Understanding Suicidal Thoughts and Behaviors Among LGBTQ+ Youth: Differential Associations between Bullying and Substance Use

This version of the article has been accepted for publication, after peer review and is subject to Springer Nature&rsquo;s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s11121-025-01783-1 <strong>Abstract</strong> Rates of suicidal thoughts and behaviors (STB, i.e., suicidal thoughts, plans, and attempts), substance use, and bullying victimization are higher among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ+) youth compared to their heterosexual peers. However, research examining the interactive and potentially compounding associations of concurrent bullying and substance use (alcohol, cannabis, hallucinogens, and opioids) with STB is sparse, especially among LGBTQ+ youth. Thus, the current study aims to understand how these substances moderate the association between bullying victimization and STB&nbsp; by utilizing data (<em>N</em> = 96,482) from the combined 2003-2019 Youth Risk Behavior Survey (YRBS). Using a cross-sectional design and hierarchical logistic regression, we found that, on average, LGBTQ+ youth who were bullied were more likely to report planning to attempt suicide (<em>O.R.</em> = 2.71, <em>p</em> &lt; .01). Similarly, youth who reported using opioids/prescription drugs (<em>O.R.</em> = 4.60, <em>p</em> &lt; .05) or hallucinogens (<em>O.R.</em> = 8.89, <em>p</em> &lt; .01) were more likely to attempt suicide. No significant associations between alcohol use and STB were found. Lastly, cannabis emerged as a significant moderator of the associations between bullying victimization and suicidal ideation and plans, such that adolescents who were bullied and used cannabis were less likely to report suicidal ideation and planning compared to those who were bullied but did not use cannabis. These findings highlight that different substances are distinctively associated with STB among LGBTQ+ youth, providing a better understanding of how individuals who are being bullied may cope and to develop prevention programs to combat suicidal thoughts, planning, and attempts.