Alcohol Use Linked to Higher Suicide Risk Among Sexual Minority Women: JAMA

Alcohol use has been known to be a significant risk factor for suicide, with a previous meta-analysis of prospective studies indicating a risk of suicide that was almost 94% higher among those who used alcohol. Not only does alcohol use increase the risk of suicidal thoughts, but it also reduces inhibitions, which makes it easier to attempt suicide. This study aimed to determine whether alcohol use was a more frequent antecedent of suicide deaths among LGB persons than among heterosexual persons, with a focus on sex differences.

This cross-sectional study analyzed data from the National Violent Death Reporting System (NVDRS) from 2013 to 2021. The NVDRS is a national surveillance system that collects data from death certificates, law enforcement, and coroner/medical examiner records. The study was exempt from ethics review because it used de-identified surveillance data and followed the STROBE reporting guideline.

Eligible cases were persons who died by suicide (excluding murder-suicide) with known age and sex. Sexual orientation was defined as LGB or heterosexual using two validated methods: documented sexual orientation in law enforcement or medical examiner records and a systematic keyword search of narrative text. Alcohol use before death was determined using three methods:

• Presence of any blood alcohol content (BAC ≥0.01 g/dL),

• Legal intoxication (BAC ≥0.08 g/dL), and

• Alcohol involvement is defined as a suspected contribution to the suicide and/or alcohol as a recent or acute crisis factor.

Risk ratios were calculated using age-adjusted log-binomial models, stratified by age into five groups (<21, 21-29, 30-39, 40-49, and ≥50 years).

Key findings

• The analysis included 218,601 suicide decedents, with a mean age of 47 years (SD, 19). Men accounted for 169,811 deaths (77.7%).

• Among all decedents, 3,425 were identified as LGB, while 215,176 were heterosexual.

• Blood alcohol testing was performed in 120,590 cases (55.2%), allowing for a detailed assessment of alcohol involvement at the time of death.

• In the overall sample, alcohol use measured by BAC did not differ significantly between LGB and heterosexual decedents.

• The age-adjusted risk ratio for the presence of any BAC was 1.00 (95% CI, 0.96–1.05), and for legal intoxication was 0.99 (95% CI, 0.93–1.05).

• However, alcohol involvement as a contributing or crisis factor was more common among LGB decedents, with an age-adjusted risk ratio of 1.13 (95% CI, 1.06–1.22). When results were stratified by sex, clear differences emerged.

• LGB women showed consistently higher risks for all alcohol-related antecedents of suicide, while no significant differences were observed among men.

Compared with heterosexual women, LGB women had:

• A 15% higher risk of any detectable BAC (95% CI, 7%–24%),

• A 17% higher risk of legal intoxication (95% CI, 7%–28%), and

• A 38% higher risk of documented alcohol involvement (95% CI, 25%–54%).

• Statistical tests confirmed significant interactions between sexual orientation and sex for all alcohol measures, indicating that the association between LGB orientation and alcohol involvement in suicide differs substantially between women and men.

This large national study provides evidence that alcohol use is more commonly a factor in suicide deaths among LGB women than among heterosexual women, but not among men. These results highlight the need to address alcohol use as a specific, intervenable risk factor in suicide prevention efforts to reduce disparities by sexual orientation, particularly for women.

Reference:

McKetta S, Hughes LD, Anderson AM, Barzilay R, Rahman B, Clark KA. Sexual Orientation–Related Differences in Alcohol Use and Suicide Death. JAMA Netw Open. 2026;9(1):e2554680. doi:10.1001/jamanetworkopen.2025.54680