(PS9-16) Minority Stress, Thwarted Belongingness, Alcohol Use, and Suicidality in LGBTQ+ Adults: A Moderated Mediation Model

Background: LGBTQ+ individuals frequently endorse more interpersonal struggles, substance use, and suicidality compared to their cisgender, heterosexual peers (Eisenberg & Resnick, 2005; Hatzenbuehler et al., 2008; Williams et al., 2021). Minority Stress Theory (Brooks, 1981; Meyer, 2003) posits that LGBTQ+ people endure identity-related stress, which may predict poor mental health outcomes. Specifically, high minority stress has predicted increased substance use (Lehavot & Simoni, 2017) and increased suicidality (de Lange et al., 2022). Thwarted belongingness and substance use may also be risk factors for suicidality among LGBTQ+ people (Chang et al., 2022; Kellerman et al., 2024). Thus, we hypothesized that alcohol use would mediate the relation between minority stress and suicidality. Further, we anticipated that thwarted belongingness would moderate the relation between minority stress and alcohol use, such that the strength of the relation between minority stress and alcohol use would increase among LGBTQ+ adults reporting high thwarted belongingness.

Methods: LGBTQ+ adults (n = 350; M_age = 35.59, 53.7% identified as cisgender women, 70.0 % white) recruited through MTurk completed the 10-item Interpersonal Needs Questionnaire, Minority Stress Scale, Suicide Behavior Questionnaire, and a demographics questionnaire. We tested our hypothesis using a moderated mediation model (Process Model 7; Hayes, 2012). We standardized all predictor and outcome variables and log-transformed alcohol use and suicidality variables to correct skewness before analysis.

Results: Our moderated mediation model was supported, as the index of moderated mediation was significant (b = 0.41, Bootstrap 95% CI[0.09, 0.92]). The indirect conditional effect of minority stress on suicidality through alcohol use was significant for LGBTQ+ adults with high (+1 SD) thwarted belongingness (b = 0.09, Bootstrap 95% CI[0.02, 0.21]). Because the confidence intervals include zero, we conclude that this relation was no longer significant at moderate (M; b = 0.02, Bootstrap 95% CI[-0.03, 0.10]) and low (-1 SD) thwarted belongingness (b = -0.04, Bootstrap 95% CI[-0.15, 0.03]). Thwarted belongingness moderated the relation between minority stress and alcohol use (path a; b = 3.03, p < .001, R² = .05), such that the conditional effect of minority stress on alcohol use was greater for LGBTQ+ adults who reported high (+1 SD) thwarted belongingness (b = 0.65, p = .006). Further, alcohol use predicted suicidality (path b; b = 0.13, p = .009), and minority stress directly predicted suicidality (path c’; b = 0.76, p < .001). Therefore, alcohol use partially mediated the relation between minority stress and suicidality among LGBTQ+ adults with high thwarted belongingness.

Conclusions: These findings emphasize the roles of minority stress, thwarted belongingness, and alcohol use in predicting suicidality among LGBTQ+ adults. Understanding the roles of minority stress and thwarted belongingness in alcohol use and suicidality among LGBTQ+ people may enable clinicians to tailor interventions to LGBTQ+ adults’ specific mental health needs.