Clinical Summary: Sexual Abuse and Its Impact on Suicidal Ideation and Attempts and Psychiatric Illness in Children and Adolescents With Posttraumatic Stress Disorder
Hospitalized youth with posttraumatic stress disorder often present with suicidality and multiple psychiatric comorbidities, but risk is not uniform across patients. A history of sexual abuse marks a subgroup with more depression, more substance use disorder, and higher unadjusted suicidal ideation/attempt rates, making this a high-yield history element during inpatient assessment.
Key Findings
- Suicidal ideation/attempt was higher in PTSD+S patients than in the PTSD only group (35.4% vs 29.8%, P = .05).
- In the unadjusted analysis, odds of suicidal ideation/attempt incidence were 29% higher in the PTSD+S group than in the PTSD only group (OR = 1.29, P = .05), but PTSD+S showed no association with suicidal ideation/attempt in the multivariate analysis (OR = 1.16, P = .29).
- Major depressive disorder was more common in the PTSD+S group than in the PTSD only group (23.0% vs 14.4%, P < .001), and in multivariate logistic regression MDD was one of the strongest predictors of suicidal ideation/attempt (OR = 1.66, P < .001).
- Substance use disorder was more prevalent in PTSD+S patients than in PTSD only patients (19.6% vs 10.8%, P < .001), and suicidal ideation/attempt incidence was 18% higher in patients with SUD than in those without SUD (P < .001).
- The PTSD+S group was more often female (80.9% vs 66.3%, P < .001), and female sex independently predicted suicidal ideation/attempt (OR = 1.50, P < .001).
Among hospitalized children and adolescents with posttraumatic stress disorder, a sexual abuse history identifies patients with higher depressive and substance use comorbidity and higher unadjusted suicidality, but the excess suicide risk is explained largely by comorbid major depressive disorder, substance use disorder, and female sex. Clinical care should prioritize aggressive assessment and management of these co-occurring risks rather than treating sexual abuse history alone as an independent predictor.
Practice Implications
- When a child or adolescent is hospitalized with posttraumatic stress disorder, ask directly about sexual abuse history because the PTSD+S group had higher rates of major depressive disorder (23.0% vs 14.4%, P < .001), substance use disorder (19.6% vs 10.8%, P < .001), and suicidal ideation/attempt (35.4% vs 29.8%, P = .05).
- If sexual abuse history is present, intensify screening for major depressive disorder and substance use disorder, since MDD independently predicted suicidal ideation/attempt (OR = 1.66, P < .001) and suicidal ideation/attempt incidence was 18% higher in patients with SUD than in those without SUD (P < .001).
- Use female sex as an added risk marker during suicide assessment in youth with posttraumatic stress disorder, as the PTSD+S group was predominantly female (80.9%) and female sex independently increased suicidal ideation/attempt risk (OR = 1.50, P < .001).
- Broaden the psychiatric assessment in PTSD patients with sexual abuse history to look beyond core PTSD symptoms, because anxiety disorders (other than PTSD) were higher in the PTSD+S group (P = .01) and there was no significant difference in psychotic disorders, adjustment disorders, or behavioral disorders between the groups.
