Veterans with PTSD who use cannabis frequently have more depression, anxiety, and suicidal thoughts | Research

The takeaway

In a nationally representative survey of 608 US veterans with PTSD symptoms, those who used cannabis more than weekly were 3-4 times more likely to screen positive for depression, anxiety, and suicidal ideation.

Veterans using cannabis for PTSD, VA clinicians, and policymakers evaluating cannabis for PTSD treatment.

3-4x higher rates of depression and suicidal ideation in frequent users

What the researchers found

Veterans with PTSD who used cannabis more than weekly were significantly more likely to screen positive for depression (OR 3.4-3.8), anxiety, and suicidal ideation compared to non-users. They scored lower on cognitive functioning, were 8-12 times more likely to use avoidance coping strategies, and were no more likely to seek mental health treatment despite worse symptoms.

Why it matters

Many veterans with PTSD use cannabis for symptom relief, but this large representative survey found that frequent use was associated with worse psychiatric outcomes and avoidance coping, not better functioning.

The numbers in context

N=608 veterans with PTSD. Frequent users had ORs of 3.4-3.8 for depression/anxiety/suicidal ideation vs. non-users. Avoidance coping ORs of 8.2-12.2. Substance use coping OR of 4.4. Cognitive functioning effect sizes: d=0.25 vs. non-users, d=0.71 vs. infrequent users.

How the study worked

Analysis of the 2019-2020 National Health and Resilience in Veterans Study, a nationally representative survey. Focused on 608 veterans with current subthreshold or full PTSD who reported on past-6-month cannabis use, psychiatric symptoms, functioning, and coping strategies.

What this study cannot tell us

Cross-sectional design cannot determine whether cannabis use caused worse outcomes or whether veterans with worse symptoms were more likely to use cannabis. Self-reported data. Cannabis potency and composition not measured.

How to read the evidence

Large, nationally representative veteran survey with robust statistical analysis, but cross-sectional design limits causal inference.

When this study was published

Published in 2022, using 2019-2020 survey data.

The bigger picture

The finding that frequent cannabis-using veterans were not more likely to engage in mental health treatment despite having more severe symptoms suggests cannabis may function as a substitute for, rather than complement to, professional care.

Questions still open

Does cannabis use prevent veterans from seeking treatment they need? Would controlled therapeutic cannabis use produce different outcomes than self-directed frequent use?

Common questions

Does cannabis help veterans with PTSD?

In this nationally representative survey, veterans with PTSD who used cannabis frequently had worse psychiatric symptoms, lower cognitive functioning, and more avoidance coping than those who used less or not at all.

Are veterans who use cannabis less likely to get mental health treatment?

Despite having more severe symptoms, veterans who used cannabis frequently were no more likely to engage in mental health treatment than those who did not use cannabis.

Read the original research

Cannabis use among U.S. military veterans with subthreshold or threshold posttraumatic stress disorder: Psychiatric comorbidities, functioning, and strategies for coping with posttraumatic stress symptoms.

Journal of traumatic stress, 35(4), 1154-1166

View on PubMed ↗Publisher’s paper ↗

Citation

Hill, Melanie L; Loflin, Mallory; Nichter, Brandon; Na, Peter J; Herzog, Sarah; Norman, Sonya B; Pietrzak, Robert H. (2022). Cannabis use among U.S. military veterans with subthreshold or threshold posttraumatic stress disorder: Psychiatric comorbidities, functioning, and strategies for coping with posttraumatic stress symptoms.. Journal of traumatic stress, 35(4), 1154-1166. https://doi.org/10.1002/jts.22823