Journal of the American Academy of Child and Adolescent Psychiatry, 2003, 42(11):1301-1309. DOI: 10.1097/01.CHI.0000084831.67701.d6 Sexual Abuse and Suicidal Behavior: A Model Constructed From a Large Community Sample of Adolescents Helen A. Bergen, Ph.D. Graham Martin, MD, FRANZCP Angela S. Richardson, B.Psych. Stephen Allison, MBBS, FRANZCP Leigh Roeger, BA (Hons.) Abstract Objective: To investigate relationships between self-reported sexual abuse, depression, hopelessness, and suicidality in a community sample of adolescents. Method: In 1995, students (mean age 13 years) from 27 high schools in Australia (n = 2,603) completed a questionnaire including measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale), hopelessness, sexual abuse, and suicidality. Data analysis included logistic regression. Results: Sexual abuse is associated with suicidality, both directly and indirectly through hopelessness and depressive symptoms in the model developed. High suicide risk (behavior exceeding thoughts such as plans and threats, or deliberate self-injury) is strongly correlated with suicide attempts (odds ratio 28.8, 95% CI 16–52, p < .001). Hopelessness is associated with high suicide risk only, whereas depressive symptoms are associated with high suicide risk and attempts. Hopelessness is more strongly associated with sexual abuse in boys than girls. Depressive symptoms are more strongly associated with high suicide risk in girls than boys. Controlling for other variables, sexual abuse is independently associated with suicide attempts in girls but not boys. Conclusions: Clinical assessment should consider gender differences in relationships between sexual abuse, depressive symptoms, hopelessness, and suicidality. Sexually abused girls may be at increased risk of attempting suicide, independent of other psychopathology. Keywords: sexual abuse; suicidality; adolescents; depression; hopelessness. Sexually abused children and adolescents experience many adverse effects on their psychosocial development. Functioning into adulthood may be gravely affected (Nelson et al., 2002; Santa Mina and Gallop, 1998), and recent evidence supports a multifaceted model of traumatization rather than a specific sexual abuse syndrome (Paolucci et al., 2001). One adverse outcome associated with the trauma of childhood and adolescent sexual abuse (CSA) is an increase in suicidality (Beautrais, 2000), defined as suicidal ideation, making threats, plans, deliberate self-harm, and suicide attempts (Pearce and Martin, 1994). Early evidence (Beitchman et al., 1991) did not fully support a link between suicidality and CSA in the absence of force or threat of force. A more recent meta-analysis, however, confirms the association between all forms of CSA and negative short- and long-term sequelae, including in-creased suicidality (Paolucci et al., 2001). Suicidality is uncommon in young children, rates tending to increase with age in adolescence. Cross-sectional studies have found a significantly increased risk of suicide attempts in younger adolescents who report experiences of CSA (Martin, 1996; Riggs et al., 1990). Retrospective studies of adults (Brown et al., 1999; Dube et al., 2001) and longitudinal studies of individuals from birth to 18 and 21 years (Fergusson et al., 1996; Silverman et al., 1996) confirm a greatly increased risk of attempted suicide in those experiencing CSA (odds ratios of 10–11). The impact of emotional, physical, and sexual abuse is related in a linear fashion to suicide