Gender Differences in Cannabis as a Mediator Between Distress Factors and Non-Fatal Suicidal Behaviors

Emerging evidence suggests gender-based heterogeneity in suicide risk associated with cannabis use, while the role of cannabis in gender-dependent suicide risk is elusive. The objective of the present study is to determine whether cannabis use contributes differently to the pathway from depression or pain conditions to non-fatal suicidal behaviors (e.g., suicidal ideation, plans, or attempts) in men versus women. We analyzed the data was extracted from the National Survey of Drug Use and Health (NSDUH) from 2020–2022 during the COVID-19 pandemic. Causal mediation analysis was conducted to assess the mediating role of cannabis in the association between depression, pain conditions, and suicide ideation/plan/attempt in two gender groups. A sample of 93,743 individuals aged 18–50 years who participated in the NSDUH survey. Mediation analysis revealed that cannabis use accounted for a greater proportion of the effect of depression on suicidal ideation or attempts in women (mediation fraction: 2.3% for ideation) compared to men (1.2% for ideation). Similarly, cannabis mediated 12.5% (95% CI: 0.081–0.272) of the effect of pain conditions on suicidal ideation in women, versus 5.9% (95% CI: 0.038–0.128) in men. These findings suggest that cannabis plays a more substantial role in non-fatal suicidal behaviors for women than men, particularly in the context of depression and pain conditions. Tailored interventions addressing cannabis use as a self-medication strategy, especially for women, are critical for suicide prevention.