Intimate Partner Violence and Childhood Sexual Violence Drive a Major Share of Global Disability
In 2023, intimate partner violence against females and sexual violence against children remained among the most consequential drivers of disease burden worldwide, with effects that reach far beyond injury or immediate trauma. The Global Burden of Disease Study 2023 estimated that 608 million females aged 15 years and older had ever experienced intimate partner violence, while 1.01 billion people aged 15 years and older had experienced sexual violence during childhood. Those exposures translated into a vast burden of disability: 18.5 million DALYs attributable to intimate partner violence among females and 32.2 million DALYs attributable to sexual violence against children among males and females.
The numbers are stark because the harms are not confined to a single diagnosis or a single moment in time. Violence in the home and violence in childhood alter risk trajectories across mental health, self-harm, psychotic disorders, substance use, and infectious and chronic disease outcomes. In practical terms, the exposure is upstream, but the clinical consequences present everywhere in medicine.
Mental Health Disorders Carry the Largest Attributable Burden
Among females exposed to intimate partner violence, anxiety disorders and major depressive disorder accounted for the largest shares of attributable burden. Anxiety disorders contributed 5.43 million DALYs, with an uncertainty interval stretching from -1.25 to 14.6 million, and major depressive disorder accounted for 3.96 million DALYs, with a 95% uncertainty interval of 1.71 to 6.92 million. Those estimates place the psychiatric consequences of abuse at the center of the burden calculation, not at the margins.
A similar pattern emerged for sexual violence against children, though the range of outcomes was broader. The analysis linked childhood sexual violence to 14 health outcomes spanning mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia contributed the greatest burdens in 2023, with sexual violence against children accounting for 6.71 million DALYs due to self-harm and 4.15 million DALYs due to schizophrenia. These are not abstract statistical associations. They reflect the long tail of trauma, in which early violence can reshape coping behavior, stress responses, sleep, cognition, social functioning, and vulnerability to psychiatric illness well into adulthood.
The pathophysiology is plausible and clinically familiar. Chronic trauma can drive persistent hyperarousal, dysregulated stress signaling, and impaired emotional processing. Over time, those changes increase the probability of depression, anxiety, self-injury, and substance use as survivors attempt to manage symptoms that were never voluntarily chosen. When abuse begins in childhood, the developmental consequences can be even more severe because exposure occurs during periods when attachment, neurodevelopment, and behavioral regulation are still forming.
Why These Exposures Rank So High in Women of Reproductive Age
Among females aged 15 to 49 years, intimate partner violence and sexual violence against children ranked as the fourth and fifth leading risk factors for DALYs, respectively. That placement is especially important because this is a life stage in which health systems often focus on pregnancy, contraception, infectious disease, or acute care encounters without consistently identifying violence exposure as a root cause of ongoing morbidity.
A single sentence captures the clinical implication: these exposures are already among the dominant drivers of health loss in women during the years when reproductive, mental health, and family responsibilities overlap.
The study’s design makes the burden hard to dismiss. Investigators estimated prevalence and attributable burden for 204 countries and territories from 1990 to 2023, using self-reported exposure data from global databases and a systematic review of associated health outcomes. Prevalence modeling used spatiotemporal Gaussian process regression with adjustments for measurement heterogeneity, and burden-of-proof methodology informed the relative risks used to calculate population attributable fractions and DALYs. The result is a globally comparable estimate that is intended to be useful for policy, planning, and prevention.
A Broad Clinical Footprint Extends Beyond Psychiatry
Although mental health outcomes absorbed the largest share of attributable burden, the analysis makes clear that the damage extends beyond depression, anxiety, or self-harm. Sexual violence against children was associated with chronic and infectious disease outcomes as well as substance use disorders, reinforcing the idea that trauma influences health across multiple organ systems and over long time horizons. Abuse can affect cardiovascular risk through chronic stress pathways, worsen sleep and health behaviors, and complicate adherence to treatment. It can also impair trust in healthcare settings, reducing the likelihood that survivors seek help early or disclose symptoms that might otherwise be recognized sooner.
This breadth matters because it changes how clinicians should think about screening and intervention. Violence history is not only a social determinant in the broad sense; it is a measurable risk factor with a disease burden large enough to rival better-known global hazards. When a child’s exposure later appears as self-harm, a young woman’s abuse history later appears as depressive illness, or a survivor’s chronic somatic symptoms later appear without a clear biomedical explanation, the original exposure may be the most important diagnostic clue.
Prevention Is a Health-System Strategy, Not Only a Social Goal
The burden estimates argue for prevention at the level of policy, law, community support, and healthcare delivery. Preventing intimate partner violence and sexual violence against children would avert millions of DALYs each year and reduce premature mortality tied to downstream mental and physical health effects. Sustained investment is also needed for survivor-centered services that address the complexity of these cases, including mental health care, safety planning, trauma-informed primary care, reproductive health services, and long-term follow-up.
The scale of the problem is not evenly distributed across countries or territories, but the global totals alone make clear that violence prevention belongs in the same conversation as other major public health priorities. Resources devoted to screening, safe referral pathways, and integrated behavioral health services are not optional additions to care; they are part of the response to a major driver of disability.
Uncertainty Remains in the Measurement, Not in the Public Health Need
The burden estimates carry uncertainty intervals, including some wide ranges around cause-specific DALYs, and the childhood sexual violence estimates incorporate both male and female survivors. Those analytic features reflect the difficulty of measuring violence that is often hidden, underreported, or inconsistently defined across settings. Even so, the direction of the signal is unambiguous. The burden is large, the exposure is common, and the consequences are distributed across more than one disease category.
Funding for the analysis came from the Gates Foundation. The policy implication is straightforward: governments, health systems, and international agencies need to treat intimate partner violence and sexual violence against children as central causes of preventable disease, not as peripheral social concerns. The remaining challenge is not whether the burden exists. It is whether national prevention budgets and survivor services will be scaled to match it.