More than 75% of people questioned in a survey in the Irish Republic said they felt the Catholic Church did not deal properly with the issue of sex abuse.
Almost 1,300 people were interviewed for the Church-commissioned survey, including both abusers and victims.
The Irish Royal College of Surgeons report examined the psychological and social impact of clerical child abuse.
The Catholic Primate of Ireland, Archbishop Sean Brady, said the report made for "painful reading".
"It tells of mistakes made in responding to those who came to the Church seeking sensitivity and compassion," he said, launching the report.
Archbishop Brady pledged "the greatest possible protection for all children in the future".
The 332-page report, entitled Time to Listen, was the first survey to be commissioned internationally by the Catholic Church on child sexual abuse.
It was compiled over two years and included face-to-face interviews with seven victims of molestation and eight clergymen convicted of sex abuse crimes.
The BBC's Mary Campbell reports from Dublin that hardly a week goes past when there is not a court case or a newspaper headline concerning child abuse.
Lower confidence
This report says 3% of convicted sex abuse offenders in Ireland are clerics and that most abuse is carried out within the home but, our correspondent notes, victims' groups believe the incidence of abuse carried out by priests to be higher.
The survey found that confidence in the Church of those abused and their families had declined.
It found that the Church's response often lacked compassion and that legal concerns had taken priority over pastoral care.
A number of bishops admitted that anxiety about the scandal which might ensue sometimes took precedence over compassion when abuse cases were reported to them.
Of those surveyed, 72% said they believed priests overall had been unfairly judged because of abuse but public satisfaction with the Church as an institution stood at just 44%.
Picture of pain
Victims who were interviewed spoke of their isolation and fear and the physical and mental pain they suffered.
Many did not tell anyway about their trauma until they became adults and many wanted their lives to be over.
Most said counselling had been a great help.
The authors and the bishops hope it could be the beginning of a more open and trusting relationship between the Catholic Church and the people it is meant to serve.
One of the report's authors, Helen Goode, said a standardised approach such as a code of conduct was needed to deal with any complaints of abuse.
"This would make sure that any procedures in place would have even application across dioceses," she said.
"It's also important that all clergy have some management training in relation to dealing with complaints."