Death-Related Thoughts, Suicidal Ideation, and Substance Use Risk Among Sexual Minority Women: The Role of Sexual...

This study examined whether death-related thoughts, passive suicidal ideation (SI), and active SI prospectively predict risk of alcohol use disorder (AUD) and cigarette use among sexual minority women (SMW), and whether these associations differ by exposure to single versus multiple forms of sexual violence.

Data came from a 24-year, five-wave U.S. longitudinal study of SMW's health, using Waves 3 (2010-2012; N = 726) and 4 (2017-2019; N = 525). Multivariable logistic regression models tested associations between Wave 3 sexual violence exposure (single type, multiple types, vs. none) and death-related thoughts, passive SI, and active SI. Additional models examined whether Wave 3 death-related thoughts and SI predicted Wave 4 AUD risk and cigarette use, adjusting for sociodemographic characteristics and Wave 3 alcohol and cigarette use. Moderation by sexual violence exposure was tested using interaction terms.

Exposure to a single type of sexual violence was associated with death-related thoughts, whereas exposure to multiple types was associated with both death-related thoughts and active SI. Prospectively, death-related thoughts predicted AUD risk, and passive SI predicted cigarette use. Exploratory analyses suggested that the association between death-related thoughts and cigarette use was stronger among SMW without sexual violence histories than among those with exposure to multiple types of sexual violence.

These findings highlight sexual violence as a determinant of death- and suicide-related cognitions and demonstrate that these cognitions prospectively shape substance use risk among SMW. Results underscore the importance of targeting upstream cognitive vulnerability processes in trauma-responsive prevention and intervention efforts.