The association between cannabis use and suicidality among men and women

http://www.sciencedirect.com/science/article/pii/S0165032716304906

by nashke • 10 years ago

45 46 10 years ago

sciencedirect.com

nashke13• 10 years ago

I am one of the authors, AMA

harry8• 10 years ago

Who paid for the research?

nashke13• 10 years ago

We did the research independently (all authors work in the Israeli public health system). The NESARC survey was funded by The National Institute on Alcohol Abuse and Alcoholism (NIAAA), a part of the NIH.

cpncrunch3• 10 years ago

Thanks for doing this research, and for posting this...it's a very important field right now, considering that many countries/states are legalising Cannabis. I live in Canada and cannabis is in the process of being legalised.

I haven't read the full-text, but how well have you figured out the causation? The study seems to show that in women suicidal ideation causes cannabis use. In men it seems to be the other way around (cannabis use causes suicide ideation). However I'm wondering if even in men the desire to use cannabis is influenced by some kind of mental instability, which would have caused suicidal ideation even in the absence of cannabis. Perhaps you address this in the full-text.

Also, I'd suggest paying the $3k open-access fee to make this article available to everyone. It's a small price to pay for increased exposure, more citations, etc.

chatmasta2• 10 years ago

It's fucking nuts that you need to pay $3k for anyone to be able to read your work.

the_duke3• 10 years ago

There have to be peer relatively respecatable peer reviewed OA journals that cost considerably less then 3k, though, I'd think.

nashke13• 10 years ago

We can't show causation using this kind of methodology. Longitudinal association may suggest causation, but it does not imply it. In the discussion we offer some possible mechanisms for this association, not all of them causal in nature. We do know from previous studies that the endocannabinoid system is altered in suicidal individuals and that sex hormones both affect suicidality and have a reciprocal relationship with the endocannabinoid system. These suggest how and why intense cannabis use can affect suicidal behavior.

I've posted a link which should allow for full-text access for the next few weeks.

the_duke3• 10 years ago

The 'conclusion' hints at or indicates the assumption that cannabis use is the cause for increased suicide incidence.

What's the basis for this?

Depression being the cause for increased cannabis is intuitively a more likely assumption.

With these topics, I think it is very hard to get good data. It might very well be that men do not admit to being depressed before starting to smoke up regularily.

Can anyone comment on the quality of the data used? (National Epidemiologic Survey on Alcohol and Related Conditions)

savanaly• 10 years ago

The 'conclusion' hints at or indicates the assumption that cannabis use is the cause for increased suicide incidence.

I read the abstract and conclusions closely and I didn't think they were implying that, although this is the sort of result that is classically misreported along the lines you are articulating.

The conclusion is simply that there is an association between cannabis use and suicide ideation (in other words, when you first have thoughts of suicide) among men (let's just leave the women out of it for now). So not only do the authors not claim that cannabis causes suicide, they don't even claim cannabis is associated with suicide, they claim it's associated with suicide ideation. That no link was made between suicide incidence and cannabis is explicitly stated. ("No significant association was found for the bidirectional association between cannabis use and suicide attempts in either sex.")

From that one paragraph conclusion they seem to focus more on the differences this study turned up between the sexes than on some fantastic new conclusion along the lines of "pot leads to suicide".

Spooky23• 10 years ago

How does cannabis use compare to alcohol use with respect to suicidal behavior or depression?

jsmith0295• 10 years ago

My personal experience has been that there's more of a correlation with alcohol, and that there's somewhat of a negative feedback loop. Considerably less so with marijuana.

nashke13• 10 years ago

Alcohol is strongly associated with suicidality, but again, it's difficult to prove causality (Try randomizing people to "alcohol binging group" or "suicidal ideation group"). The association is more robust than that for cannabis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872355/

stephengillie• 10 years ago

How is self-medication handled in the study analysis? To me, it sounds like men who are hurting start self-medicating early, which supports the social stigma hypothesis. They often use this as their sole resource.

