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Cited by 106Suicide and Self-Harm StudiesCannabis and Cannabinoid ResearchSubstance Abuse Treatment and Outcomes

Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status

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Han, Beth, Compton, Wilson M., Einstein, Emily B., Volkow, Nora D.·2021·JAMA Network Open
DOI 10.1001/jamanetworkopen.2021.13025PMC PMC8220498
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Abstract

Importance: During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. Objective: To determine whether cannabis use and cannabis use disorder (CUD) are associated with a higher prevalence of suicidality among young adults with or without depression and to assess whether these associations vary by sex. Design, Setting, and Participants: This survey study examined data from 281 650 adults aged 18 to 34 years who participated in the National Surveys on Drug Use and Health. Data were collected from January 1, 2008, to December 31, 2019. Exposures: Prevalence of past-year daily or near-daily cannabis use (≥300 days in the past year), CUD, and major depressive episode (MDE). Past-year CUD and MDE were based on DSM-IV diagnostic criteria. Main Outcomes and Measures: Past-year suicidal ideation, plan, and attempt. Results: Among the 281 650 adults aged 18 to 34 (men, 49.9% [95% CI, 49.6%-50.2%]; women, 50.1% [95% CI, 49.8%-50.4%]) included in the analysis, past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. National trends in adjusted prevalence of past-year suicidal ideation, plan, and attempt varied by daily and nondaily cannabis use and CUD among adults with or without MDE. After controlling for MDE, CUD, cannabis use status, and potential confounding factors, the adjusted prevalence of suicidal ideation, plan, and attempt increased 1.4 to 1.6 times from the 2008-2009 to 2018-2019 periods (adjusted risk ratio [ARR] for suicidal ideation, 1.4 [95% CI, 1.3-1.5]; ARR for suicide plan, 1.6 [95% CI, 1.5-1.9]; ARR for suicide attempt, 1.4 [95% CI, 1.2-1.7]), with 2008 to 2009 as the reference period. Past-year CUD, daily cannabis use, and nondaily cannabis use were associated with a higher prevalence of past-year suicidal ideation, plan, and attempt in both sexes (eg, among individuals without MDE, prevalence of suicidal ideation for those with vs without CUD was 13.9% vs 3.5% among women and 9.9% vs 3.0% among men; P < .001), but significantly more so in women than men (eg, suicide plan among those with CUD and MDE was 52% higher for women [23.7%] than men [15.6%]; P < .001). Conclusions and Relevance: From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and MDE. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors.

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  • Heavier and more frequent cannabis use was associated with suicidal ideation and suicide attempts in adolescents and young adults.

    “Heavier and more frequent cannabis use was associated with suicidal ideation and suicide attempts in adolescents and young adults [48, 49].”

    From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [49]

    The Conclusions report that cannabis use disorder, daily use, and nondaily use were associated with suicidal ideation and attempts. But the study examined adults aged 18–34, not adolescents; it also does not establish in these passages that heavier or more frequent use had a stronger association than nondaily use. (LLM, conf=0.88)

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  • A higher risk of suicidal behaviors has been reported in cannabis users with and without a history of major depressive disorders.

    “A higher risk of suicidal be haviors has also been reported in cannabis users with and without a history of major depressive disorders 132”

    From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [132]

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References 53 · Cited by 106

Research works printed but not linked: 39

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Authors
Han, B., Compton, W. M., Einstein, E. B., & Volkow, N. D.
Affiliations
National Institutes of Health (US)
Corresponding author
Han, Beth
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2021-06-22
Volume
4
Issue
6
Pages
e2113025
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2021.13025
PMC
PMC8220498
OpenAlex
W3176410777
Cited by
106
References
53
Citations by year
2026: 13 · 2025: 26 · 2024: 16 · 2023: 27 · 2022: 19 · 2021: 5
FWCI
11.42
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health
  • National Institute on Drug Abuse
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
cannabis use, cannabis use disorder, suicidality, suicidal ideation, suicide planning, suicide attempts, major depressive episode, sex differences, young adults, daily cannabis use, substance use and mental health, National Survey on Drug Use and Health, high school students, suicide prevention, access to mental health care, substance use disorder treatment access
MeSH terms
Adolescent, Adult, Age Factors, Cannabis, Major Depressive Disorder, Depressive Disorder, Major, Female, Forecasting, Humans, Male, Risk Factors, Sex Factors, Suicide, Attempted, United States, Prevalence, Odds Ratio, Substance-Related Disorders, Young Adult, Suicidal Ideation

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