Lesbian, gay, and bisexual (LGB) women are significantly more likely to have alcohol involved at the time of suicide compared with heterosexual women, according to a new study from Columbia University Mailman School of Public Health. The findings are published in JAMA Network Open.
The researchers found that lesbian and gay women had a 15 percent higher likelihood of detectable blood alcohol content, a 17 percent higher chance of intoxication, and a 38 percent higher probability of any alcohol involvement at the time of death. Statistical interaction tests confirmed that associations between alcohol involvement and suicide varied significantly by sexual identity and sex. The rates of alcohol involvement for gay men and heterosexual men, however, did not differ from each other.
"While it remains unclear whether alcohol is a more prevalent precursor to suicide mortality among LGB people compared with heterosexuals, our findings help clarify whether targeting alcohol use could be an effective strategy for reducing suicide inequities specifically among LGB women," said Sarah McKetta, MD, PhD, assistant professor of Epidemiology at Columbia Mailman School.
To assess alcohol's role as a possible forerunner of suicide, researchers analyzed data from the National Violent Death Reporting System (NVDRS) from 2013 to 2021. The analysis included individuals who died by suicide and excluded murder-suicide cases; all individuals had known age and sex data. Sexual orientation was identified through law-enforcement and coroner/medical examiner reports.
Alcohol involvement was assessed using multiple measures, including toxicology results for any detectable blood alcohol content (≥0.01 g/dL) and legal intoxication (≥0.08 g/dL). The researchers also examined investigative reports indicating whether alcohol was suspected to have contributed to the death or was identified as an acute precipitating "crisis" factor—a measure available beginning in 2016.
After excluding cases with insufficient circumstance data, the final sample included 218,601 suicide deaths, of which 3,425 were identified as LGB; 56 percent of the total sample had undergone blood alcohol testing.
"Our study focused on deceased cisgender individuals," McKetta noted. "However, prior research shows that transgender people face elevated risks of both suicide and alcohol use, underscoring the need for inclusive future research.
The findings highlight alcohol use among LGB women as a potentially modifiable target for suicide prevention efforts and point to the need for further research to better understand and address these disparities."
Co-authors are Landon Hughes, Harvard Pilgrim Health Care Institute Boston, and Harvard Medical School; Avery Anderson, University of Colorado Anschutz Medical Campus; Ran Barzilay, Children's Hospital of Philadelphia, and University of Pennsylvania Perelman School of Medicine; Banapsha Rahman, Harvard Pilgrim Health Care Institute; and Kirsty Clark, Vanderbilt University.
The study was supported by the National Violent Death Reporting System New Investigator Award by the American Public Health Association and Columbia University School of Nursing Center for Sexual and Gender Minority Health Research Pilot Program; National Institute on Alcohol Abuse and Alcoholism, K99-AA031316; and National Institute on Mental Health, K01-MH125073. Data is available upon request at https://www.cdc.gov/nvdrs/about/nvdrs-data-access.html .
Columbia University Mailman School of Public Health
