Background: A large gender gap appears in internalising mental health during adolescence. There is little high-quality longitudinal population-based research investigating the role of sexual violence experiences, which are disproportionately experienced by females. This study aims to estimate the mental health impact of sexual violence experiences in mid-adolescence. Methods: Longitudinal data from the UK Millennium Cohort Study (born 2000-02) in participants with information available on past-year sexual violence (sexual assault, unwelcome sexual approach) and mental health outcomes (psychological distress (K-6 questionnaire) in last 30 days, past-year self-harm, and lifetime attempted suicide) reported at age 17 years. Multivariable confounder adjusted regressions and propensity matching approaches were used, and population attributable fractions (PAFs) were calculated. Findings: Analyses were in 5,119 girls and 4,852 boys (mean age 17 years, 80.8% White). In the fully adjusted model, sexual violence was associated with greater mean psychological distress (mean difference girls: 2.09 [1.51; 2.68] boys: 2.56 [1.59; 3.53]) and higher risk of high distress (girls: 1.65 [1.37; 2.00] boys: 1.55 [1.00; 2.40]), self-harming (girls: 1.79 [1.52; 2.10] boys: 2.16 [1.63; 2.84]), and attempted suicide (girls: 1.75 [1.26; 2.41] boys: 2.73 [1.59; 4.67]). PAF estimates suggest that, in a scenario with no sexual violence, we could expect 3.7-10.5% (boys) to 14.0-18.7% (girls) fewer adverse mental health outcomes at this age. Interpretation: Our findings demonstrate the substantial role of sexual violence experiences for mid-adolescent mental health, especially for girls who are 4-5 times more likely to be victims. Changes are needed at societal and policy levels to prevent sexual violence and its wide-ranging impacts.

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