Exploring the association between psychological distress and cannabis edible use among u.s. adults: a descriptive epidemiologic study

Ul Haq Zeeshan; Md Rakibul Hasan

doi:10.22376/ijpbs.v16i4.111

Authors

Zeeshan Ul Haq Department of Pathology and Laboratory Medicine, University of Louisville, United States
Md Rakibul Hasan Department of Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK

Abstract

Background: Cannabis edibles represent a rapidly expanding segment of cannabis consumption in the United States, yet their association with psychological distress remains poorly understood. This descriptive cross-sectional study aimed to assess whether adults experiencing past-month psychological distress were more likely to report cannabis edible use compared with those without distress, providing evidence to inform mental health–focused prevention strategies.

Methods: Data were drawn from the 2023 National Survey on Drug Use and Health (NSDUH) and included adults aged 18 years and older. Past-month cannabis edible use served as the dependent variable, and past-month psychological distress was the primary predictor. Weighted prevalence estimates and multivariable survey-weighted logistic regression analyses were conducted, adjusting for demographic and behavioral covariates.

Results: The prevalence of edible use was substantially higher among adults with psychological distress (13.5%, 95% CI: 12.0–15.0) compared with those without distress (5.6%, 95% CI: 5.2–5.9). In adjusted analyses, psychological distress remained significantly associated with increased odds of edible use (AOR = 1.44, 95% CI: 1.21–1.71, p < 0.001). Edible users were also more likely to engage in concurrent alcohol and tobacco use and report symptoms of depression, anxiety, or suicidal ideation, suggesting overlapping behavioral risk patterns.

Conclusion: Psychological distress was independently linked to greater cannabis edible use among U.S. adults. Future research should explore causal pathways and examine how product potency, accessibility, and stress-related coping behaviors contribute to this relationship to guide public health interventions and harm-reduction efforts.

Keywords:

Psychological distress, cannabis edibles, substance use, mental health

DOI

https://doi.org/10.22376/ijpbs.v16i4.111

References

1. Substance Abuse and Mental Health Services Administration (SAMHSA). 2023 National Survey on Drug Use and Health (NSDUH): Public Use File Documentation. Rockville (MD): SAMHSA; 2024.

2. Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand S-L, et al. Short screening scales to monitor population prevalences and trends in nonspecific psychological distress. Psychol Med. 2002;32(6):959–976.

3. Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, et al. Prevalence of marijuana use disorders in the United States between 2001–2002 and 2012–2013. JAMA Psychiatry. 2015;72(12):1235–1242.

4. Barrus DG, Capogrossi KL, Coberly KR, et al. Tasty treats and tricky trips: analysis of Δ9-THC levels in edible cannabis products and implications for consumers. Drug Alcohol Depend.2016;163:107–115.

5. Vandrey R, Herrmann ES, Mitchell JM, Bigelow GE, Flegel R, LoDico C, et al. Pharmacokinetic profile of oral cannabis in humans: blood and oral fluid disposition and relation to pharmacodynamic outcomes. J Anal Toxicol. 2017;41(2):83–89.

6. Budney AJ, Sofis MJ, Borodovsky JT. An update on cannabis use disorder with a focus on adolescents. Curr Opin Psychol.2022;46:101314.

7. Hasan, M. R. (2024a). Exploring the Relationship Between Opioid Use Disorder and Major Depressive Disorder: A Case Study from Kentucky of United States. Journal of Current and Advance Medical Research, 11(1), 50–5.

8. Volkow ND, Han B, Compton WM, McCance-Katz EF. Self-reported medical and nonmedical cannabis use among U.S. adults, 2015–2018. JAMA. 2019;322(2):167–169.

9. Cuttler C, Mischley LK, Sexton M. Sex differences in cannabis use and effects: a cross-sectional survey of cannabis users. Cannabis Cannabinoid Res. 2016;1(1):166–175.

10. McCabe SE, West BT, Veliz P, Boyd CJ. Social determinants of cannabis use disorder: the role of gender, race/ethnicity, and sexual identity. Drug Alcohol Depend.2022;231:109268.

11. Hasan MR, Haq ZU, Muna MA. The Hidden Continuum of Risk: Behavioral and Mental Health Pathways from Tobacco Consumption to Illicit Drug Use Among University Students in Bangladesh. East Afr Scholars J Med Sci. 2025;8(11):380–392.https://doi.org/10.36349/easms.2025.v08i11.002.

