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

The takeaway

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.

Mental health clinicians, suicide prevention researchers, and anyone interested in the cannabis-mental health relationship.

Suicidality rose 40-60% beyond what cannabis use and depression explained

What the researchers 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.

Why it 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 numbers in context

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 the study worked

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.

What this study cannot 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.

How to read the evidence

Very large nationally representative sample across 12 years. Cross-sectional design limits causal inference but statistical power is strong.

When this study was published

2021 study analyzing NSDUH data from 2008-2019.

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.

Questions still open

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?

Common 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 the original research

Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.

JAMA network open, 4(6), e2113025

View on PubMed ↗Publisher’s paper ↗

Citation

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