# Thirty-Year Trends in Anxiety Disorders Incidence Across China, Japan, and Republic of Korea: An Age–Period–Cohort Analysis Based on GBD 2021

## TL;DR

This study analyzes 30-year trends in anxiety disorders in China, Japan, and South Korea, revealing differences in incidence patterns and the impact of modernization and the pandemic.

## Contribution

The study provides a comparative age–period–cohort analysis of anxiety disorders in East Asia, highlighting distinct trends and the influence of modernization and the pandemic.

## Key findings

- All three countries saw increased anxiety disorders after the pandemic, with China and Japan showing declining incidence rates before 2019.
- Adolescents (10–14 years) had the highest anxiety incidence across all three countries, with China and South Korea showing a second peak in middle age.
- Period and cohort effects indicate decreasing anxiety trends in China and Japan but stability in South Korea.

## Abstract

Background: East Asia accounts for the highest number of anxiety disorders cases globally, with China, Japan, and Republic of Korea representing 17.5% of global incidence according to GBD 2021. These nations offer a unique context for examining how different modernization paths impact anxiety disorders patterns. This study examined anxiety disorders incidence trends across these countries from 1992 to 2021 to compare disease burdens and inform public health strategies. Methods: Using GBD 2021 data, we employed age–period–cohort analysis to evaluate factors affecting anxiety disorders incidence, examining age-specific rates, period effects, and birth cohort influences. Results: All three countries experienced sharp increases in anxiety disorders following COVID-19. Age-standardized incidence rates decreased by 4.89% in China and 10.52% in Japan from 1992 to 2019, while remaining stable in Republic of Korea. Net drift was −0.40% for China, −0.50% for Japan, and approximately 0 for Republic of Korea. Local drifts were positive among older adults in China and Japan, and middle-aged adults in Republic of Korea. Longitudinal age curves showed inverted V-shaped patterns, peaking in the 10–14 age group across all three countries. China and Republic of Korea exhibit a second peak during middle age, while Japan shows continuous decline after the 10–14 age group. Period and cohort effects indicating overall decreases in China and Japan, with minimal changes in Republic of Korea. Conclusions: Different modernization trajectories have produced distinct anxiety disorders patterns across these East Asian nations. The elevated risk among adolescents across all countries warrants targeted interventions, while high risks among middle-aged adults in China and Republic of Korea requires age-specific approaches. Countries should utilize their healthcare systems’ strengths to create targeted strategies for reducing anxiety disorders while addressing pandemic-related mental health impacts.