Cannabis Use, Cognitive Processing, and Suicide Risk in Young Adults

Cannabis use is a rapidly growing public health concern among adolescents and young adults (AYA), a population for whom suicide remains the second leading cause of death in the United States and globally. Numerous studies indicate that AYA cannabis users face a two-fold or greater increased risk of suicidal ideation and attempts, with evidence suggesting a dose-dependent relationship. However, the mechanisms linking cannabis use to elevated suicide risk are not well-understood. This proposal seeks to address this critical gap by investigating the role of cognitive control, specifically hot cognitive control, or the regulation of cognitive processes in emotionally charged situations in mediating the relationship between cannabis use and suicidality in AYA. Prior studies show that cannabis use disrupts neural circuits responsible for emotion regulation, decision-making, and impulse control, which may in turn increase vulnerability to suicidal thoughts and behaviors.

The project comprises three specific aims. Aim 1 will establish a cohort of 200 young adult cannabis users, recruited from Penn outpatient psychiatry clinics, to directly assess how cannabis use, cognitive control (measured with the Penn Computerized Neurocognitive Battery), and suicidality (assessed via clinical interview and Columbia-Suicide Severity Rating Scale) are interrelated. Aim 2 leverages the power of the Adolescent Brain Cognitive Development Study- following over 10,000 youth longitudinally- to test whether cognitive control performance at age 16 (via NIH Toolbox tasks such as Emotional Stroop, and Flanker) mediates the relationship between mid-adolescent cannabis use (ages 13-15) and subsequent suicidality (ages 17-18). Prospective mediation models will be used to clarify this mechanistic pathway. Aim 3 implements a participatory framework by establishing a Youth Advisory Board of cannabis-using young adults to inform study design, interpretation, and dissemination, ensuring that lived experiences, motivations, and cultural context are incorporated into the research process.

Innovation and impact stem from this project’s integration of multimodal neurocognitive testing, longitudinal data, and participatory research methods, as well as its focus on high-risk, diverse populations. By clarifying how cannabis use and cognitive deficits interact to raise suicide risk, this research will guide tailored prevention strategies and screening practices for clinicians and inform policies affecting vulnerable AYA. The ultimate long-term goal is to inform interventions that lower suicide risk among cannabis-using AYA, advancing health equity and suicide prevention nationwide.

Jessica Stubbing, D. Clinical Psych Cambridge Health Alliance, Harvard Medical School