The global burden of depression attributable to childhood sexual abuse, intimate partner violence, and bullying victimization from 1990 to 2021: an analysis based on the global burden of disease study.

Background: Depression is a leading cause of global disability, and among the behavioral risks defined in the Global Burden of Disease (GBD) framework, childhood sexual abuse (CSA), intimate partner violence (IPV) against women, and bullying victimization have emerged as key contributors to depressive disorders. However, long-term, comprehensive assessments of their combined impact on depression burden-by region, age group, and socio-demographic context-are lacking. This study quantifies trends in depression burden attributable specifically to CSA, IPV, and bullying from 1990 to 2021.

Methods: We extracted age-standardized rates and disability-adjusted life years (DALYs) attributable to CSA, IPV, and bullying for 204 countries and territories from the GBD 2021 database (1990-2021). We computed estimated annual percentage changes (EAPCs) for each risk factor, applied decomposition analysis to separate demographic vs. exposure effects, conducted frontier analysis to benchmark national performance, and used inequality metrics to assess disparities across Socio-demographic Index (SDI) quintiles.

Results: CSA-attributable DALYs remained largely stable or declined slightly (global EAPC of age-standardized DALY rate: - 0.12, 95% CI: - 0.20 to - 0.04), while IPV and bullying-related DALYs increased modestly (IPV EAPC: 0.45, 95% CI: 0.37-0.53; bullying EAPC: 0.88, 95% CI: 0.80-0.96).The largest relative increases were observed in adolescents aged 15-19 for bullying (EAPC 1.25, 95% CI: 1.12-1.38) and in young adults 20-24 for IPV (EAPC 0.78, 95% CI: 0.65-0.91).In 2021, CSA contributed the highest age-standardized DALY rates in low-SDI regions, high-income North America, and Greenland; IPV burden peaked in low-SDI and Central Sub-Saharan African settings (notably Uganda); bullying burden was greatest in high-SDI regions, high-income North America, and Greenland.Together, these three interpersonal risks accounted for 13.12% of global depression DALYs in 2021-bullying 6.12%, IPV 4.94%, CSA 2.65%-a figure we explicitly modelled from GBD attributable fractions.Frontier analysis highlighted Switzerland, Norway, Monaco, and Germany as leaders in minimizing trauma-related depression burden. Decomposition analysis showed that population aging and growth drove most burden increases in middle- to low-SDI regions, while changes in exposure levels explained regional rises in bullying and IPV. Inequality measures confirmed widening gaps between high- and low-SDI settings.

Conclusions: Between 1990 and 2021, depression burden attributable to CSA has stabilized or declined, but IPV and bullying burdens have risen-especially among adolescents and in lower-SDI regions. These results underscore the urgency of age- and context-specific violence prevention, child protection, and school-based anti-bullying initiatives to reduce trauma-related depression worldwide. Further research should integrate subnational data and evaluate the effectiveness of targeted interventions.