Childhood sexual abuse (CSA) as a predictor of depression and self-destructive behaviors in adulthood was examined relative to other traumatic stressors in childhood and adulthood with special attention to sex differences. In a college sample of 173 men and 265 women, 16% of male (n = 28) and 24% of female respondents (n = 63) reported having been sexually abused as children. CSA, ranging from unwanted kissing and fondling to unwanted sexual intercourse, predicted depression, chronic self-destructiveness, self-harm ideation, acts of self-harm, suicide ideation, and suicide attempts, for both men and women. The more frequent and severe the sexual abuse and the longer its duration, the more depression and self-destructiveness reported in adulthood. Other stressors predicted these effects less consistently but their occurrence in combination with CSA contributed to the negativity of long-term outcomes. Study results affirm previous findings of a relationship between CSA and depression and self-destructiveness in adult females and extend them to males.