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. 2026 Jan 3;407(10523):31-52.
doi: 10.1016/S0140-6736(25)02503-6. Epub 2025 Dec 9.

Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023

GBD 2023 Intimate Partner Violence and Sexual Violence against Children Collaborators
Collaborators, Affiliations

Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023

GBD 2023 Intimate Partner Violence and Sexual Violence against Children Collaborators. Lancet. .

Abstract

Background: Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels.

Methods: We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor.

Findings: Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023.

Interpretation: IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors.

Funding: Gates Foundation.

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Conflict of interest statement

Declaration of interests S Afzal reports support for the present manuscript from the Institute of Public Health Lahore; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational seminars provided by the Dean Institute of Public Health Lahore; support for attending meetings and travel provided by the Dean Institute of Public Health, Lahore Pakistan; participation on a data and safety monitoring board or advisory board as member of the Pakistan National Bioethics Committee, member of the Institutional Review Board of Fatima Jinnah Medical University, member of the Ethical Review Board and Data Monitoring Board Institute of Public Health Lahore Pakistan, and in-charge Clinical Research Organization King Edward Medical University; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as member of the Pakistan Higher Education Commission Research Committee, member of the Pakistan Medical and Dental Commission Research and Journals Committee, member of the Pakistan Society of Internal Medicine, member of the Pakistan Association of Medical Editors, member of the Medical Microbiology and Infectious Diseases Society, Fellow of Leads International, Fellow of Faculty of Public Health UK, and as a Fellow of the College of Physicians and Surgeons Pakistan; receipt of computer software and equipment from Bergen University Norway for research writing; other financial or non-financial support from the Dean Public Health and Preventive Medicine King Edward Medical University; outside the submitted work. J S Chandan reports support for the present manuscript from the National Institute for Health and Care Research; grants or contracts from the National Institute for Health and Care Research, Youth Endowment Fund, College of Policing, University of Birmingham, Birmingham City Council; consulting fees from Dexter AI (Chief Medical Officer); support for attending meetings and/or travel from the University of Miami and the University of Washington; outside the submitted work. K Deuba reports grants or contracts from the Research Council of Norway (project no 335495); outside the submitted work. D Dias da Silva reports grants or contracts from Fundação para a Ciência e a Tecnologia, project 2024.06933 RESTART (payment made to institution) and E2S|P.Porto—Escola Superior de Saúde do Politécnico do Porto (tenure position as an Adjunct Professor), LAQV-Requimte PT national funds (FCT/MECI, Fundação para a Ciência e Tecnologia and Ministério da Educação, Ciência e Inovação) through the project UID/50006—Laboratório Associado para a Química Verde—Tecnologias e Processos Limpos; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Faculdade de Farmácia da Universidade do Porto (Portugal) payment made to institution for lectures, Faculdade de Medicina da Universidade do Porto (Portugal) payment made to institution for lectures; support for attending meetings and/or travel from E2S|P.Porto—Escola Superior de Saúde do Politécnico do Porto, Portugal, and travel and meetings expenses from Research Unit LAQV-REQUIMTE, Portugal; outside the submitted work. A Faro reports support for the present manuscript from National Council for Scientific and Technological Development (CNPq), Brazil, CNPq Researcher (PQ B). R C Franklin reports support for attending meetings and/or travel from Australasian College of Tropical Medicine Annual Conference 2022-2025; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as President of Australasian College of Tropical Medicine, President of Kidsafe Australia, Board Member of the Royal Life Saving Society Australia, and Board Member of Auschem Trainingas; outside the submitted work. D Fry reports support for attending meetings and/or travel from the Institute for Health Metrics and Evaluation for attending an advisory group meeting related to this work; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) on the Childlight's Index Technical Sub-Committee which is also around the topic of child sexual abuse data. F M Knaul reports grants or contracts with Merck KGaA/EMD Serono (research grant paid to the University of Miami), Tides Foundation via the Oak Foundation (two research grants paid to the University of Miami), Fondation Botnar, and the Finker-Frenkel Family Foundation. FMK also reports gifts to the University of Miami from the Wellcome Trust, Mena Catering, the Gloria Estefan Foundation, and the Jose Milton Foundation to support the Lancet Commission on Gender-based Violence and Maltreatment of Young People; consulting fees from Tecnológico de Monterrey; provided strategic guidance on research priorities and lectures for the Institute for Obesity Research at the Tecnólogico de Monterrey (university); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Cannon Medical Systems—FMK received honoraria for participation in two webinars related reducing disparities in women's health; leadership or fiduciary roles as Founding President of Tómatelo a Pecho, a Mexican non-profit organisation that promotes research, advocacy, awareness, and early detection of breast cancer and has expanded its mission to promote women's health more broadly; Senior Economist (unpaid) with the Mexican Health Foundation; Member of the Board of Directors (unpaid) for Esperanza United; and Member of the Board of Directors for Kristi House Children's Advocacy Center; outside the submitted work. K Krishan acknowledges non-financial support from the University Grants Commission (UGC) Centre of Advanced Study, CAS II, awarded to the Department of Anthropology, and RUSA 2.O grant awarded to Panjab University, Chandigarh, India, outside the submitted work. A-M L Laslett reports support for the present manuscript from the National Health and Medical Research