In a longitudinal study of 6,811 US Army veterans, cannabis use was among several substance use behaviors that predicted subsequent suicidal ideation and suicide planning, though not suicide attempts.
VA clinicians, military mental health providers, suicide prevention researchers
Cannabis use among veterans predicted 1.4-2.6x higher odds of subsequent suicidal ideation
What the researchers found
Cannabis use at baseline was significantly associated with subsequent suicidal ideation (AOR range: 1.42-2.60 across substance use measures) and suicide planning. Binge drinking, prescription drug abuse, illicit drug use, and alcohol use disorder showed similar associations. No substance use variable predicted suicide attempts as a main effect, though interactions with depression and sex were found.
Why it matters
Veterans have elevated suicide rates, and understanding modifiable risk factors is critical. This study identifies substance use, including cannabis, as a prospective predictor of suicidal thoughts, providing potential screening and intervention targets.
The numbers in context
6,811 veterans/reservists; two survey waves; substance use variables associated with ideation (AOR 1.42-2.60) and planning; no main effects on attempts; interactions with sex and depression found for some substances; 1,527 had ideation at baseline
How the study worked
Longitudinal survey of 6,811 US Army veterans and deactivated reservists who completed surveys at two timepoints (2016-2018 and 2018-2019). Logistic regression adjusted for demographics and prior suicidality examined associations between substance use and subsequent suicidal behaviors.
What this study cannot tell us
Self-reported substance use and suicidality, survey-based study may miss those in acute crisis, Army-specific population may not generalize to all veterans, two-year follow-up may miss longer-term effects, attrition between waves
How to read the evidence
Large longitudinal study with prospective design controlling for prior suicidality; strong methodology but self-reported measures
When this study was published
Published 2025
The bigger picture
The finding that substance use predicts ideation and planning but not attempts suggests that substance use may increase suicidal thinking without necessarily being the factor that pushes someone to act. This has implications for how clinicians assess and intervene on suicide risk.
Questions still open
- Does treating cannabis use disorder reduce suicidal ideation in veterans? Are the associations driven by cannabis itself or by co-occurring conditions? Should cannabis use screening be integrated into veteran suicide risk assessment?
Common questions
Does cannabis use increase suicide risk in veterans?
Is cannabis the only substance linked to veteran suicide risk?
Read the original research
Prospective associations of alcohol and drug misuse with suicidal behaviors among US Army soldiers who have left active service.
Psychological medicine, 55, e119
Citation
Campbell-Sills, Laura; Sun, Xiaoying; Kessler, Ronald C; Ursano, Robert J; Jain, Sonia; Stein, Murray B. (2025). Prospective associations of alcohol and drug misuse with suicidal behaviors among US Army soldiers who have left active service.. Psychological medicine, 55, e119. https://doi.org/10.1017/S0033291725000947
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