Self-harm and suicide ideation presenters to hospital in Northern Ireland: a registry-based study

Background

Suicidal behaviour is often described as a continuum, ranging from thoughts of suicide to engaging in self-harm or completing suicide. However, few studies have focused on people with suicidal ideation as a patient group. The aim of this study was to describe presentations to hospital following self-harm and suicidal ideation and to examine patterns of repetition.

Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth

Background: American Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15–24. Objectives: This article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US. Methods: White Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15–24 years. Findings regarding characteristics of co-occurrence – including differences in the type of self-harm behavior, gender, and reported reasons for the act – were interpreted through a community-based participatory research process. Results: From 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15–24 were “drunk or high” at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were “drunk or high” during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males. Conclusion: High rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions. Scientific Significance: Tribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.     

Understanding the Relationship between Substance Use and Self-Injury in American Indian Youth

Background: American Indian communities compared to other US populations are challenged by the largest health disparities in substance abuse and suicidal behavior among youth ages 15-24. Objectives: This article examines the co-occurrence of substance use and self-injury among reservation-based youth in the US. Methods: White Mountain Apache tribal leaders and Johns Hopkins University formed a partnership to address self-injury and substance abuse among Apache youth. Data on suicide (deaths, attempts, ideation), non-suicidal self-injury, and substance use were analyzed from the White Mountain Apache tribally mandated self-injury surveillance registry from 2007 to 2010, including 567 validated incidents from 352 individuals aged 15-24 years. Findings regarding characteristics of co-occurrence - including differences in the type of self-harm behavior, gender, and reported reasons for the act - were interpreted through a community-based participatory research process. Results: From 2007 to 2010, 64% (n = 7/11) of Apache youth ages 15-24 were "drunk or high" at the time of suicide death with data missing for 2/11 deaths; 75.7% (n = 118/156) were "drunk or high" during suicide attempt; 49.4% (n = 83/168) during suicidal ideation; and 49.4% (81/166) during non-suicidal self-injury. Co-occurrence of substance use was higher for more lethal acts and among males. Conclusion: High rates of co-occurring self-injury and substance use within this population highlight the importance of research to understand relationships between these behaviors to design preemptive and integrated interventions. Scientific Significance: Tribal-specific and culturally informed data on the co-occurrence of self-injury and substance use hold promise for reducing the combined toll of years of productive life lost among American Indian youth.     

Solvent use and psychiatric comorbidity

From a family study of 286 alcoholics, 157 felons, 60 control subjects, and 1640 of their relatives, 130 solvent users were retrospectively identified. Risk for diagnosis of antisocial personality disorder was significantly elevated for all solvent users. Relatives, though not probands, were more likely to receive diagnoses of alcoholism and secondary depression, but this relationship appeared to be mediated by the presence of antisocial personality disorder. Solvent users were not at increased risk for primary depression or other psychiatric illnesses. Subjects reporting any solvent use also had significantly increased risk of suicidal ideation and suicide attempt compared to non-users, with half of the solvent users reporting suicidal ideation and 30% reporting a history of suicide attempt. However, risk for suicidal ideation and suicide attempt among solvent users appeared to covary with presence of antisocial personality disorder, alcoholism, and secondary depression rather than being specifically associated with solvent use.     

Suicidality among nonadherent patients living with HIV in Buenos Aires,Argentina: prevalence and correlates

Of those in the general population hospitalized for suicidal ideation and suicide attempts in Argentina, many reattempt suicide and are readmitted. However, few studies in Argentina have examined suicidal ideation and suicide-related behaviors among people living with HIV (PLHIV) and none have examined these factors among nonadherent PLHIV, though the prevalence of suicidal ideation in this group may be higher than in the general population and also than in other groups of PLHIV. This study of PLHIV in Buenos Aires, Argentina, examined the correlates of suicidal ideation in nonadherent PLHIV. Nonadherent patients with HIV (N?=?118) were recruited from two clinics providing outpatient healthcare services to PLHIV in Buenos Aires, Argentina. Participants completed assessments on demographic characteristics, depression and suicidality, stigma, and self-efficacy. Participants were HIV-infected men (51%) and women (49%) with a median age of 40 years (IQR?=?11). About half had completed high school or more, two-thirds were employed, and had a mean monthly income of 4196.79 (SD?=?3179.64) Argentine pesos (USD$221). Thirty-three (28% [95% CI 20.3, 37.3]) participants reported suicidal ideation in the past two weeks, and one-third (35.6% [27.1, 44.9]) reported lifetime suicidal ideation. In bivariate analyses, attending a public clinic, being female, younger, unemployed, and experiencing greater stigma and depression were associated with suicidal ideation. In multivariable logistic regression, stigma interacted with the number of years since HIV diagnosis to predict suicidal ideation. The impact of stigma on suicidal ideation decreased with time since HIV diagnosis, suggesting that suicidal ideation may arise following HIV diagnosis due to perception of HIV-related stigma. Interventions to reduce perceived stigma during the period following HIV diagnosis may reduce suicidal ideation in this population. Organizational initiatives that explore HIV stigma microagressions in the healthcare setting may be needed to optimize health outcomes.     