Women wait much longer to self medicate, it sounds like. This may be from women being given other social support options, or because they face a larger stigma around handling their problems themselves. Nevertheless, women who are hurting do begin to self-medicate as a last resort.

It sounds like men have more opportunity to develop a solo coping mechanism, with women not developing this because they aren't isolated early, and instead have other resources to try first.

Disclaimer: I've been a functional daily cannabis smoker for 7 years. I use it to cope with loneliness, depression, and social anxiety. I work for a major cloud and ISP company.

nashke13• 10 years ago

We analysed self-medication variables from the data and found that indeed men tend to self-medicate more. However, our findings regarding cannabis self-medication for suicidality are opposite, i.e. women were much more likelt to initiate cannabis use after reporting suicidality, but not men. Of course, self-medication is but one of the possible explanations for this finding.

spdustin• 10 years ago

I don't have a question, but an observation, and some unsolicited advice.

You said "AMA" hours ago, and haven't returned (as of my comment timestamp) to answer the questions that have been posted here. On HN, the story may fall off the homepage before you have a chance to come back, which would limit the audience that would see your answers.

I've upvoted it, because I think it's an important study and the conversation that could be had here in the comments may help someone. But I'd urge you (and anyone who says "AMA" on a popular site) to check in every 5-15 minutes for a few hours, just to keep momentum going.

Good luck, and thanks (in advance) for any answers you may offer to the other comments!

Noted• 10 years ago

It looks like it might've been more of a time delay issue as it seems like they've answered lots of stuff in the intervening hours. I'm not entirely sure how much answering questions late at night actually affects the audience. I do definitely hope that this post stays relevant because it's always great when the authors are around to answer questions on posts.

calgoo• 10 years ago

So the cause could be that there are a lot of depressed men that smoke cannabis to try to escape their depression instead of taking medication?

Maybe it shows a tendency for women to seek professional help where men do not? Especially in cases regarding depression or other "non-physical" illnesses?

p4wnc6• 10 years ago

Which could further be caused by social tendency to punish or ridicule men more than women for the choice to seek mental health help.

nashke13• 10 years ago

We adjusted all analyses for depression and other mental disorders.

nelxaretluval• 10 years ago

Here is the article: http://sci-hub.cc/10.1016/j.jad.2016.07.010

cik2e• 10 years ago

People are always looking for something to blame other than themselves. I'm sure there's at least one person in history that committed suicide solely due to weed consumption, but I would wager a guess that there haven't been more than 10.

lolc• 10 years ago

"suicide solely due to weed consumption" is not a useful metric.

dwaltrip• 10 years ago

People are always looking for something to blame other than themselves

More often, people are looking to blame the moral failures of others rather than acknowledging and addressing the complexity in life that results in unfortunate situations.

nashke13• 10 years ago

http://authors.elsevier.com/a/1TQFMbXYiRe8A This link should allow access to the full text for the next few weeks.

sandstrom• 10 years ago

Why only for a few weeks?

nashke13• 10 years ago

The publisher gives a link for sharing on social networks which works for 50 days, after that, it's paywalled.

byteface2• 10 years ago

Becuase it's illegal it causes people to be isolated and hide their behaviour for fear of persecution. This I imagine increases depression and anxiety.

I only smoke it to stop me from wanting to kill everybody else :)

nashke13• 10 years ago

Illegality is indeed one of the possible mediators of the association. A recent study has demonstrated decreased suicidality in states where cannabis was legalized

byteface2• 10 years ago

Ye I wasn't being facetious, more drawing from personal experience. Amazing to hear that it is actually correlated though. It does cause users stress from it being illegal and hard to get hold of. It means lying to friends, colleaugues and also maintaining unsavoury aquantances to be able to score etc. Many also genuinely smoke it to block out the bullsh!t of the world and reality which can make them feel helpless, angry or depressed.

dietrichepp• 10 years ago

So, since the authors are here, I have a couple questions.

How is this correlated with legalization? From an intuitive standpoint, it seems like someone who thinks they have "less to lose" would try illegal drugs which carry risk of incarceration, and that same kind of person might consider suicide.

