In a session at the 2025 Pediatric Academic Societies Meeting in Honolulu, Hawaii, Jesse Hinckley, MD, PhD, presented findings linking cannabis use to major depressive disorder and suicidal behavior among adolescents, drawing from a secondary analysis of the National Comorbidity Survey—Adolescent Supplement (NCSA).^1,2

“Both trends have been on the increase or on the rise over the last decade or so,” Hinckley explained, citing growing concerns over cannabis legalization and the lagging pace of related scientific research. Hinckley emphasized the importance of studying cannabis use given its increasing prevalence among youth and the significant associations found between cannabis use, depression, and suicidality.

In the study, adolescents with lifetime cannabis use had 2.07 times higher odds of mild or moderate major depressive disorder (MDD) and 3.32 times higher odds of severe MDD compared to non-users (aOR, 95% CI = 2.31-4.75). “We could see that using cannabis was also associated with not just the prevalence, but also the severity of major depressive disorder,” Hinckley said. Further analysis demonstrated that lifetime cannabis use was associated with a 6.90 times higher odds of lifetime suicide attempt, even after controlling for major depression (aOR, 95% CI = 4.67-10.19). “When we looked at lifetime suicide attempt after accounting for whether or not they had a major depressive disorder, those who had used cannabis in their lifetime were 6.9 times more likely to have attempted suicide,” Hinckley stated.¹

Importantly, the study also explored the impact of frequency of cannabis use. Adolescents who used cannabis three to four days per week or more had an 8.7 times higher odds of attempting suicide, and even less frequent users (less than monthly) had a 4.9 times higher odds of suicide attempt compared to non-users. “When we look at what we can colloquially call like that dose effect, whereas exposure goes up, the outcome goes up, that lets us know that, oh, maybe there really is something here,” Hinckley noted. “If you lecture these kids, they’ve been lectured by so many people, they kind of just shut it off,” he said. Instead, Hinckley recommends using motivational interviewing techniques to “help them bring those 2 things back together” and increase awareness about the risks.

The findings underscore the critical need for pediatricians and mental health providers to screen for cannabis use when assessing suicidality risks in adolescents. “Having active substance use problems is one of the things that can help distinguish those who have suicidal thoughts from those who will then act on those thoughts,” Hinckley concluded.

References:

1. Hinckley J, Mikulich-Gilbertson SK, He JP, et al. Cannabis Use Is Associated With Depression Severity and Suicidality in the National Comorbidity Survey—Adolescent Supplement. J Am Acad Child Adolesc Psychiatry. Volume 1, Issue 1, 24 – 35.
2. Hinckley J. Cannabis use and suicidal behavior in youth. Hot Topic Symposia session. Presented at: Pediatric Academic Societies 2025 Meeting; April 24-28, 2025. Honolulu, Hawaii.