High prevalence of psychiatric and substance use disorders among persons seeking treatment for HIV and other STIs in Jamaica: a short report

This cross-sectional study explored the range of psychiatric and substance use disorders and unmet need for mental health care among 84 HIV-positive and 44 HIV-negative public clinic attendees in Jamaica. We used a brief interviewer-administered diagnostic tool, the Client Diagnostic Questionnaire. Two-thirds (65.6%) screened positive for at least one psychiatric disorder; 30.5% screened positive for multiple disorders. The most common disorders were post-traumatic stress disorder (PTSD) (41.4%), alcohol abuse (22.7%), and depressive disorders (21.9%). One in fourteen (7.1%) participants with at least one diagnosis received care in the last 6 months. Adjusting for age and sex, PTSD was associated with non-adherence to antiretroviral treatment (AOR?=?5.32), anxiety disorders (AOR?=?5.82), depression (AOR?=?4.29), and suicidal ideation (AOR?=?8.17). Psychiatric and substance use disorders, particularly PTSD, were common among STI/HIV clinic attendees in Jamaica. Such clinics may be efficient places to screen, identify, and treat patients with psychiatric disorders in low- and middle- income countries.     

Suicidal ideation among adolescents with alcohol use disorders during treatment and aftercare

The objectives of this study are to assess the magnitude and course of suicidal ideation during outpatient treatment and aftercare for adolescents with alcohol use disorders (AUD). One hundred seventy-seven adolescents meeting eligibility criteria, including no past 30-day suicidal behavior, participated in 9 weeks of outpatient cognitive-behavioral group therapy. Treatment completers were randomized into: (1) No-Active, (2) In-Person, or (3) Telephone aftercare conditions for a period of 12 weeks. No specific intervention for suicidal behavior was provided during the study. The Suicide Ideation Questionnaire (SIQ-JR, Reynolds, 1988) was administered at baseline, end of treatment, and end of aftercare. The results are as follows, a higher baseline suicidal ideation was associated with higher retention at the end of treatment and through aftercare. The In-Person Aftercare condition showed a significant decrease in suicidal ideation, relative to the No-Active Aftercare condition. There was a trend for similarly reduced severity of suicidal ideation in the Telephone Aftercare condition. In conclusion, the type of aftercare and resulting decrease in AUD may play a role in the reduction in suicidal ideation. The mechanism of change by which suicidal ideation is reduced in adolescents in treatment for AUD needs to be further explored.     

Correlates of suicidal ideation among HIV-positive persons

OBJECTIVES: The present investigation sought to determine the extent to which demographic characteristics, illness-related burdens, alcohol and other substance use, and psychosocial factors are independently associated with suicidal ideation in HIV-positive individuals. DESIGN: HIV-positive individuals in four US cities (San Francisco, Los Angeles, Milwaukee, and New York City) were screened between July 2000 and January 2002 for recruitment into a randomized behavioral prevention trial. Utilizing data from this screening visit, rates and correlates of suicidal ideation were examined in a diverse sample of 2909 HIV-positive individuals. METHODS: Using binary logistic regression study sites, demographic characteristics, illness-related burdens, alcohol and substance use, and psychosocial factors were entered as predictors of suicidal ideation. This cross-sectional model thus examined the independent effects of each factor. RESULTS: Approximately one-fifth (19%) of participants reported thoughts of suicide in the past week. We observed that participants who were not heterosexual, rated HIV-related symptoms and medication side effects as more severe, reported regular marijuana use, and described elevated affective symptoms of depression were those who were more likely to report suicidal ideation. Conversely, participants who identified as Hispanic/Latino, individuals in a primary romantic relationship, and those who reported greater self-efficacy for coping were less likely to report suicidal ideation. CONCLUSION: Suicidal ideation among HIV-positive individuals is relatively common and is associated with multiple factors. These independent correlates may assist with identifying HIV-positive individuals who are at increased risk of suicidal ideation so that they may be assessed regularly and referred for psychological treatment when appropriate.     

