Purpose. To examine the co-occurrence of mental health (depression, anxiety, nonsuicidal self-injury, suicide ideation) and substance use outcomes among female, male, and transgender–gender nonbinary (TNB) college students exposed to sexual assault (SA).Methods. Data were drawn from a 2018 U.S. national survey of college student wellbeing (N = 50,438). Inverse propensity-weighted three-step latent class analysis was used to examine co-occurrence of outcomes while adjusting for 31 potential confounders of the relation between SA exposure and outcomes.Results. Four latent classes were identified for female and male participants, and two for TNB participants, reflecting a range from low to high outcome risk. Exposure to SA was associated with significantly and substantially increased odds (ORs: 2.03–3.64) of membership to the highest-risk outcome class compared to the lowest risk class.Conclusions. Exposure to SA in the college setting is associated with substantially increased risk of co-occurrence of depression, anxiety, non-suicidal self-injury, and suicide ideation regardless of gender identity.