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Eur Psychiatry. 2018 Nov 14;56:8-13. doi: 10.1016/j.eurpsy.2018.10.006. [Epub ahead of print]

Cannabis use and suicide attempts among 86,254 adolescents aged 12-15 years from 21 low- and middle-income countries.

Author information

1
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. Electronic address: andre.carvalho@camh.ca.
2
South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK; Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, De Crespigny Park, London, AF, SE5 8, UK; Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, CM1 1SQ, UK.
3
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium.
4
Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
5
IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Victoria, Australia; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
6
NICM Health Research Institute, School of Science and Health, Western Sydney University, Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
7
Health Outcomes and Performance Evaluation (HOPE) Research Unit within the Social and Epidemiological Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry and Institute of Mental Health Policy Research, University of Toronto, Toronto, Ontario, Canada; Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Science (ICES), Toronto, ON, Canada.
8
Department of Psychiatry and MRC Unit on Risk and Resilience in Mental Disorders, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
9
Department of Psychiatry and Institute of Mental Health Policy Research, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.
10
Research and Development Unit, Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain.

Abstract

BACKGROUND:

Evidence suggests that cannabis use may be associated with suicidality in adolescence. Nevertheless, very few studies have assessed this association in low- and middle-income countries (LMICs). In this cross-sectional survey, we investigated the association of cannabis use and suicidal attempts in adolescents from 21 LMICs, adjusting for potential confounders.

METHOD:

Data from the Global school-based Student Health Survey was analyzed in 86,254 adolescents from 21 countries [mean (SD) age = 13.7 (0.9) years; 49.0% girls]. Suicide attempts during past year and cannabis during past month and lifetime were assessed. Multivariable logistic regression analyses were conducted.

RESULTS:

The overall prevalence of past 30-day cannabis use was 2.8% and the age-sex adjusted prevalence varied from 0.5% (Laos) to 37.6% (Samoa), while the overall prevalence of lifetime cannabis use was 3.9% (range 0.5%-44.9%). The overall prevalence of suicide attempts during the past year was 10.5%. Following multivariable adjustment to potential confounding variables, past 30-day cannabis use was significantly associated with suicide attempts (OR = 2.03; 95% CI: 1.42-2.91). Lifetime cannabis use was also independently associated with suicide attempts (OR = 2.30; 95% CI: 1.74-3.04).

CONCLUSION:

Our data indicate that cannabis use is associated with a greater likelihood for suicide attempts in adolescents living in LMICs. The causality of this association should be confirmed/refuted in prospective studies to further inform public health policies for suicide prevention in LMICs.

KEYWORDS:

Adolescence; Cannabis; Epidemiology; Psychiatry; Suicide; Survey

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