Exposure to trauma and posttraumatic stress disorder symptoms in older veterans attending primary care: comorbid conditions and self-rated health status

OBJECTIVES: Assess the prevalence of posttraumatic stress disorder (PTSD) symptomatology and its association with health characteristics in a geriatric primary care population. DESIGN: Cross‐sectional screening assessments during a multisite trial for the treatment of depression, anxiety, and at‐risk drinking. SETTING: Department of Veterans Affairs (VA)‐based primary care clinics across the United States. PARTICIPANTS: Seventeen thousand two hundred five veterans aged 65 and older. MEASUREMENTS: Sociodemographic information, the General Health Questionnaire (GHQ‐12), questions about death wishes and suicidal ideation, quantity and frequency of alcohol use, smoking, exposure to traumatic events, and PTSD symptom clusters. RESULTS: Twelve percent (2,041/17,205) of participants screened endorsed PTSD symptoms. Veterans with PTSD symptoms from some (partial PTSD) or each (PTSD all clusters) of the symptom clusters were significantly more likely to report poor general health, currently smoke, be divorced, report little or no social support, and have a higher prevalence of mental distress, death wishes, and suicidal ideation than those with no trauma history or those with trauma but no symptoms. Group differences were most pronounced for mental distress and least for at‐risk drinking. Presence of PTSD all clusters was associated with poorer outcomes on all of the above‐mentioned health characteristics than partial PTSD. CONCLUSION: PTSD symptoms are common in a substantial minority of older veterans in primary care, and careful inquiry about these symptoms is important for comprehensive assessment in geriatric populations.     

Prevalence and correlates of suicidal ideation in SLE inpatients: Chinese experience

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs. Because of double damages of body and mind, SLE patients are in a potential risk of suicide. Many factors may contribute to the occurrence of suicide in SLE: socioeconomic factors, medical factors, mental health, family support and coping style. This study aims to investigate the prevalence and correlates of suicidal ideation in SLE inpatients in China in order to determine whether they had risk of suicide, and if so, what factors should be paid more attention to prevent suicide in wards. A total of 285 SLE patients were interviewed with questionnaires on suicidal ideation and socio-demographic characteristics, Beck Depression Inventory (BDI), Family APGAR and Trait Coping Style Questionnaire (TCSQ). Disease activity was assessed with SLE Disease Activity Index. The other medical information was collected from the patients’ medical records. In total, 34.4% of SLE patients had current suicidal ideation. Significant individual risk factors for current suicidal ideation in SLE patients included having religious belief, heavy self-reported financial burdens, long duration of SLE, low level of family functioning and negative coping style. And in the presence of these risk factors, being separated, divorced or widowed, having premorbid suicidal ideation and depression were independent predictors of suicidal ideation. In summary, the rate of suicidal ideation in SLE patients in China is higher than that in other countries. Factors that contribute to risk of suicidal ideation include social and cultural domains and physical and psychological health. Although the association of suicidal ideation to religions and medical factors is still to be investigated, these findings may give some references to suicide prevention efforts for SLE patients in China.     

Personality traits and suicidal behavior and ideation in depressed inpatients 50 years of age and older

Completed suicide may be the most preventable lethal complication of depressive disorders in older adults. Identification of risk factors for suicidal behavior has therefore become a major public health priority. Using data collected on 81 depressed patients 50 years of age and older, we report analyses designed to determine the associations between the personality traits that constitute the Five Factor Model of personality and measures of suicidal behavior and ideation. We hypothesized that low Extraversion would be associated with a lifetime history of attempted suicide, and high Neuroticism would be associated with suicidal ideation. Results were generally consistent with the hypotheses. We also observed a relationship between Openness to Experience and suicidal ideation. These findings suggest that longstanding patterns of behaving, thinking, and feeling contribute to suicidal behavior and thoughts in older adults and highlight the need to consider personality traits in crafting and targeting prevention strategies.     

