Sexual identity as a moderator of associations between lifetime MDMA/ecstasy or psilocybin use and mental health outcomes: An exploratory analysis of a nationally representative sample using NSDUH 2015–2019
Research Square July 2, 2026 Maya Seale
Among a nationally representative U.S. sample, the associations between lifetime use of MDMA/ecstasy or psilocybin and mental health outcomes differ by sexual identity. For heterosexual individuals, lifetime use of either substance was linked to higher odds of past-year major depressive episode and serious psychological distress, whereas for sexual minority individuals (lesbian, gay, bisexual), these associations were weaker or absent. The findings suggest that sexual identity moderates the relationship between psychedelic use and mental health, highlighting the need for identity-informed research in this area.