Among 3,233 Iraq/Afghanistan-era veterans, those with cannabis use disorder had 2.3 times the odds of a lifetime suicide attempt, even after accounting for PTSD, depression, alcohol, and combat exposure.
Read this if you are a veteran who uses cannabis or if you work with veteran populations on mental health.
Veterans with cannabis use disorder had 2.3x the odds of a lifetime suicide attempt
What the researchers found
This study examined the relationship between cannabis use disorder (CUD) and suicidal behavior in a large sample of 3,233 Iraq/Afghanistan-era veterans.
Veterans with lifetime CUD had significantly higher odds of both current suicidal ideation (OR = 1.683) and lifetime suicide attempts (OR = 2.306). What makes this finding notable is that these associations persisted after statistically controlling for numerous other risk factors: sex, PTSD, depression, alcohol use disorder, non-cannabis drug use disorder, childhood sexual abuse history, and combat exposure.
The fact that CUD predicted suicide attempts independently of PTSD, depression, and other substance use disorders suggests it may represent a unique risk factor rather than simply a marker of other problems. This is particularly relevant for veteran populations, where suicide prevention is a critical priority.
Why it matters
Veteran suicide remains a national crisis. Identifying CUD as an independent risk factor for suicide attempts provides a specific, actionable screening target. Veterans with CUD may benefit from additional suicide risk assessment and prevention efforts.
The numbers in context
3,233 veterans. CUD associated with suicidal ideation OR = 1.683 (p = 0.008). CUD associated with suicide attempts OR = 2.306 (p < 0.0001). Associations held after controlling for sex, PTSD, depression, alcohol use disorder, other drug use disorder, childhood sexual abuse, and combat exposure.
How the study worked
Cross-sectional analysis of 3,233 Iraq/Afghanistan-era veterans using well-validated instruments to assess cannabis use disorder, suicidal ideation, suicide attempt history, and relevant covariates including PTSD, depression, alcohol use disorder, other drug use disorder, childhood sexual abuse, and combat exposure.
What this study cannot tell us
Cross-sectional design cannot establish whether CUD contributes to suicide risk or whether underlying factors drive both CUD and suicidal behavior. Self-reported data may be affected by recall bias. The veteran population may not generalize to civilian populations.
How to read the evidence
Large cross-sectional study with comprehensive covariate controls. Moderate because the cross-sectional design limits causal inference.
When this study was published
Published in 2017.
The bigger picture
This study adds cannabis use disorder to the list of independent suicide risk factors in veteran populations. Given that cannabis use is increasing among veterans (some using it to self-medicate PTSD), the finding that CUD independently predicts suicide attempts creates an important clinical tension: veterans may use cannabis hoping to reduce distress, but problematic use patterns may independently increase suicide risk.
Questions still open
- Does cannabis use disorder increase suicide risk through a specific mechanism (impulsivity, withdrawal dysphoria)? Would effective CUD treatment reduce suicide risk in veterans? Is it the cannabis use disorder specifically, or any pattern of problematic substance use, that drives this association?
Common questions
Does cannabis use increase suicide risk in veterans?
Is this about all cannabis use or just problematic use?
Read the original research
Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans.
Journal of psychiatric research, 89, 1-5
Citation
Kimbrel, Nathan A; Newins, Amie R; Dedert, Eric A; Van Voorhees, Elizabeth E; Elbogen, Eric B; Naylor, Jennifer C; Ryan Wagner, H; Brancu, Mira; Beckham, Jean C; Calhoun, Patrick S. (2017). Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans.. Journal of psychiatric research, 89, 1-5. https://doi.org/10.1016/j.jpsychires.2017.01.002
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