Among rural Maryland ER patients, cannabis use disorder was associated with a 2.7-fold higher likelihood of suicidal ideation, though depression carried a far stronger association.
Rural health advocates, mental health providers, people concerned about cannabis and mental health
OR 2.67 for suicidal ideation
What the researchers found
Cannabis use disorder was positively associated with suicidal ideation in rural Maryland emergency department visits (OR 2.67, 95% CI 1.37-5.18), though its association was smaller than that of major depressive disorder (OR 79.3), alcohol use disorder (OR 6.87), or opioid use disorder (OR 5.39).
Why it matters
Rural communities face disproportionate burdens of substance use and suicide, with fewer mental health resources. Understanding which substance use disorders carry the strongest associations with suicidal ideation could help target limited rural prevention resources.
The numbers in context
Cannabis use disorder OR for suicidal ideation: 2.67 (95% CI 1.37-5.18). Opioid use disorder: OR 5.39 (95% CI 3.63-7.99). Alcohol use disorder: OR 6.87 (95% CI 4.97-9.51). Major depressive disorder: OR 79.30 (95% CI 51.91-121.15).
How the study worked
Researchers analyzed Maryland HCUP State Emergency Department Database discharge data, using logistic regression to assess associations between ICD-10 coded substance use disorders and suicidal ideation, controlling for income, race, age, and gender.
What this study cannot tell us
Cross-sectional ER data cannot establish causation or determine the direction of the association. Rural Maryland may not represent other rural regions. ICD-10 coding may undercount cannabis use disorder. The study could not assess severity or frequency of use.
How to read the evidence
Cross-sectional emergency department data with statistical controls, but cannot establish causation and limited to one state.
When this study was published
2024 study using Maryland HCUP emergency department data
The bigger picture
This study places cannabis use disorder within the broader landscape of rural mental health crises. While cannabis carries the smallest association with suicidal ideation among the substances studied, the co-occurrence of multiple substance use disorders and depression in rural populations suggests compounding risk.
Questions still open
- Does the association between cannabis use disorder and suicidal ideation differ by frequency or method of use? How does cannabis interact with co-occurring depression to affect suicide risk in rural populations?
Common questions
Was cannabis the biggest risk factor for suicidal ideation?
Does this prove cannabis causes suicidal thoughts?
Read the original research
Substance Use Disorder and Suicidal Ideation in Rural Maryland.
Chronic stress (Thousand Oaks, Calif.), 8, 24705470241268483
Citation
Ahuja, Manik; Jain, Monika; Mamudu, Hadii; Al Ksir, Kawther; Sathiyaseelan, Thiveya; Zare, Shahin; Went, Nils; Fernandopulle, Praveen; Schuver, Trisha; Pons, Amanda; Dooley, McKenzie; Nwanecki, Chisom; Dahal, Kajol. (2024). Substance Use Disorder and Suicidal Ideation in Rural Maryland.. Chronic stress (Thousand Oaks, Calif.), 8, 24705470241268483. https://doi.org/10.1177/24705470241268483
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