Cannabis Vaping Is Associated With Past 30-Day Suicide Attempts and Suicidal Ideation Among Adolescents in a Psychiatric Inpatient Setting

Objective

Increasing evidence links adolescent cannabis use (CU) to suicidal thoughts and behaviors. CU may be associated with both developing and self-medicating psychiatric symptoms. Although relatively new, cannabis vaping is increasing among adolescents. This chart review investigation evaluated the association between cannabis vaping and suicidal thoughts and behaviors among adolescents experiencing acute psychiatric symptomatology.

Method

The sample included 470 adolescents (ages 11-18; 64% biological female) admitted to an inpatient psychiatric hospital between 2021 and 2023. Adolescents completed an assessment battery measuring CU, psychiatric symptoms, and suicidal thoughts and behaviors. Separate regressions tested links between cannabis vaping and 2 outcomes—past 30-day suicide attempt and suicidal ideation (SI)—controlling for age and biological sex.

Results

In this sample, 26.8% reported past 30-day suicide attempts; 44.3% endorsed ever using cannabis, and 31.5% reported past 30-day CU. Of adolescents who ever used cannabis, 30.8% reported their most frequent method was vaping. Vaping as the most frequent cannabis method was associated with past 30-day suicide attempts (adjusted odds ratio = 2.38, p = .002) and greater SI (b = 8.71, p = .020). The association remained significant for suicide attempts, but only marginally significant for SI (p = .087), after controlling for depressive symptoms, impulse control, psychosocial impairment, and past 30-day substance use.

Conclusion

Vaping as the most frequent method of CU was significantly associated with suicide attempts and SI. Because data are cross-sectional, causality cannot be inferred. Nonetheless, cannabis vaping is important to assess among adolescents with acute psychiatric concerns because it may place them at higher risk for suicidal thoughts and attempts.

Plain language summary

Vaping can deliver higher potency cannabis than other routes of administration, and adolescents are increasingly vaping to consume cannabis. This chart review study of 470 adolescents admitted to an inpatient psychiatric hospital found that vaping is the most frequent way of using cannabis. Vaping was associated with a greater likelihood of a past 30-day suicide attempt and worse suicidal thoughts compared to adolescents who never used or who smoked cannabis as their primary method. Adults should be aware of how adolescents are consuming cannabis, especially if it is occurring in the context of psychiatric disorders.