Frequently Asked Questions

Yes in unadjusted analyses, but not after adjustment for other risk factors. Suicidal ideation/attempt was more common in hospitalized youth with posttraumatic stress disorder and a history of sexual abuse than in those with PTSD alone (35.4% vs 29.8%, P = .05), and the unadjusted odds were 29% higher (OR = 1.29, P = .05).

However, in multivariate analysis, sexual abuse history was not independently associated with suicidal ideation/attempt (OR = 1.16, P = .29). The authors concluded that the higher suicide rate in the PTSD plus sexual abuse group may be explained largely by co-occurring major depressive disorder and substance use disorder.

Among hospitalized children and adolescents with posttraumatic stress disorder, a sexual abuse history was associated with higher rates of several psychiatric comorbidities. Major depressive disorder was present in 23.0% of the PTSD plus sexual abuse group versus 14.4% of the PTSD-only group (P < .001), and substance use disorder was present in 19.6% versus 10.8% (P < .001).

Anxiety disorders other than PTSD were also more common in the sexual abuse group (P = .01). The study found no significant group differences in psychotic disorders, adjustment disorders, or behavioral disorders.

The strongest predictors identified in the multivariate model were major depressive disorder, female sex, and substance use disorder. Major depressive disorder had an odds ratio of 1.66 (P < .001), female sex had an odds ratio of 1.50 (P < .001), and suicidal ideation/attempt incidence was 18% higher in patients with substance use disorder than in those without it (P < .001).

By contrast, a history of sexual abuse was not independently associated with suicidal ideation/attempt after adjustment (OR = 1.16, P = .29).

Hospitalized youth with posttraumatic stress disorder and a history of sexual abuse were more likely to be female and Hispanic than those with PTSD alone. Female patients made up 80.9% of the PTSD plus sexual abuse group versus 66.3% of the PTSD-only group (P < .001), and Hispanic patients made up 28.4% versus 12.6% (P < .001).

The mean age was similar between groups: 12.9 years in the PTSD plus sexual abuse group and 13.0 years in the PTSD-only group.

This was an observational study using the National Inpatient Sample database from 2006 to 2014. The investigators included children and adolescents aged 6017 years with a primary diagnosis of posttraumatic stress disorder, identified PTSD using ICD-9 code 30981, and identified sexual abuse history using ICD-9 code 99553.

The final cohort included 251 hospitalizations in the PTSD plus sexual abuse group and 24,243 in the PTSD-only group. The authors compared baseline characteristics, psychiatric comorbidities, and suicidality between groups and used logistic regression to examine predictors of suicidal ideation/attempt.

The most important limitation is that the database captures hospitalizations, not individual patients, so the same patient may have been counted more than once. The study was also observational, which means the results are vulnerable to confounding bias.

Other key limitations were the lack of follow-up data, inability to validate individual ICD codes, and missing information on medication history, age at abuse, and number of abuse episodes. The dataset also lacked other potentially important confounders such as family composition, socioeconomic support, and other childhood adversities.

The study suggests clinicians should be especially vigilant for suicidality and should actively assess for co-occurring major depressive disorder and substance use disorder. In this inpatient cohort, youth with posttraumatic stress disorder and a sexual abuse history had higher rates of major depressive disorder (23.0% vs 14.4%), substance use disorder (19.6% vs 10.8%), and suicidal ideation/attempt (35.4% vs 29.8%).

Because sexual abuse history was not an independent predictor of suicidal ideation/attempt after adjustment, the findings support focusing suicide risk assessment on the broader clinical picture, particularly depression, substance use, and female sex.