Patterns of Suicidality and Alcohol Use in Alcoholics with Major Depression

The aims of this study were (1) to comprehensively characterize a population of alcoholics with major depression in a psychiatric hospital, (2) to determine the prevalence of suicidal behavior in this sample, and (3) to determine whether quantity of alcohol ingested was associated with level of suicidality. Ratings of drinking, depression, and suicidality were obtained using both self-rated and observer-rated instruments. The prevalence of suicide attempts in the week before hospitalization was remarkably high, approaching 40%, whereas 70% had made a suicide attempt at some point in their lifetime. These suicide attempts were typically impulsive in nature, involving little if any premeditation. Most subjects reported drinking more heavily than usual on the day of their suicide attempt. Recent suicidal behavior was significantly associated with recent very heavy drinking (<70 drinks per week) and with number of drinks per drinking day. Quantity of drinking per drinking day was also significantly higher in those making a recent suicide attempt. However, no association was found between quantity of alcohol consumption and suicidal ideation. These findings suggest that recent heavy alcohol use primarily affects suicidality by increasing the likelihood of acting on suicidal ideation rather than by inducing suicidal ideation.     

Reducing suicidal ideation in depressed older primary care patients

OBJECTIVES: To determine the effect of a primary care-based collaborative care program for depression on suicidal ideation in older adults. DESIGN: Randomized, controlled trial. SETTING: Eighteen diverse primary care clinics. PARTICIPANTS: One thousand eight hundred one adults aged 60 and older with major depression or dysthymia. INTERVENTION: Participants randomized to collaborative care had access to a depression care manager who supported antidepressant medication management prescribed by their primary care physician and offered a course of Problem Solving Treatment in Primary Care for 12 months. Participants in the control arm received care as usual. MEASUREMENTS: Participants had independent assessments of depression and suicidal ideation at baseline and 3, 6, 12, 18, and 24 months. Depression was assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (SCID). Suicidal ideation was determined using the SCID and the Hopkins Symptoms Checklist. RESULTS: At baseline, 139 (15.3%) intervention subjects and 119 (13.3%) controls reported thoughts of suicide. Intervention subjects had significantly lower rates of suicidal ideation than controls at 6 months (7.5% vs 12.1%) and 12 months (9.8% vs 15.5%) and even after intervention resources were no longer available at 18 months (8.0% vs 13.3%) and 24 months (10.1% vs 13.9%). There were no completed suicides in either group. Information on suicide attempts or hospitalization for suicidal ideation was not available. CONCLUSION: Primary care-based collaborative care programs for depression represent one strategy to reduce suicidal ideation and potentially the risk of suicide in older primary care patients.     

Shattered childhood: a key issue in suicidal behavior among drug addicts?

Aims. To assess the relative importance of various adverse childhood experiences for the occurrence of later suicidal behavior in terms of experienced suicide attempts and suicidal ideation among drug addicts, and to assess possible gender differences in these associations. Design. Cross-sectional survey. Setting. Residential and outpatient treatment units for drug addicts in Norway. Participants. National sample of 800 drug addicts admitted to treatment in 1992-93. Measurements. Self-reports of attempted suicide (life-time prevalence) and suicidal ideation (1 month prior to admission). Data collected from structured interviews with therapists. Findings. A total of 38.0% of the drug addicts reported having attempted suicide once or several times; the proportion was higher among those who reported various adverse experiences during childhood (sexual or violent assaults, bullying, parents' alcohol abuse, parents' psychiatric problems, school adjustment problems and own psychiatric problems), and increased with number of areas of such adverse childhood experiences. Forty-two per cent of the clients reported suicidal ideation in the month prior to admission, displaying the same kind of associations with adverse childhood experiences, and also a significant association when controlling for previous suicide attempts. There were relatively small gender differences in self-reported suicidal behavior, the proportion being somewhat higher among women, but only among those with no or few adverse childhood experiences. Conclusions. Self-reported suicidal behavior and ideation among drug addicts is highly prevalent and more so with increasing number of areas of childhood adversities.     

