Alcohol Use Mediates the Association Between Sexual Dating Violence Victimization and Attempted Suicide Among U.S. High School Students.

Abstract

High school students experiencing sexual dating violence may use alcohol as a coping mechanism for trauma, emotional pain, and stress from victimization, increasing the risk of suicide attempts due to impaired judgment. Few studies have investigated how alcohol consumption influences the association between sexual dating violence and the likelihood of attempted suicide. We assessed the mediating role of alcohol use in this association. We analyzed cross-sectional data of weighted 10,875 U.S. high school students from the 2021 pooled Youth Risk Behavior Surveillance dataset. We performed multivariable logistic regression analyses to assess associations between sexual dating violence and the likelihood of attempted suicide. We also conducted the four-way decomposition mediation analyses. Data were analyzed in 2024. Sexual dating violence was significantly associated with attempted suicide in the overall high school student sample (AOR=4.85, p<0.001), with stronger effects observed in subgroups, including males, 11th and 12th graders, and Black or African Americans. Alcohol use attributed 29.29% of the total effect of sexual dating violence victimization on attempted suicide, with 4.11% attributed to alcohol use only, and 25.18% to both interactions (between sexual dating violence victimization and alcohol use) and mediation (alcohol use). Sexual dating violence is associated with suicide attempts among high school students overall and across subgroups. Alcohol use plays a critical mediating role, indicating the need for targeted alcohol-specific interventions to reduce suicide risk, particularly among high-risk groups such as male students, younger cohorts, and racial/ethnic minorities. Prioritizing alcohol interventions among these vulnerable populations may address health disparities in suicide attempts and enhance suicide prevention efforts.