To me, the fact that the effects happen in reverse order (whether suicidal ideation precedes cannabis use or vice versa) indicates that there could be some kind of common cause for the two effects, and that it just manifests differently for men and women. Unfortunately the full paper is paywalled.

nashke13• 10 years ago

Regarding legalization- we had no relevant data, so I can't say. The bidirectional association may indeed indicate a third cause, as discussed in the paper. I have added a link that should allow access to the full-text, let me know if it doesn't work for you.

youngButEager• 10 years ago

The very interesting thing is the degree of denial - of ANY negative side effect -- of using pot among any user. The vast majority of smokers would laugh it off if they were told "there's a notable correlation between suicide and pot use."

I smoked it for about 3 years as a teen, between 1976 and 1978. In those days about zero 'horticultural engineering' was done to the stuff -- the potency was low.

But the effects were dramatic. And negative.

Now? The stuff out there now simply MUST be highly 'engineered' after 40 years of time from when I used it recreationally. The odor is so overwhelming, so strong. The 'skunk' odor.

Back in my day the stuff consisted of stems, leaves, and a bud here and there. The buds had seeds. The seeds would sometimes explode like popcorn. All the pictures of the stuff I see nowadays -- it looks like all buds, and seedless.

In the 1970s, what made me stop it was this. Recall that if you're riding a bike on the right side of the road, cars pass by. Okay, imagine a huge truck passing you and suddenly it swerves to the right -- the huge truck almost hits you but you escape being hit/run over by steering your bike into a ditch.

You are quite shaken, lots of anxiety.

It's NORMAL to feel anxiety at a time like that.

The "I'm in trouble" indicator is -- feeling anxiety for no such reason. No imminent threat, no "I'm late for my final exam", etc. Just smoking the stuff and then feeling anxiety.

You know you're in trouble with that stuff when you cannot seem to shake off the anxiety.

Contrary to what 99.99% of pot users say, the drug -- like most drugs -- HAS SIDE EFFECTS.

I stopped because I felt anxiety and could not shake it.

Stopping the recreational use solved that problem.

Suicidal tendencies from pot use? I had friends back then going to psyche wards and rehab to try getting off that stuff. In the 1970s. When it was FAR LESS potent than today. I don't know if any of my friends/acquaintances back then ever got low enough to off themselves.

I never argue with anyone these days when they discuss how 'wonderful' pot is. My only wish would be -- remember, it's a drug and drugs have side effects.

You'll know you're in trouble when you have anxiety for no reason -- other than the pot use -- and you cannot shake it.

nashke13• 10 years ago

I personally am in favor of decriminalizing cannabis use, as well as other drugs. Unfortunately, the debate regarding legalization is very polarized, and tends to not be based on scientific findings. One side tends to demonize cannabis while the other dismisses any information regarding negative effects. I believe there are many reasons for legalization, but mainly as a method for harm reduction, not because cannabis is some sort of a wonder-drug. Here are some studies regarding long-term negative effects: http://www.nejm.org/doi/full/10.1056/NEJMra1402309

http://archpsyc.jamanetwork.com/article.aspx?articleid=24880...

Our findings in no way imply cannabis use causes suicidality. There are many other factors we couldn't analyze which could be the cause of this association. The reality is that these two behaviors (cannabis use and suicidality) are very complex, and this study is just one small step in the understanding of how these complex behaviors interact.

I believe proponents of cannabis legalization should look at all the data regarding long-term effects of cannabis with as little bias as possible - there are enough good reasons for legalization, it is dangerous to ignore scientific data regarding risks.

heisenbit• 10 years ago

Suicidal ideation is a serious problem for the person and also for anyone close to them who learns of it. Finding evidence that it is associated with cannabis use may be helpful in directing attention.

It is interesting that unlike ideation suicide attempts were not associated with cannabis use. How is this to be understood? Suicidal ideation is often a precursor to suicide attempts. Is the number of suicide attempts in cannabis users equivalent to the general population or to a population with the same level of suicidal ideation?

The association between cannabis use and suicidality among men and women

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