Abstract
Background
We know relatively little about how mental health varies across countries around the world or among demographic groups in diverse nations and cultures.
Methods
The current study addresses these issues by analyzing symptoms of depression and anxiety using data from the Global Flourishing Study (GFS), an international, nationally-representative survey of 202,898 individuals from 22 geographically, economically, and culturally diverse countries collected in 2022-2023.
Results
Here we show that proportions of individuals with substantial symptoms of depression range from 0.14 in Poland to 0.50 in the Philippines. These two countries report the lowest and highest substantial symptoms of anxiety as well (0.13 and 0.48, respectively). Lower-income, non-Western countries tend to have higher proportions of both outcomes compared with higher-income, predominantly Western nations. Symptoms of depression and anxiety also vary across age, gender, marital status, education, employment status, religious service attendance, and immigration status in one or more countries. The results of random effects meta-analyses show that several demographic factors are significant predictors of both outcome variables when the results for all 22 countries are pooled.
Conclusions
While being mindful of varying cultural contexts and possible translation and interpretive issues with the survey questions, the results suggest substantial variations in symptoms of both depression and anxiety across nations and key demographic groups. This work lays the foundation for future longitudinal GFS studies of mental health from a cross-national and global perspective.
Plain language summary
This study examines how mental health varies in countries around the world and among demographic groups in diverse nations and cultures. Data from a nationally-representative survey of 202,898 individuals from 22 geographically, economically, and culturally diverse countries is analyzed. The data was collected in 2022-2023. The percentage of individuals reporting substantial symptoms of depression ranges from 14%-50% in different countries, while anxiety ranges from 13%-48%. Symptoms of both outcomes also vary across age, gender, marital status, education, employment status, religious service attendance, and immigration status in one or more countries. These findings highlight considerable variation across countries in mental health, as well as important demographic differences, which identify vulnerable populations that can be targeted with interventions.
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Data availability
This study analyzed cross-sectional data from Wave 1 of the GFS, which is publicly available through the COS (https://doi.org/10.17605/OSF.IO/3JTZ8), the host for all data collected for the study. For additional information about data access and use, see the COS website (https://www.cos.io/gfs-access-data) or contact them by email (globalflourishing@cos.io). All relevant data are available from the corresponding author.
Code availability
All code to reproduce the analyses are openly available in an online repository hosted by the COS (https://doi.org/10.17605/osf.io/vbype). Versions are available for R, SAS, Stata, and SPSS.
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Acknowledgements
The authors would like to acknowledge and thank Noah Padgett, Ying Chen, Sung Joon Jang, and Koichiro Shiba for their help with the data analysis. The GFS was generously funded by the John Templeton Foundation (#61665), the Templeton Religion Trust (#1308), the Templeton World Charity Foundation (#0605), Well-Being for Planet Earth, Fetzer Institute (#4354), Well Being Trust, Paul L. Foster Family Foundation, and the David & Carol Myers Foundation. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of these organizations. The funding source had no impact on the study design; on the collection, analysis, and interpretation of data; on the writing of the manuscript; or on the decision to submit the article for publication.
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M.B.: Conducted the data analysis, contributed to the interpretation of the data, and drafted the original manuscript. K.S.: Contributed to reviewing and editing the manuscript. S.J.J.: Contributed to the development of code for data analysis and revision of the manuscript. B.V.K.: Review and editing. R.B.: Critical review and editing. B.R.J.: Obtained funding for the project as the Principal Investigator, led and contributed to every phase of the project, contributed to the interpretation of the data, and contributed to writing and editing the manuscript. T.J.V.: Obtained funding for the project as the Principal Investigator, led and contributed to every phase of the project, contributed to the interpretation of the data, and contributed to writing and editing the manuscript.
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Tyler J. VanderWeele reports partial ownership and licensing fees from Gloo Inc. The remaining authors declare no competing interests.
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Bradshaw, M., Shiba, K., Jang, S.J. et al. Demographic variation in symptoms of depression and anxiety across 22 Global Flourishing Study countries. Commun Med (2026). https://doi.org/10.1038/s43856-025-01366-9
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DOI: https://doi.org/10.1038/s43856-025-01366-9