Council of Australia (GNT 2016706; fellowship/salary); support for attending meetings and/or travel from the University of Agder, Norway for the Visiting Travel Award—local airfares and accommodation provided for visit (no conflict of interest); leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as a member of the International Society for Addiction Journal Editors and as Secretary of the Kettil Bruun Society for Social and Epidemiological Research on Alcohol (La Trobe University Academic Board); outside the submitted work. J Liu reports support for the present manuscript from the National Natural Science Foundation (72474005) and Beijing Youth Scholar Program (081); grants or contracts from the National Natural Science Foundation (72474005) and Beijing Youth Scholar Program (081); outside the submitted work. K S-K Ma reports grants or contracts from a research grant from the International Team for Implantology; outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health to the Institute of Maternal and Child Health—IRCCS Burlo Garofol. LM received funds from the Italian Ministry of Health payments made to the Institute for Maternal and Child Health—IRCCS Burlo Garofolo under project RC 34/2017. R S Moreira reports grants or contracts from CNPq Research Productivity Scholarship (National Council for Scientific and Technological Development); scholarship registration number 308986/2025-3, outside the submitted work. R F Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Angelini, Casen Recordati, Lundbeck, Neuraxpharm, Rubió, Servier, Takeda; support for attending meetings and/or travel from Angelini, Italfarmaco, Advanz Pharma, Takeda, Lundbeck, Camurus; outside the submitted work. L Ronfani reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. V Sharma acknowledges support from the Directorate of Forensic Science Services (DFSS) Ministry of Home Affairs (MHA) research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, and RUSA grant to Panjab University by Ministry of Education, Govt. of India, outside the submitted work. D J Stein reports support from consultancy honoraria from Discovery Vitality, Kanna, L'Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, and Wellcome; outside the submitted work. R Tabares-Seisdedos reports grants or contracts from the Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58) and the Spanish Ministry of Science, Innovation and Universities (PID2021-129099OB-I00); these funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study's conduct, outside the submitted work. S J Tromans reports grants or contracts from the 2023/4 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England (a contracted study from NHS Digital, via the Department of Health and Social Care); contributed to multiple chapters of the 2023/4 Adult Psychiatric Morbidity Survey report (payments made to University of Leicester); grants or contracts as lead on a study funded by the National Institute for Health and Care Research Clinical Research Network, on optimising survey design for people with learning disability and autistic people (payments made to University of Leicester); served as the lead on a study from the National Institute for Health and Care Research related to evaluating a national training programme for health and social care professionals relating to learning disability and autism (payments made to University of Leicester); was co-applicant on a study funded by the National Institute for Health and Care Research related to identification, recording, and reasonable adjustments for people with a learning disability and autistic people in NHS electronic clinical record systems (payments made to University of Leicester); was co-applicant on a study funded by the National Institute for Health and Care Research related to medication support interventions and strategies for people with learning disabilities (payments made to University of Leicester); served as lead applicant on a study funded by the Baily Thomas Charitable Fund investigating barriers, enablers and interventions to facilitate de-prescribing for people with intellectual disability (payments made to University of Leicester); has received support for attending meetings and/or travel from the Royal College of Psychiatrists for accommodation and travel to conference events due to academic secretary role in the faculty of the Psychiatry of Intellectual Disability, including conference fees waived for Royal College of Psychiatrists events; reports leadership or fiduciary roles in other board, society, committee or advocacy groups (unpaid) as Academic Secretary and Executive Committee Member for the Neurodevelopmental Psychiatry Special Interest Group and Psychiatry of Intellectual Disability Faculty at the Royal College of Psychiatrists; is Associate Editor for the Journal of Mental Health Research in Intellectual Disabilities; is Editorial Board Member for Progress in Neurology and Psychiatry, Advances in Mental Health and Intellectual Disability, Advances in Autism, BMC Psychiatry, and BJPsych Open; and received royalties as Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press); all outside the submitted work. A C Tsai reports support for the present manuscript from the US National Institutes of Health (K24DA061696); leadership or fiduciary roles in other board, society, committee or advocacy groups (paid) with Elsevier, receipt of financial honorarium for work as Co-Editor in Chief of the Elsevier-owned journal SSM—Mental Health, and from BMJ Publishing Group, receipt of financial honorarium for work as Clinical Editorial Advisor for the BMJ Publishing-owned journal The BMJ, outside the submitted work. A Vieira reports leadership or fiduciary roles in other board, society, committee or advocacy groups (unpaid) with the American Academy of Sleep Medicine as the ambassador 2025; outside the submitted work. S Zadey reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Hindu; leadership or fiduciary roles in other board, society, committee or advocacy groups (paid or unpaid) as Co-founder and Board Member of The Association for Socially Applicable Research, an Advisor with Nivarana, a Permanent Council Member for G4 Alliance and Chair of the Asia Working Group, a Drafting Committee Member for the Maharashtra State Mental Health Policy, a Fellow for a Lancet Commission, a Fellow for the Blood DESERT Coalition, and an Adjunct Appointment at Dr D Y Patil Vidyapeeth (deemed to be university); outside the submitted work. G Zamagni reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo.

