Cannabis May Play a Larger Role in Women's Suicidal Behavior Than Men's
Cannabis use mediated a greater proportion of the link between depression and suicidal behaviors in women than in men, and an even larger share of the link between pain conditions and suicidal ideation in women.
Quick Facts
What This Study Found
Cannabis use mediated 2.3% of the effect of depression on suicidal ideation in women versus 1.2% in men, and 1.7% versus 1.0% for suicide attempts. For pain conditions, cannabis mediated 12.5% of the effect on suicidal ideation in women versus 5.9% in men.
Key Numbers
n=93,743 (ages 18-50); NSDUH 2020-2022; cannabis mediation of depression-suicidal ideation: women 2.3% vs men 1.2%; depression-suicide attempts: women 1.7% vs men 1.0%; pain-suicidal ideation: women 12.5% (95% CI 0.081-0.272) vs men 5.9% (95% CI 0.038-0.128).
How They Did This
Mediation analysis using data from the National Survey of Drug Use and Health (NSDUH) 2020-2022, with 93,743 individuals aged 18-50. Causal framework assessed the mediating role of cannabis between depression, pain conditions, and non-fatal suicidal behaviors across genders.
Why This Research Matters
Understanding gender-specific pathways from distress to suicidal behavior through cannabis use could improve suicide risk screening. The finding that cannabis plays a larger mediating role for women, particularly in the pain-suicidality pathway, suggests that women using cannabis for pain management may need additional mental health monitoring.
The Bigger Picture
This study adds a gender lens to the growing literature on cannabis and suicide risk. The larger mediating effect in women, especially through pain conditions, suggests that self-medication with cannabis may have different downstream mental health consequences by gender.
What This Study Doesn't Tell Us
Cross-sectional survey data cannot establish causal direction. Self-reported substance use and mental health measures may be imprecise. The mediation percentages, while statistically significant, are small in absolute terms. Data collected during COVID-19 pandemic may reflect atypical patterns.
Questions This Raises
- ?Why does cannabis play a larger mediating role for women than men?
- ?Is the gender difference driven by different patterns of cannabis use, different biological responses, or different co-occurring conditions?
- ?Would longitudinal data confirm these mediating pathways?
Trust & Context
- Key Stat:
- Cannabis mediated 12.5% of the pain-suicidal ideation link in women vs 5.9% in men
- Evidence Grade:
- Moderate: Large nationally representative sample with rigorous mediation analysis, though cross-sectional design limits causal inference and effect sizes are small.
- Study Age:
- Published in 2025 using NSDUH data from 2020-2022.
- Original Title:
- Gender Differences in Cannabis as a Mediator Between Distress Factors and Non-Fatal Suicidal Behaviors.
- Published In:
- International journal of mental health and addiction (2025)
- Authors:
- Nayeem, Nawar(3), Walsh, McKenna, Bello-Kottenstette, Jennifer, Messias, Erick, Lin, Ping-I
- Database ID:
- RTHC-07242
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
What does it mean that cannabis "mediates" suicidal behavior?
Mediation means cannabis use is part of the pathway from a risk factor (like depression or pain) to suicidal behavior. It does not mean cannabis directly causes suicidality, but rather that some of the link between distress and suicidal behavior runs through cannabis use.
Why might cannabis play a larger role for women?
The study did not identify specific mechanisms, but possibilities include gender differences in self-medication patterns, different biological responses to cannabis, or different social contexts around cannabis use and help-seeking behavior in women versus men.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-07242APA
Nayeem, Nawar; Walsh, McKenna; Bello-Kottenstette, Jennifer; Messias, Erick; Lin, Ping-I. (2025). Gender Differences in Cannabis as a Mediator Between Distress Factors and Non-Fatal Suicidal Behaviors.. International journal of mental health and addiction. https://doi.org/10.1007/s11469-025-01570-7
MLA
Nayeem, Nawar, et al. "Gender Differences in Cannabis as a Mediator Between Distress Factors and Non-Fatal Suicidal Behaviors.." International journal of mental health and addiction, 2025. https://doi.org/10.1007/s11469-025-01570-7
RethinkTHC
RethinkTHC Research Database. "Gender Differences in Cannabis as a Mediator Between Distres..." RTHC-07242. Retrieved from https://rethinkthc.com/research/nayeem-2025-gender-differences-in-cannabis
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.