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This study quantified global and regional prevalence, disability-adjusted life-years (DALYs), and years lived with disability (YLDs), and temporal trends of mental disorders and SUDs among AYAs from 1990\u20132021. Estimates were generated using DisMod-MR 2.1, with standardized case definitions, severity weights, and pandemic-period adjustments. Temporal trends were assessed with Joinpoint regression. In 2021, the global point prevalence of mental disorders was 15.2% in adolescents, and 16.1% among young adults, with anxiety disorders being the most common condition. Mental disorders were the leading cause of YLDs and DALYs in 2021. High-income regions exhibited the highest rates of mental disorders. Significant sex differences were observed, with higher prevalence of attention-deficit hyperactivity disorder and autism spectrum disorders in males, and anorexia nervosa was more prevalent in females. SUDs were the 15th cause of YLDs and 22nd cause of DALYs among adolescents and ranked 8th for YLDs and 11th for DALYs for young adults. During the pandemic, a significant increase in the prevalence of mental disorders and a decline in SUDs was observed. DALYs for mental disorders increased significantly during the pandemic, especially for depressive and anxiety disorders, with higher DALYs in females than males. Mental disorders remain a leading cause of disability in AYAs worldwide, with a marked surge during 2019\u20132021. Although SUDs declined, the rising burden of depression and anxiety demonstrated urgent needs for age-specific, sex-responsive, and regionally tailored mental health strategies.<\/jats:p>","DOI":"10.1038\/s41380-026-03503-9","type":"journal-article","created":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T17:43:52Z","timestamp":1772300632000},"page":"3880-3897","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The global burden of mental and substance use disorders among adolescents and young adults"],"prefix":"10.1038","volume":"31","author":[{"given":"Xiangyu","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ligang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luofei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pujing","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenshuo","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-0666","authenticated-orcid":false,"given":"Milap C.","family":"Nahata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"3503_CR1","doi-asserted-by":"publisher","first-page":"2030","DOI":"10.1016\/S0140-6736(19)31013-X","volume":"393","author":"SJ Blakemore","year":"2019","unstructured":"Blakemore SJ. 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This research was conducted without any external funding or financial support, ensuring complete independence in the study design, data collection, analysis, and interpretation. All authors contributed equally to the research process, including the formulation of the study, the analysis of the data, and the writing of the manuscript. No personal, institutional, or financial relationships with any organizations or entities that could have influenced the outcomes of the research were present. The decision to submit this manuscript for publication was made solely by the authors, with no external pressures or interests involved. All authors are committed to upholding the highest standards of scientific integrity and transparency.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study utilized publicly available data from the Global Burden of Disease (GBD) Study, which does not involve direct interaction with human participants or the use of identifiable personal information. Therefore, ethics committee approval was not required for this research. The data used in this study was fully anonymized, and no specific individual-level information was accessed. All analyses were conducted in accordance with the ethical guidelines set forth for secondary data research, ensuring compliance with international standards for the ethical use of health data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Committee approval"}}]}}