(PS8-45) Examining Problematic Substance Use, Hopelessness, and Suicidal Ideation in Sexual and Gender Minorities Using Ecological Momentary Assessment

Abstract Text:

Introduction: Sexual and gender minorities (SGMs) face higher rates of suicidal ideation and attempts than cisgender and heterosexual individuals. The self-medication hypothesis infers that the combination of problematic substance use and hopelessness may account for this health disparity in that hopelessness may serve as both a cause and consequence of problematic substance use. This study aimed to test this assumption in SGMs through examining associations between trait problematic substance use and momentary fluctuations in hopelessness as prospective predictors of momentary suicidal ideation.

Method: Participants were 92 sexual and gender minority adults (64% White, 19-62 years of age) located across the United States. Participants completed baseline measures followed by ecological momentary assessment (EMA) prompts up to 6 times per day over a 2-week period (excluding weekends) using the mEMA phone application. Problematic alcohol, drug, and marijuana use were measured at baseline using the Externalizing Spectrum Inventory Brief Form. Hopelessness (measured by a single item on the Inventory for Daily Expressions of Psychopathology) and suicidal ideation severity (measured using the Depression Symptom Index-Suicidality Subscale) were assessed at each EMA timepoint. A series of multilevel models were estimated to examine the hypothesized interaction between substance use and hopelessness as prospective predictors of suicidal ideation in addition to the calculation of intraclass correlation coefficients (ICCs). Variance of hopelessness and suicidal ideation was parsed into within-subject and between-subject variance to parse differential effects of “state” and “trait” variance.

Results: Problematic alcohol use was not a significant predictor of suicidal ideation severity (p’s > .05). On the other hand, problematic drug use (β = -.18, SE = .05, p =.001) and problematic marijuana use (β = -.13, SE = .04, p = .004) were significant predictors of suicidal ideation. However, when state and trait hopelessness were added as predictors, problematic drug and marijuana use were no longer significant predictors of suicidal ideation severity (p’s > .05). Hopelessness was consistently a significant predictor of suicidal ideation, although state and trait hopelessness varied in their ability to predict suicidal ideation the further suicidal ideation was temporally lagged from hopelessness.

Conclusion: This research aims to clarify the relationships between problematic substance use, hopelessness, and suicidal ideation in SGMs, with the aim of optimizing suicide prevention for this population. Overall, hopelessness seems to be a more robust predictor of suicidal ideation above and beyond problematic substance use. Interestingly, problematic drug and marijuana use were negatively associated with suicidal ideation, which was contrary to expectations. Furthermore, the significance of trait and state hopelessness varied as predictors of suicidal ideation over time, demonstrating that the impact of hopelessness may vary across the source of its variance and time. Taken together, targeting hopelessness through cognitive behavioral therapy may be key for suicide prevention efforts.