The association between cannabis use and suicidality among men and women: A population-based longitudinal study

Background Evidence regarding the role of sex differences in the association between cannabis use and suicidality is lacking. We explored sex differences in the bidirectional association between cannabis use and suicidality in a 3-year longitudinal study. Methods Data were drawn from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Bidirectional analyses were conducted separately by sex, exploring incidence of suicidality among cannabis users (n=963 vs. 30,586 non-users) as well as initiation of cannabis use among suicidal individuals (n=1805 vs. 25,729 non-suicidal). Cannabis use was categorized based on frequency of use. Multivariate logistic regression analyses controlling for multiple covariates were conducted. Results Cannabis use was significantly associated with increased incidence of suicidality among men (Adjusted Odds Ratio [AOR] for any cannabis use =1.91[1.02–3.56]) but not among women (AOR=1.19[0.64–2.20]). Daily cannabis use was significantly associated with increased incidence of suicidality among men (AOR=4.28[1.32–13.82]) but not among women (AOR=0.75[0.28–2.05]). Conversely, baseline suicidality was associated with initiation of cannabis use among women (AOR=2.34[1.42–3.87]) but not among men (AOR=1.10[0.57–2.15]). Separate analyses of suicidal ideation and suicide attempts demonstrated a significant association between cannabis use and subsequent incidence of suicidal ideation in men, and a significant association between baseline suicidal ideation and subsequent initiation of cannabis use in women. No significant association was found for the bidirectional association between cannabis use and suicide attempts in either sex. Limitations Suicidality was assessed only in individuals reporting depressed mood and/or anhedonia. Conclusions Our findings support a longitudinal association between heavy cannabis use and the incidence of suicidality in men, but not in women. Conversely, baseline suicidality is longitudinally associated with the initiation of cannabis use in women, but not in men. This may have implications on clinical and social aspects of cannabis use and merit further research into the unique effects of sex differences on cannabis induced psychopathology.