Elevated suicidal thoughts and behaviors among adults reporting symptoms of Cannabinoid Hyperemesis Syndrome: Results from a national survey of US adults

Background: Cannabinoid hyperemesis syndrome (CHS), a disorder characterized by severe nausea, vomiting, and abdominal pain among heavy cannabis users. We previously showed that CHS symptoms are associated with several behavioral and psychological characteristics linked to psychosocial impairment. We examined links between CHS symptoms and suicidal thoughts, behaviors, and proximal suicide risk factors. Methods: We used data from the National Firearms, Alcohol, Cannabis, and Suicide survey, a nationally representative survey of 7034 US adults. Items assessed symptoms of CHS and suicidal thoughts and behaviors, proximal suicide risk factors, and non-suicidal self-injury. Comparisons focused on: those with daily cannabis use and CHS symptoms (n = 191), those with daily cannabis use without CHS symptoms (n = 882), those with past year cannabis use but not daily use (n = 1288), and those without past year cannabis use (n = 4673). Results: Those with CHS symptoms reported the highest lifetime and past 12 months prevalence of suicidal thoughts and behaviors with nearly all being significantly higher than those with daily cannabis use without CHS symptoms. Those with CHS symptoms also reported higher mean-levels of proximal risk factors for suicide (i.e., perceived burdensomeness, thwarted belongingness, defeat, entrapment) than all the other groups. Conclusions: Those with CHS symptoms reported especially high rates of suicidal thoughts, behaviors, and attempts even when compared to others with daily cannabis use. People with CHS symptoms appear to be at high risk of suicide, possibly related to distress from their gastrointestinal symptoms and psychiatric, substance use, and medical comorbidities.