(PS9-40) The role of intersecting identities in moderating the relationship between opioid misuse and suicidal ideation

Abstract Text: Intersecting sexual orientation, gender, and ethnoracial identities shape individuals' experiences and health outcomes, including substance misuse and suicide risk. Marginalized groups often face limited access to resources and bear disproportionate mental and physical health burdens. Suicidal ideation often co-occurs with opioid misuse, yet limited research has explored how intersecting identities influence this relationship. The present study examined if intersecting gender, ethnoracial, and sexual orientation identities moderate the relationship between opioid misuse and suicidal ideation.

Secondary analyses were conducted using the 2023 National Survey on Drug Use and Health, which included 45,133 adults (20,173 men, 24,960 women). Over half (57.7%) were non-Hispanic White (White), 11.6% were Black/African American (Black), 19.5% were Hispanic/Latine, 5.4% were Asian/Native Hawaiian, and 5.8% endorsed multiple races. Analyses included only White, Black, and Hispanic/Latine participants to ensure statistical power. Most participants (79.2%) identified as heterosexual, 7% as bisexual, and 2.8% as gay/lesbian. Participants completed items assessing opioid misuse and suicidal ideation.

Among women, results indicated a significant interaction between opioid misuse and identity in relation to past-year suicidal ideation. The relation between opioid misuse and suicidal ideation was strong and positive among lesbian Black women (OR = 6.31, p = .030), heterosexual White women (OR = 3.81, p < .001), and heterosexual Hispanic/Latina women (OR = 3.64, p < .001), but non-significant among other intersecting identity groups (ps = .198 to .867). Among men, no interaction effects were significant (ps = .172 to .997), indicating that the strength of the relation between opioid misuse and suicidal ideation did not differ across different identities. Indeed, this association was comparable in strength across all adequately powered groups: heterosexual White men (OR = 2.84, p < .001), bisexual White men (OR = 3.17, p = .002), heterosexual Black men (OR = 3.26, p = .002), and heterosexual Hispanic men (OR = 2.84, p < .001).

These findings illuminate the crucial role of intersecting identities in moderating the relationship between opioid misuse and suicidal ideation among women. Individuals from specific ethnoracial, gender, and sexual minority groups face unique risks related to substance use and suicidal ideation, likely due to systematic disadvantages and the additive effects of chronic stressors. Societal stigma, discrimination, and limited resources further increase barriers to care. Our findings emphasize the need for mental health interventions and prevention efforts tailored to the experiences of individuals with intersecting marginalized identities.