Substance Use and Suicide Attempts among Adolescent Sexual Minority Males: A Comparison of Synthesized Substance Use Measures.

Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a signficant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n=849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on usage frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (Quasi-Information Criterion=854.00) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared to those who used none (aPR=3.35, 95% CI 2.41, 4.66). A 3 latent class model had the second best fit to the data (Quasi-Information Criterion=878.44), with the highest prevalence of suicide attempts (aPR=2.54, 95% CI 1.80, 3.57) among the high substance use class compared to the low use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.