Psychological Distress Mediates the Relationship between Perceived Social Isolation and Medical vs. Recreational Marijuana Use Among Adults in the United States

  1. Derek Sean Falk
  2. Christian E Vazquez
  3. Swasati Handique

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Abstract

Marijuana use in the United States (U.S.) has diversified alongside expanding legalization, yet little is known about the psychosocial factors that distinguish medical from recreational use. This study examined whether psychological distress mediates the association between perceived social isolation and marijuana use type among U.S. adults. We analyzed cross-sectional, nationally representative data from the 2024 Health Information National Trends Survey (HINTS, cycle 7). Marijuana use was categorized as medical (including medical and both medical/recreational) versus recreational. Perceived social isolation was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation t-score, and psychological distress was assessed with the Personal Health Questionnaire (PHQ)-4. Sur-vey-weighted descriptive analyses and a structural equation mediation model accounting for the complex sampling design were conducted. Medical marijuana users reported significantly higher levels of psychological distress and perceived social isolation than recreational users. Greater social isolation was strongly associated with higher psychological distress, and higher distress was associated with a greater likelihood of medical (vs. recreational) marijuana use. The indirect effect of social isolation on marijuana use type through psychological distress was statistically significant, while the direct effect of social isolation was not significant after accounting for distress. Overall, greater perceived social isolation predicted medical marijuana use primarily through elevated psychological distress. These findings suggest that medical marijuana use among U.S. adults may reflect coping with psychological distress linked to social disconnection, under-scoring the importance of integrating mental health and social context in-to clinical and public health approaches to cannabis use.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a Structured PREreview. You can view the complete PREreview at https://prereview.org/reviews/18345188.

    Does the introduction explain the objective of the research presented in the preprint? Yes
    Are the methods well-suited for this research? Highly appropriate
    Are the conclusions supported by the data? Somewhat supported The measurement of social isolation and marijuana use (medical/recreational) needs to be more robust as there are three categories of Marijuana use- Medical, medical/recreational, and recreational. Social isolation if correlated with the two extremes of the spectrum from medical to recreational would help understand which category the majority lies in. Whereas the "medical/recreational" category would benefit from an added confounding factor to determine significance of inclination towards either side of the spectrum.
    Are the data presentations, including visualizations, well-suited to represent the data? Highly appropriate and clear
    How clearly do the authors discuss, explain, and interpret their findings and potential next steps for the research? Very clearly
    Is the preprint likely to advance academic knowledge? Somewhat likely
    Would it benefit from language editing? No
    Would you recommend this preprint to others? Yes, but it needs to be improved
    Is it ready for attention from an editor, publisher or broader audience? Yes, after minor changes

    Competing interests

    The author declares that they have no competing interests.

    Use of Artificial Intelligence (AI)

    The author declares that they did not use generative AI to come up with new ideas for their review.

  2. Version published to 10.20944/preprints202601.1645.v1