Men are twice as likely to have cannabis use disorder, but mental illness narrows the gender gap

In the CUD-only group, males were twice as likely as females to have CUD (OR=2.0). Among mental illnesses, males were more likely to have CUD with schizophrenia (OR~2.6) and other psychotic, mood, and substance use disorders. However, a reversed pattern (females more likely) was observed for anxiety disorders and antisocial personality disorder (OR=0.8). Mental illness increased the likelihood of CUD among females for most conditions except psychotic disorders and depression.

Systematic review and meta-analysis of 37 studies including clinical trials, cohort, and case-control studies. Generated pooled odds ratios comparing sex differences in CUD prevalence among individuals with and without mental illnesses. Meta-analysis was inconclusive due to high heterogeneity.

Understanding sex differences in CUD across mental illness diagnoses is critical for tailoring prevention and treatment. The finding that mental illness differentially affects CUD risk by sex suggests that screening and intervention strategies should be diagnosis-specific.

The standard narrative that CUD is primarily a male problem is oversimplified. When mental illness enters the picture, the sex distribution shifts substantially for certain diagnoses, meaning clinicians treating women with anxiety disorders or antisocial personality should be particularly vigilant for CUD.

High heterogeneity prevented valid meta-analysis across MI groups. Different studies used different CUD definitions. Cannot determine directionality (whether MI leads to CUD or vice versa). Publication bias possible.