Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study

Purpose: Cannabis use is associated with increased risk for suicidality. However, the directionality of this association and the role of shared familial influences—such as genetics and environment—remains uncertain. Further, despite higher rates of cannabis use and suicidality endorsement in clinica...

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Main Authors: Elisa F. Stern, Jarrod M. Ellingson, Jonathan D. Schaefer, Jesse D. Hinckley, Michael C. Stallings, Robin P. Corley, Christian Hopfer, Tamara L. Wall, Soo Hyun Rhee
Format: Article
Language:English
Published: Elsevier 2025-12-01
Series:Addictive Behaviors Reports
Online Access:http://www.sciencedirect.com/science/article/pii/S2352853225000380
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author Elisa F. Stern
Jarrod M. Ellingson
Jonathan D. Schaefer
Jesse D. Hinckley
Michael C. Stallings
Robin P. Corley
Christian Hopfer
Tamara L. Wall
Soo Hyun Rhee
author_facet Elisa F. Stern
Jarrod M. Ellingson
Jonathan D. Schaefer
Jesse D. Hinckley
Michael C. Stallings
Robin P. Corley
Christian Hopfer
Tamara L. Wall
Soo Hyun Rhee
author_sort Elisa F. Stern
collection DOAJ
description Purpose: Cannabis use is associated with increased risk for suicidality. However, the directionality of this association and the role of shared familial influences—such as genetics and environment—remains uncertain. Further, despite higher rates of cannabis use and suicidality endorsement in clinical samples, research in these populations is limited. This study examines cross-sectional and prospective associations between cannabis use and suicidality in a sample characterized by earlier cannabis initiation and heavier use than typically reported, while accounting for shared familial influences. Method: Adolescent sibling groups were recruited from Denver and San Diego (N = 1,261); at least one sibling was recruited from a substance use treatment program, alternative school, or juvenile probation. Participants completed clinical interviews assessing substance use and suicidality at three waves (2001-–2019). Cannabis use frequency was examined as a predictor of suicidality using multilevel models accounting for shared familial influences and within-family clustering. Covariates included alcohol, tobacco, other substance use, age, and sex. Reverse associations and exploratory models assessing tobacco as a predictor were also examined. Results: Cannabis use was not associated with suicidality (all p’s > 0.05). Exploratory analyses suggested a possible association between tobacco and suicidality (e.g., Wave 1 within-family effect: OR = 1.037, p = 0.016), though these associations were largely reduced to non-significance after accounting for other substance use. Conclusions: Findings in this high-risk clinical sample are inconsistent with literature linking cannabis use to suicidality in community samples. Results underscore the need for further research on the association between general and polysubstance use risk and suicidality.
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spelling doaj-art-333bd5f9a23d41259d20aa76e519cfb82025-08-20T02:39:48ZengElsevierAddictive Behaviors Reports2352-85322025-12-012210062010.1016/j.abrep.2025.100620Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling studyElisa F. Stern0Jarrod M. Ellingson1Jonathan D. Schaefer2Jesse D. Hinckley3Michael C. Stallings4Robin P. Corley5Christian Hopfer6Tamara L. Wall7Soo Hyun Rhee8Department of Psychology and Neuroscience, University of Colorado, UCB Boulder, CO 80309, USA; Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St Boulder, CO 80303, USA; Corresponding author at: Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO 80309-0345, USA.Department of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, Aurora, CO 80045, USA; Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St Boulder, CO 80303, USADepartment of Psychology, Vanderbilt University, PMB 407817 2301 Vanderbilt Place, Nashville, TN 37240, USADepartment of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, Aurora, CO 80045, USADepartment of Psychology and Neuroscience, University of Colorado, UCB Boulder, CO 80309, USA; Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St Boulder, CO 80303, USADepartment of Psychology and Neuroscience, University of Colorado, UCB Boulder, CO 80309, USA; Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St Boulder, CO 80303, USADepartment of Psychiatry, University of Colorado School of Medicine, 1890 N Revere Ct, Aurora, CO 80045, USADepartment of Psychiatry, University of California, 3120 Biomedical Sciences Wy, La Jolla, CA 92093, USADepartment of Psychology and Neuroscience, University of Colorado, UCB Boulder, CO 80309, USA; Institute for Behavioral Genetics, University of Colorado Boulder, 1480 30th St Boulder, CO 80303, USAPurpose: Cannabis use is associated with increased risk for suicidality. However, the directionality of this association and the role of shared familial influences—such as genetics and environment—remains uncertain. Further, despite higher rates of cannabis use and suicidality endorsement in clinical samples, research in these populations is limited. This study examines cross-sectional and prospective associations between cannabis use and suicidality in a sample characterized by earlier cannabis initiation and heavier use than typically reported, while accounting for shared familial influences. Method: Adolescent sibling groups were recruited from Denver and San Diego (N = 1,261); at least one sibling was recruited from a substance use treatment program, alternative school, or juvenile probation. Participants completed clinical interviews assessing substance use and suicidality at three waves (2001-–2019). Cannabis use frequency was examined as a predictor of suicidality using multilevel models accounting for shared familial influences and within-family clustering. Covariates included alcohol, tobacco, other substance use, age, and sex. Reverse associations and exploratory models assessing tobacco as a predictor were also examined. Results: Cannabis use was not associated with suicidality (all p’s > 0.05). Exploratory analyses suggested a possible association between tobacco and suicidality (e.g., Wave 1 within-family effect: OR = 1.037, p = 0.016), though these associations were largely reduced to non-significance after accounting for other substance use. Conclusions: Findings in this high-risk clinical sample are inconsistent with literature linking cannabis use to suicidality in community samples. Results underscore the need for further research on the association between general and polysubstance use risk and suicidality.http://www.sciencedirect.com/science/article/pii/S2352853225000380
spellingShingle Elisa F. Stern
Jarrod M. Ellingson
Jonathan D. Schaefer
Jesse D. Hinckley
Michael C. Stallings
Robin P. Corley
Christian Hopfer
Tamara L. Wall
Soo Hyun Rhee
Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
Addictive Behaviors Reports
title Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
title_full Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
title_fullStr Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
title_full_unstemmed Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
title_short Associations between cannabis use frequency and suicidal thoughts and behaviors: A clinical longitudinal sibling study
title_sort associations between cannabis use frequency and suicidal thoughts and behaviors a clinical longitudinal sibling study
url http://www.sciencedirect.com/science/article/pii/S2352853225000380
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