Longitudinal associations between childhood sexual abuse-related PTSD symptoms and passive and active suicidal ideation among sexual minority men

Background: Sexual minority men report high rates of childhood sexual abuse (CSA) and adult-hood suicidality. However, mechanisms (e.g., PTSD symptoms) through which CSA might drive suicidality remain unknown. Objective: In a prospective cohort of sexual minority men, we examined: (1) associations between CSA and suicidal thoughts and behaviors; (2) prospective associations between CSA-related PTSD symptoms and suicidal ideation; and (3) interpersonal moderators of these associations. Participants and setting: Participants included 6305 sexual minority men (Mage = 33.2, SD = 11.5; 82.0% gay; 53.5% White) who completed baseline and one-year follow-up at-home online surveys. Methods: Bivariate analyses were used to assess baseline demographic and suicidality differences between CSA-exposed participants and non-CSA-exposed participants. Among CSA-exposed par-ticipants, multivariable logistic regression analyses were used to regress passive and active sui-cidal ideation at one-year follow-up on CSA-related PTSD symptoms at baseline. Interactions were examined between CSA-related PTSD symptoms and interpersonal difficulties. Results: CSA-exposed sexual minority men reported two-and-a-half times the odds of suicide attempt history compared to non-CSA-exposed men (95% CI = 2.15-2.88; p < 0.001). Among CSA-exposed sexual minority men, CSA-related PTSD symptoms were prospectively associated with passive suicidal ideation (adjusted odds ratio [aOR] = 1.38; 95% CI = 1.19; 1.61). Regardless of CSA-related PTSD symptom severity, those with lower social support and greater loneliness were at elevated risk of active suicidal ideation at one-year follow-up. Conclusions: CSA-related PTSD symptom severity represents a psychological mechanism contributing to CSA-exposed sexual minority men's elevated suicide risk, particularly among those who lack social support and report loneliness.

Automated summary

Sexual minority men who have experienced childhood sexual abuse (CSA) are twice as likely to have a history of suicide attempts compared to those who have not experienced CSA. Among CSA-exposed individuals, the severity of CSA-related PTSD symptoms is prospectively associated with passive suicidal ideation. Regardless of the severity of PTSD symptoms, those with lower social support and greater loneliness are at a higher risk of active suicidal ideation in the future.