Serious psychological distress and elevated suicide risk among food insecure sexual- and gender-minority college students: Evidence from the NCHA-III.

OBJECTIVE: To estimate positive serious psychological distress and suicide-risk screening prevalence across identity-by-food-security groups. PARTICIPANTS: 215,330 US college students from four ACHA-NCHA IIIb administrations (Fall 2023 to Spring 2025). METHODS: Prevalence was estimated across three identity groups and four food-security levels, and binary logistic models estimated mutually adjusted associations and tested identity-by-food-security interaction. RESULTS: Serious distress ranged from 8.7% (cisgender heterosexual, high food security) to 55.9% (gender diverse, very low food security), and elevated suicide risk from 13.6% to 73.3%. Odds were higher for cisgender sexual-minority and gender-diverse students (suicide-risk ORs = 3.39 and 7.16) and rose monotonically as food security worsened. Gender-diverse students with low or very low food security were 3.6% of the sample but 9.5% of positive suicide-risk screens. Interactions were small or nonsignificant. CONCLUSIONS: Gender-diverse students screened positive most often at every food-security level. Campuses could integrate food assistance with identity-affirming mental health services.