Hubei, Hong Kong, Tibet and Ningxia.

The burden was also uneven across age groups. DALYs were relatively high among people ages 5–19, 30–39 and 50–59, with anxiety disorders particularly prevalent among children and adolescents.

The figures prompted skepticism from some mainland Chinese social-media users, who argued that the true number of people experiencing psychological problems could be higher.

“This figure is definitely conservative,” one commenter wrote, according to Chinese-language reports circulating after the study was published.

“It can only be more, not less,” another said. “Some people in the early stages of illness do not even know they have a mental disorder.”

Such comments are personal opinions and do not establish that the Lancet estimate is an undercount. The study itself provides a 95 percent uncertainty interval of approximately 175.7 million to 213.2 million cases.

Depression risk among Chinese students draws concern

Concerns are particularly acute among children and adolescents.

The Chinese Academy of Sciences’ Institute of Psychology reported in 2023 that its China National Mental Health Development Report (2021–2022), based on surveys involving nearly 200,000 respondents, found that 14.8 percent of surveyed adolescents showed varying degrees of depression risk. Researchers also found that depression, loneliness and problematic cellphone use generally increased with grade level.

Earlier Chinese research reported substantially higher depression-screening rates among older students. The China National Mental Health Development Report (2019–2020) found rates of about 10 percent among primary-school students, roughly 30 percent among middle-school students and close to 40 percent among high-school students. Those figures refer to screening for depressive symptoms, however, and should not be interpreted as rates of clinically diagnosed depression.

A more recent systematic review likewise found depressive symptoms were common among Chinese students, estimating pooled prevalence at 28.2 percent among high-school students, 24.2 percent among middle-school students and 17 percent among primary-school students.

Pandemic-related disruption also intensified concern over mental health. Chinese Academy of Sciences academician Lu Lin previously cited estimates of approximately 70 million additional cases of depression and 90 million cases of anxiety during the COVID-19 pandemic. Those numbers referred to the global increase associated with the pandemic, rather than to China alone.

Teacher warns of intense academic pressure

Against that backdrop, some Chinese teachers and parents have increasingly criticized the pressures imposed on students.

A Douyin blogger using the name “Zhao Jiumei Academic Guidance,” who said she had 21 years of frontline teaching experience, drew attention after arguing that parts of China’s school system were “mass-producing people with mental illness” and “mass-producing depression.”

She described one school where students reportedly arrived shortly after 6 a.m. and remained until 11 p.m., attending classes six days a week while receiving extensive homework for their sole day off.

Under such conditions, she said, children could spend more than 300 days a year under intense pressure.

“A child who was once full of vitality can no longer even smile,” she said.

The account represents an individual teacher’s description and cannot be taken as representative of every Chinese school. Research, however, has found associations between heavy academic pressure and poorer psychological outcomes.

A report examining students after China’s “double reduction” education reforms found that children who reported heavier homework loads had a depression-risk screening rate of 33.5 percent, compared with 16 percent among those who reported having less homework. Students with less time for sports or personal interests also recorded substantially higher depression-risk rates.

Reports of strained child mental-health services

Parents and social-media users have also described difficulty accessing psychiatric care for children.

In one widely circulated Douyin video, a blogger claimed that child psychiatric services in Beijing were overwhelmed and that some students experienced such severe anxiety at school that “their hands tremble when they write.”

“The flowers of the nation are sick,” he said, before arguing that the surrounding educational environment was partly responsible.

Another Douyin commentator similarly claimed that psychology and psychiatry departments at children’s hospitals were crowded in cities across China and that appointments had become difficult to obtain. Those specific social-media claims have not been independently verified.

There is, however, broader evidence that demand has strained China’s limited child mental-health resources. Earlier reporting on pediatric psychiatric services described long outpatient lines and appointment systems filling immediately, with some children being diverted to adult psychiatric departments because specialist services were unavailable.

Chinese researchers have also warned that routine mental-health monitoring among children remains inadequate. A 2024 review noted that much of the existing data comes from self-reported screening rather than clinical diagnosis, complicating comparisons between studies and making it important to distinguish symptoms, elevated risk and diagnosed psychiatric illness.

Viral criticism targets education and employment pressures

Broader frustration has also surfaced in viral online commentary about education, unemployment and the prospects facing young Chinese graduates.

In one video circulated on X, a Chinese man argued that families spend enormous amounts on tutoring and education only to see some graduates struggle to find work. He described unemployed young people as being “like walking corpses” and asked, “Are these really the talents we spent huge amounts of money educating?” 

His remarks represent political and social commentary rather than evidence about the prevalence or causes of mental illness. They nevertheless reflect a broader online debate over academic competition, employment pressure and the psychological toll facing younger generations.

The Lancet researchers did not attribute China’s rising mental-disorder burden to any single social or political cause. Instead, they called for better allocation of mental-health resources and interventions tailored to different age groups, regions and populations.