Self-harm, suicide, and ICD-11 complex posttraumatic stress disorder in treatment-seeking adolescents with major depression

Background. Posttraumatic stress disorder (PTSD) is linked with self-harm and suicide, but
few studies have examined these severe outcomes in relation to complex trauma. This study
examined the associations between self-harm and suicide-related phenomena with ICD-11
complex PTSD (CPTSD) among treatment-seeking youths. Methods. A convenience sample
of 109 adolescents with major depression (69.7% female; mean age=15.24) were recruited
from an outpatient psychiatric clinic. Participants completed measures for ICD-11 CPTSD,
adverse childhood experiences (ACEs), self-harm behaviors, and past-year history of four
suicide-related phenomena. Relationships between each self-harm and suicide-related
variable with CPTSD were assessed at the symptom and diagnostic levels. Results.
Participants reported an average of three ACEs; 33.9% met diagnostic requirements for ICD11 CPTSD. Past-year suicidal thought and attempt, but not self-harm, significantly associated
with CPTSD status. At the symptom level, self-harm associated with CPTSD total symptom
and all symptom clusters scores, with strongest associations found with symptoms of
negative self-concept. CPTSD total symptom scores also associated strongly with past-year
history of suicidal thought, plan, and attempt; the three core PTSD symptom clusters scores
consistently and strongly linked with these suicide-related phenomena. For symptoms of
complex trauma, relationship disturbances associated with having a suicide attempt, and
negative self-concept associated with both having a plan and an attempt. Conclusions.
Assessing and targeting ICD-11 CPTSD symptoms have potential to reduce self-harm and
suicidality in young people experiencing mental distress, particularly for those with a trauma
history and regardless of whether they meet criteria for a diagnosable trauma response.