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.
Suicide prevention researchers, clinicians screening for suicidal risk, women's health advocates.
Cannabis mediated 12.5% of the pain-suicidal ideation link in women vs 5.9% in men
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Moderate: Large nationally representative sample with rigorous mediation analysis, though cross-sectional design limits causal inference and effect sizes are small.
When this study was published
Published in 2025 using NSDUH data from 2020-2022.
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.
Questions still open
- 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?
Common questions
What does it mean that cannabis "mediates" suicidal behavior?
Why might cannabis play a larger role for women?
Read the original research
Gender Differences in Cannabis as a Mediator Between Distress Factors and Non-Fatal Suicidal Behaviors.
International journal of mental health and addiction
Citation
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
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