Cannabis use disorder linked to higher suicidality in young adults, especially women

Among 281,650 young adults, cannabis use disorder and daily cannabis use were associated with higher rates of suicidal ideation, plans, and attempts, with significantly stronger associations in women.

Han, Beth et al.·JAMA network open·2021·Strong EvidenceCross-Sectional
RTHC-03186Cross SectionalStrong Evidence2021RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Cross-Sectional
Evidence
Strong Evidence
Sample
N=281,650

What This Study Found

Cannabis use disorder was associated with substantially higher suicidality regardless of depression status. Among those without depression, suicidal ideation prevalence was 13.9% for women with CUD vs. 3.5% without, and 9.9% for men with CUD vs. 3.0% without. Suicide planning among those with both CUD and depression was 52% higher in women (23.7%) than men (15.6%). Overall suicidality increased 40-60% from 2008-2019 beyond what cannabis use and depression alone could explain.

Key Numbers

281,650 adults aged 18-34. Suicidality increased 1.4-1.6 times from 2008-2009 to 2018-2019 after controlling for CUD and depression. Among women without depression with CUD: 13.9% suicidal ideation vs. 3.5% without CUD. Suicide plan with CUD+depression: women 23.7%, men 15.6%.

How They Did This

Cross-sectional analysis of 281,650 adults aged 18-34 from the 2008-2019 National Surveys on Drug Use and Health. Examined associations between cannabis use (daily, non-daily, CUD) and past-year suicidal ideation, plans, and attempts, stratified by sex and depression status.

Why This Research Matters

This study separates the cannabis-suicidality association by sex and depression status, revealing that the link is strongest in women and persists even among those without depression. The finding that suicidality increased beyond what cannabis and depression explain points to additional unmeasured factors.

The Bigger Picture

The 40-60% increase in suicidality that cannot be attributed to cannabis or depression trends suggests broader societal factors are at play. Cannabis may be a marker or amplifier of risk rather than the sole driver, and the sex difference points to potential biological or social vulnerability differences.

What This Study Doesn't Tell Us

Cross-sectional data cannot establish whether cannabis use causes suicidality or reflects shared risk factors. Self-reported measures. CUD diagnosis based on DSM-IV criteria. Cannot account for all confounders.

Questions This Raises

  • ?What is driving the 40-60% increase in suicidality beyond cannabis and depression?
  • ?Why are women with CUD at disproportionately higher risk?
  • ?Would these associations hold in a longitudinal design that can test directionality?

Trust & Context

Key Stat:
Suicidality rose 40-60% beyond what cannabis use and depression explained
Evidence Grade:
Very large nationally representative sample across 12 years. Cross-sectional design limits causal inference but statistical power is strong.
Study Age:
2021 study analyzing NSDUH data from 2008-2019.
Original Title:
Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.
Published In:
JAMA network open, 4(6), e2113025 (2021)
Database ID:
RTHC-03186

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-Control
Cross-Sectional / ObservationalSnapshot without intervening
This study
Case Report / Animal Study

A snapshot of a population at one point in time.

What do these levels mean? →

Frequently Asked Questions

Was the cannabis-suicidality link present even without depression?

Yes. Among adults without a major depressive episode, those with cannabis use disorder had roughly four times the rate of suicidal ideation compared to those without CUD.

Why was the association stronger in women?

The study found significantly higher suicidality rates among women with CUD compared to men with CUD, but the reasons remain unclear. The authors suggest further research is needed on sex-specific mechanisms.

Read More on RethinkTHC

Cite This Study

RTHC-03186·https://rethinkthc.com/research/RTHC-03186

APA

Han, Beth; Compton, Wilson M; Einstein, Emily B; Volkow, Nora D. (2021). Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.. JAMA network open, 4(6), e2113025. https://doi.org/10.1001/jamanetworkopen.2021.13025

MLA

Han, Beth, et al. "Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.." JAMA network open, 2021. https://doi.org/10.1001/jamanetworkopen.2021.13025

RethinkTHC

RethinkTHC Research Database. "Associations of Suicidality Trends With Cannabis Use as a Fu..." RTHC-03186. Retrieved from https://rethinkthc.com/research/han-2021-associations-of-suicidality-trends

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.