# Global, regional and national burden of childhood sexual abuse and bullying in adolescents and young adults: a Global Burden of Disease 2021 analysis

## TL;DR

This study shows that while deaths from childhood sexual abuse and bullying have decreased, the disability burden has increased, especially affecting young women in low-resource areas.

## Contribution

The paper provides the first global analysis of CSA/B's impact on mortality and disability using GBD 2021 data across 204 countries and territories.

## Key findings

- CSA/B-related deaths decreased by 28%, but DALYs increased by 45% from 1990 to 2021.
- Mental health issues like anxiety and depression dominate disability in different age groups.
- Low-SDI regions saw the fastest rise in DALYs, highlighting disparities in resource-poor settings.

## Abstract

Childhood sexual abuse and bullying (CSA/B) undermine adolescent and young-adult health worldwide. We quantified CSA/B-attributable mortality and disability globally across 204 countries and territories (1990–2021), with regional and national disaggregation.

We analysed the GBD 2021 dataset and applied the comparative risk assessment framework to estimate CSA/B-attributable deaths and disability-adjusted life years (DALYs) by sex, age and Sociodemographic Index (SDI), summarising temporal trends using estimated annual percentage change (EAPC).

CSA/B-related deaths fell from 260 to 187 (–28 %), whereas DALYs rose from 2.54 million to 3.69 million (+45 %). The age-standardised mortality rate declined (EAPC –2.4 %), but the age-standardised DALY rate grew slightly (EAPC +0.5 %). Males carried higher absolute counts, yet females showed steeper DALY growth (+51 % vs +40 %). High-middle and middle-SDI regions achieved the greatest mortality reductions; deaths climbed 103 % and DALY rates 220 % in low-SDI areas. Anxiety accounted for most disability at 15–19 years, whereas depressive and alcohol-use disorders predominated at 20–24 years. Regionally, South Asia led deaths/DALYs, Australasia was lowest; Age-standardised mortality rates (ASMR) peaked in Eastern Europe, age-standardised DALY rates (ASDR) in high-income North America; DALYs rose fastest in Western/Central/Eastern sub-Saharan Africa.

Falling mortality alongside expanding disability reveals a widening survivorship gap driven by mental ill-health, particularly among young women in resource-poor settings. Age-specific, gender-responsive violence-prevention and mental-health services are urgently needed to stem the growing DALY burden and advance global AYA wellbeing.