Figures

Figure 1
Figure 1
Age-standardised prevalence of intimate partner among females aged 15 years and older (A) and sexual violence against children among females (B) and males (C), in 2023 Exposure to sexual violence against children was estimated for females and males aged 15 years or older retrospectively reporting on sexual violence experienced during childhood (before age 18 years).
Figure 1
Figure 1
Age-standardised prevalence of intimate partner among females aged 15 years and older (A) and sexual violence against children among females (B) and males (C), in 2023 Exposure to sexual violence against children was estimated for females and males aged 15 years or older retrospectively reporting on sexual violence experienced during childhood (before age 18 years).
Figure 2
Figure 2
Age-standardised rates of cause-specific DALYs attributable to intimate partner violence among females (A) and to sexual violence against children among females (B) and males (C) aged 15 years and older, globally and by super-region, 2023 Bar heights represent all-cause DALY rates attributed to the respective risk factor and among the respective population globally and in each of the seven GBD super-regions. Colours indicate cause groupings, while shading within each colour category denotes specific Level 3 causes in the GBD cause hierarchy. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 3
Figure 3
Age-standardised DALY rates attributable to intimate partner violence among females (A) and to sexual violence against children among females (B) and males (C) aged 15 years and older, 2023 DALY rates are presented per 100 000 people. DALY=disability-adjusted life-year.
Figure 3
Figure 3
Age-standardised DALY rates attributable to intimate partner violence among females (A) and to sexual violence against children among females (B) and males (C) aged 15 years and older, 2023 DALY rates are presented per 100 000 people. DALY=disability-adjusted life-year.
Figure 4
Figure 4
Rankings of DALY counts attributable to intimate partner violence among females (A) and to sexual violence against children among females (B) and males (C), compared with other Level 3 risk factors included in GBD 2023, globally and by super-region Rows display DALY count rankings for all individuals aged 15 years and older, as well as for specific age strata. Columns show rankings globally and across each of the seven GBD super-regions. Numbers within each cell indicate the ranking of the respective risk factor among GBD Level 3 risk factors (see full list in appendix 1 section 8) within each population group and geographical region in 2023. Cell colours represent the relative rankings, ranging from red (lower ranking, higher DALYs) to blue (higher ranking, lower DALYs). Detailed risk factor rankings for ages 15 years and older and 15–49 years are available in appendix 2 (figures S3–S6). DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study.
Figure 5
Figure 5
Percentage of cause-specific health burden attributable to intimate partner violence among females (A) and to sexual violence against children among females and males combined (B) aged 15 years and older, globally and by super-region, 2023 Percentages represent the proportion of cause-specific DALYs among individuals aged 15 years and older attributed to intimate partner violence or sexual violence against children globally or within a specific super-region. Numbers within each cell are estimated mean percentages, while cell colours represent the relative level of the mean percentage, ranging from yellow (lower percentage) to red (higher percentage). Causes are presented at Level 3 of the GBD cause hierarchy. DALY=disability-adjusted life-year. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. *Female-specific condition.
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References

    1. Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018. Lancet. 2022;399:803–813. - PMC - PubMed
    1. Cagney J, Spencer C, Flor L, et al. Prevalence of sexual violence against children and age at first exposure: a global analysis by location, age, and sex (1990–2023) Lancet. 2025;405:1817–1836. - PMC - PubMed
    1. UNICEF . UNICEF; New York: 2024. When numbers demand action: confronting the global scale of sexual violence against children.https://data.unicef.org/resources/when-numbers-demand-action/
    1. Spencer CN, Khalil M, Herbert M, et al. Health effects associated with exposure to intimate partner violence against women and childhood sexual abuse: a burden of proof study. Nat Med. 2023;29:3243–3258. - PMC - PubMed
    1. Hailes HP, Yu R, Danese A, Fazel S. Long-term outcomes of childhood sexual abuse: an umbrella review. Lancet Psychiatry. 2019;6:830–839. - PMC - PubMed

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