Abstract
OBJECTIVE: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.