Mixed method examination of alcohol and suicidality among actively suicidal adults who engage in heavy episodic drinking.

Suicide is a serious public health problem in the United States. Alcohol use has been substantially documented as a risk factors for suicide, yet it is unclear how alcohol is associated with suicidal ideation (SI) and behavior (SIB) at the event level. We examined the association between alcohol use and SI using a mixed methods approach that included daily assessments from 13 adults who engage in heavy episodic drinking with current SI and qualitative interviews among 12 of those adults. Participants were recruited on social media. Separate mixed effects logistic regression models indicated that individuals' alcohol use on a given day was associated with SI (OR = 1.37), and suicidal urges (OR = 1.41). Adjusting for repeated measures, the expected marginal mean for intensity of SI (EMM = 3.33) and urges (EMM = 2.94) were higher on days with reported drinking behavior than days without reported drinking (EMM = 2.68 and EMM = 2.62 respectively). Qualitative data indicated that the association between alcohol use and SIB is more complex than a single directionality. Instead, the association can be unidirectional, bidirectional, and/or dependent on factors including mental health and amount of alcohol consumed. Overall, these findings emphasize a need for integrated alcohol and SIB interventions while providing insight on possible daily, just-in-time adaptations.

Racial Disparities in Sexual Assault Characteristics and Mental Health Care After Sexual Assault Medical Forensic Exams.

Background: Sexual assault (SA) is common, but Black individuals might be at higher risk of SA and negative health sequalae. Racial differences in SA characteristics and health care utilization after SA are largely unknown. Materials and Methods: We reviewed medical records of 690 individuals (23.9% Black; 93.6% women) who received a SA medical forensic exam (SAMFE) at a southeastern U.S. hospital. We examined bivariate racial differences in SA characteristics and used zero-inflated Poisson regressions to estimate racial differences in mental health outpatient visits at the SAMFE hospital. Results: Among survivors of SA, Black survivors were more likely than White survivors to have been victimized by an intimate partner (odds ratio [OR] = 1.77, confidence interval [95% CI] = 1.02-3.07) and they had more post-SA outpatient mental health visits at the SAMFE hospital (incidence rate ratio [IRR] = 2.05, 95% CI = 1.70-2.47). Black survivors were less likely to report alcohol or drug use before the SA (OR = 0.42, 95% CI = 0.28-0.62). In multivariable models, Black survivors trended toward more mental health visits than White survivors (IRR = 1.63, 95% CI = 0.82-2.44), but intimate partner violence (IPV) significantly moderated that association (IRR = 0.01, 95%CI = ≤0.001-0.03). Black survivors assaulted by an intimate partner were less likely to access mental health care than White IPV survivors. Conclusions: The hospital setting of a SAMFE could be a unique opportunity to serve Black survivors and reduce racial disparities in mental health sequelae, but additional support will be needed for Black survivors experiencing IPV. An intersectional, reproductive justice framework has the potential to address these challenges.