OBJECTIVES: In China, depressive disorder (DD) among middle-aged and older adults is a significant public health concern. This research utilized the latest Global Burden of Disease Study (GBD) database to evaluate the evolving disease burden of DD in this demographic over the past 3 decades. METHODS: Data on the incidence and disability-adjusted life years (DALY) of DD among people aged 45-89 in China between 1992 and 2021 were collected from the GBD 2021. The age-period-cohort (APC) model was applied to determine the effects of age, period, and cohort on the incidence and DALY rates of DD. RESULTS: (1) Over the last 30 years, there was a 6.49% increase in the overall age-standardized incidence rate (ASIR) and a 3.99% increase in age-standardized DALY rates (ASDR) for DD among middle-aged and older adults in China, with females consistently exhibiting higher ASIR and ASDR than males. In 2020, COVID-19 significantly increased the ASIR and ASDR of DD in the population, especially in females. (2) The APC analysis revealed an annual net drift of 0.38% in incidence and 0.17% in DALY rate. For both genders, local drifts of incidence were negative for the 45-54 age group and positive for the 55-89 age group
DALY rates showed negative local drifts for the 45-59 age group and positive for the 60-89 age group. (3) Incidence and DALY rates increased with age, displaying a trend of initial decline followed by an increase in period effects, but a trend of initial increase followed by a decrease in cohort effects. Moreover, the impacts of age, period, and cohort exhibited gender differences. CONCLUSIONS: Our findings provide a comprehensive and in-depth perspective for studying the changing trends of DD's burden in China and for identifying targeted prevention and treatment policies for DD from different aspects.