Depression and suicidal behaviors in medicare primary care patients under age 65

OBJECTIVE: To examine suicidal behavior and depression prevalence among a group of Medicare patients under age 65 with functional impairment and recent significant health care services use. DESIGN: An observational study of baseline characteristics of participants in a randomized controlled trial. SETTING: A Medicare demonstration (N=1,605) that enrolled primary care patients in 8 counties in New York, 6 counties in West Virginia, and 5 counties in Ohio. PATIENTS/PARTICIPANTS: All demonstration participants under age 65 (n=164). Participants were required to have impairment in at least 2 activities of daily living or 3 instrumental activities of daily living, and to have had recent significant health care use. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The Paykel questionnaire for suicidal ideation and attempts, the Mini-international Neuropsychiatric Interview Major Depressive Episode module, and the 15-item Geriatric Depression Scale were administered at baseline; 14.8% of the patients indicated suicidal ideation during the past year, 4.9% reported a suicide attempt during that time, 25.9% indicated at least 1 lifetime suicide attempt, 34.6% had a major depressive episode in the last month, and 58.3% had clinically significant depressive symptoms during the previous week. CONCLUSIONS: These levels of suicidal ideation and behaviors and of depression are far higher than those found in studies of nonelderly American adults, and may indicate the need for routine screening in this population.     

Psychological adjustment and suicidal ideation in patients with AIDS

This article assesses the psychosocial adjustment to illness and examines the relationship between adjustment and psychosocial and medical variables in 91 ambulatory HIV-infected patients. The 91 subjects were receiving ambulatory medical care in hospitals (Memorial Hospital, New York Hospital, and St. Vincent's Hospital) and in private medical consult (Gay Men's Health Crisis) in New York. The majority (74.5%) of subjects had AIDS. The sample was composed principally of white Roman Catholic homosexual men living alone. However, 49.5% were black or hispanic, 31.9% had intravenous drug use as their HIV risk behavior, 54.9% had past psychiatric history (including illegal drug use), and 22% had previous suicide attempts. Self-report measures of psychological adjustment (Psychological Adjustment to Illness Scale), mood (Brief Symptom Inventory), physical (PHYS) and psychological (PSYCH) symptoms from the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), social support (Social Support Questionnaire-Short Report), suicidal ideation (Scale for Suicide Ideation Self-Report), and measures of disease status (Karnofsky Performance Rating Scale, HIV CDC Classification, and Absolute CD4+ Lymphocyte Count) were used in the study. The average age of subjects was 40 years (SD = 6.80). fifty-two (63.4%) subjects acknowledged some indication of suicidal ideation. Variables that correlated with poor medical adjustment (health-care posture) were current suicide ideation (0.32, p = 0.003), number of psychological symptoms (0.45, p = 0.0001), physical symptoms (0.31, p = 0.006), social support (-0.24, p = 0.03), and satisfaction with the social support received (-0.36, p = 0.001). Poor sexual adjustment was related to current suicide ideation (0.39, p = 0.0004), number of psychological symptoms (0.40, p = 0.0003), satisfaction with the social support received (-0.28, p = 0.01), and number of physical symptoms (0.35, p = 0.002). In patients with a diagnosis of AIDS, the number of psychological symptoms (Beta = 0.29, R2 = 0.07, p = 0.02) and the satisfaction with the social support received (Beta = -0.38, R2 = 0.14, p = 0.003) were clear predictors of poor medical adjustment (health-care posture). Likewise, the predictors of poor sexual adjustment were psychological symptoms (Beta = 0.33, R2 = 0.10, p = 0.003) and suicidal ideation (Beta = 0.40, R2 = 0.10, p = 0.002). The results suggest that suicide ideation is associated with poor adjustment, rather than serving as an adaptive function, as has been suggested by others.     

Factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism: Findings from a representative community survey

Objective

To investigate factors associated with depression and suicidal ideation among individuals with arthritis or rheumatism.

Methods

The nationally representative Canadian Community Health Survey 2000–2001 included 130,880 respondents (response rate 84.7%). Respondents were diagnosed as depressed using a subset of items from the Composite International Diagnostic Interview. There were 23,405 respondents age ≥20 years who reported that they had been diagnosed with arthritis or rheumatism by a health professional. Logistic regression analyses were conducted to investigate depression and suicidal ideation.

