Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation

Chelsea D Kilimnik; Grisel García-Ramírez; Nashalys K Salamanca; G Mitchell Mazzone; K Nicole Mullican; Kelly Cue Davis; Lindsay M Orchowski; Ruschelle M Leone; Debra Kaysen; Amanda K Gilmore

doi:10.1111/acer.15194

Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation

Alcohol Clin Exp Res (Hoboken). 2023 Nov;47(11):2169-2183. doi: 10.1111/acer.15194. Epub 2023 Oct 2.

Authors

Chelsea D Kilimnik¹, Grisel García-Ramírez^{2

3}, Nashalys K Salamanca^{3

4}, G Mitchell Mazzone⁵, K Nicole Mullican^{2

3}, Kelly Cue Davis⁶, Lindsay M Orchowski⁷, Ruschelle M Leone^{2

3}, Debra Kaysen⁸, Amanda K Gilmore^{2

3}

Affiliations

¹ Department of Psychology & Neuroscience and the Renée Crown Wellness Institute, University of Colorado Boulder, Colorado, Boulder, USA.
² Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA.
³ The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA.
⁴ Department of Psychology, Georgia State University, Georgia, Atlanta, USA.
⁵ Department of Psychology, Hofstra University, New York, Hempstead, USA.
⁶ Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
⁷ Department of Psychiatry and Human Behavior, Brown University, Rhode Island, Providence, USA.
⁸ Division of Public Mental Health and Population Sciences, Department of Psychiatry, Stanford University School of Medicine, California, Stanford, USA.

PMID: 38226754
PMCID: PMC10979836 (available on 2024-11-01)
DOI: 10.1111/acer.15194

Abstract

Background: Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation.

Methods: A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks.

Results: The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men.

Conclusions: Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.

Keywords: drinking motives; gender identity; posttraumatic stress; sexual assault; sexual orientation.

Abstract

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