Posttraumatic Stress Disorder and Suicide Attempts in a Community Sample of Urban American Young Adults

Context: Previous research has shown that exposure to traumatic events, especially sexual trauma during childhood, is associated with an increased risk of attempted suicide. However, no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder (PTSD) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD. Objective: We examine the association between exposure to traumatic events with and without resulting PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults. Design: A cohort study followed young adults who had participated in a randomized trial of all first-grade students entering 19 public schools. Setting: Baltimore, Maryland, an urban setting. Participants: A total of 1698 young adults (mean age, 21; 47% male; 71% African American) who represented 75% of the original cohort of 2311 persons. Main Outcome Measure: Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and nonassaultive traumas (no PTSD), as estimated using discrete time survival analysis. Results: Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt. The PTSD-suicide attempt association was robust, even after adjustment for a prior major depressive episode, alcohol abuse or dependence, and drug abuse or dependence (adjusted relative risk, 2.7; 95% confidence interval, 1.3-5.5; P < .01). In contrast, exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide. Conclusions: Posttraumatic stress disorder is an independent predictor of attempted suicide. Exposure to traumatic events without PTSD is not associated with a later suicide attempt.