Results

One in 10 Canadians with arthritis had clinically relevant levels of major depression. The age‐ and sex‐adjusted odds ratios (ORs) of major depression (OR 2.24, 95% confidence interval [95% CI] 2.11–2.38) and suicidal ideation (OR 2.01, 95% CI 1.75–2.31) among those with arthritis were approximately twice that of those without arthritis. The adjusted ORs of major depression among those with arthritis were significantly higher among women, the unmarried, younger, and poorer individuals. Individuals in pain, with limitations in activities of daily living, with limitations in instrumental activities of daily living, and with greater numbers of chronic conditions had higher odds of major depression. Less than half of those with major depression had consulted a mental health professional. One in 5 individuals with arthritis and major depression had been suicidal in the past year.

Conclusion

The majority of individuals with arthritis and major depression were not receiving adequate treatment for major depression. Clients should be screened for major depression and suicidal ideation, particularly if they fall into the identified vulnerable groups.     

Suicidal ideation and suicide attempts among human immunodeficiency virus-infected adults: differences in risk factors and their implications

Many studies have investigated risk factors for suicidal ideation and suicide attempt; however, most have failed to show differences in risk factors between suicidal ideation and suicide attempt among the human immunodeficiency virus (HIV)-infected population. This study was designed to identify differences in risk factors between suicidal ideation and suicide attempts among HIV-infected adults in Seoul. A face-to-face survey of 457 HIV-infected adults was conducted by the Seoul Metropolitan Government in 2013. Multivariate logistic regression analysis was used to identify factors associated with suicidal ideation and suicide attempt. Among 422 participants, 44% had suicidal ideation, and 11% had suicide attempts. The independent risk factors for suicidal ideation were young and middle age, living with someone, history of AIDS-defining opportunistic disease, history of treatment for depression, lower social support, and psychological status. Beneficiaries of National Medical Aid, economic barriers to treatment, history of treatment for depression, and lower psychological status were independently associated with suicide attempts. Patients with HIV in Korea were treated without cost in some centers. Thus, experiencing an economic barrier to treatment might be due in part to ignorance of HIV care policies. Our findings indicate that suicide attempts are associated with socioeconomic factors and information inequality regarding medical care. In conclusion, suicidal ideation closely associated with the psychosocial factors, whereas suicide attempt demonstrates a stronger association with socioeconomic factors. Suicide prevention measures should be implemented to provide information to help HIV-infected patients.     

Posttraumatic stress disorder among Hispanic and African-American drug users

CONTEXT: Treating high-risk substance abusers who are members of minority groups may require varied protocols depending on differences among minority groups. OBJECTIVES: To explore cocaine abuse (CA)/ dependence with physiological dependence (CDPD) and posttraumatic stress disorder (PTSD) diagnosis differences between out-of-treatment Hispanic and African American adults, in order to identify cultural differences in how experiences and attitudes affect cocaine use behaviors. DESIGN, SETTING, AND PARTICIPANTS: This study uses data collected between February and November 2000, as part of a three-year longitudinal study. A cohort of 347 out-of-treatment, Hispanic and African American cocaine-using adults from the Houston metropolitan area were interviewed to measure differences between cocaine users who are dually diagnosed and those that are not. MAIN OUTCOME MEASURES: Meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for dual diagnoses of CA/PTSD or CDPD/PTSD. RESULTS: For the dual diagnoses categories, 102 (29%) participants met the requirements for CA/PTSD or CDPD/PTSD. Logistic regression models were used, with CA/PTSD and CDPD/PTSD as the dependent variables. Age, race, gender, and income were used as the independent variables. Results indicate that individuals with higher income have a greater probability of developing CA/PTSD (beta = 0.919, p < 0.05). For both dual diagnoses categories of CA/PTSD and CDPD/ PTSD, results indicate that being female increases the likelihood of developing both of these dual diagnoses, (beta = 2.106, p < 0.05) or (beta = 2.510, p < 0.05). However, being an older female decreases the probability that an individual would develop these dual diagnoses (beta = -2.227, p < 0.05) (beta = -2.577, p < 0.05). CONCLUSIONS: No differences were found for race/ethnicity among the dually diagnosed Hispanics and African Americans, however, gender differences were found. Being female increases an individual's probability of developing a dual diagnosis of CA/PTSD or CDPD/PTSD. In addition to being female, being a young female further increases an individual's probability of being dually diagnosed.