12. Hasan MR. Assessing the psychosocial determinants of mental health decline among bangladeshi university students during the COVID-19 pandemic: A rapid systematic review. Asian Journal of Public Health and Nursing. 2024;1(3).

13. Krystkiewicz, M., & Soyka, M. (2025). Suicide Risk in Alcohol Use Disorders: Literature Review and Study Protocol with Preliminary Data for a Study in Treatment-Seeking Inpatients. Healthcare (Basel, Switzerland), 13(5), 535. https://doi.org/10.3390/healthcare13050535.

14. Zeeshan U.H., Hasan M.R., Halim F.B., Ayyoubi M.T. Patterns of Marijuana Use, Psychological Distress, and Suicide Risk among U.S. Adolescents: A Descriptive Cross-Sectional Analysis. American Journal of Public Health Research. 2025; 13(6):263-274.doi: 10.12691/ajphr-13-6-2.

15. Rizk, M. M., Herzog, S., Dugad, S., & Stanley, B. (2021). Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders. Current addiction reports, 8(2), 194–207. https://doi.org/10.1007/s40429-021-00361-z

16. Kabir, R., Hasan, M. R., & Arafat, S. M. Y. (2023). Epidemiology of suicide and data quality in Bangladesh. In S. M. Y. Arafat & M. M. Khan (Eds.), Suicide in Bangladesh: Epidemiology, risk factors, and prevention (pp. 1–15). Springer Nature Switzerland AG. https://doi.org/10.1007/978-981-99-0289-7_1.

17. Hasan, M. R. (2024). Mental Health Challenges in Bangladesh Based on the Integrated Examination of Illicit Drug Use, Substance Abuse, Tobacco Consumption, and Escalating Suicidal Tendencies: A Comprehensive Review. Bangladesh Journal of Infectious Diseases, 11(1), 65–70. https://doi.org/10.3329/bjid.v11i1.73795.

18. Dvorak, R. D., Lamis, D. A., & Malone, P. S. (2013). Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students. Journal of affective disorders, 149(1-3), 326–334. https://doi.org/10.1016/j.jad.2013.01.046

19. Hasan MR, Mason K, Egbury G, Brown EL, Rogers W, Harrison A, Muna MA, Hassan S, Rahman S. Exploring meta-cognitive resilience and psycho-social well-being among Bangladeshi university students during COVID-19: a mixed-methods primary study of adaptive cognitive strategies. Journal of Mental Health and Resilience. 2025.

20. Vinnakota D, Rahman QM, Sathian B, Bai AC, Deividas N, Pellissery MV, Kareem SK, Hasan MR, Parsa AD, Kabir R. Exploring UK Knife crime and its associated factors: A content analysis of online newspapers. Nepal journal of epidemiology. 2022 Dec 31;12(4):1242.

21. Kabir R, Hasan MR, Arafat SY. Epidemiologie des selbstmords und datenqualität in bangladesch. InSelbstmord in Bangladesch: Epidemiologie, Risikofaktoren und Prävention 2024 Feb 20 (pp. 1-17). Singapore: Springer Nature Singapore.

22. Hasan, M. R., W. Parker, F., Harrison, A., & Rahman, S. (2025). Alcohol-Induced Microbial Dysbiosis and Psychosocial Stressors Undermining PrEP Adherence: A Mixed Methods Analysis in HIV-Negative African American Adults. American Journal of Human Psychology, 3(1), 161–182. https://doi.org/10.54536/ajhp.v3i1.5715.

23. Weinberger AH, Platt J, Copeland J, Goodwin RD. Cannabis use is associated with increased risk of cigarette smoking initiation and nicotine dependence among U.S. adults. Drug Alcohol Depend.2018;191:116–123.

24. Hill KP, George TP. Understanding cannabis-related disorders: insights from epidemiology, neurobiology, and treatment. Psychiatr Clin North Am. 2020;43(2):305–319.

25. Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J. The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies. Psychol Med. 2014;44(4):797–810.

26. Hasan MR, Mason K, Brown EL, Rahman S, Rogers W, Muna MA, Rabu KF, Hassan S. Exploring the transition pathways from tobacco to illicit drug use: a mental health perspective among Bangladeshi university students. Int Res J Mod Eng Technol Sci. 2025 Jan;7(1):1–11. doi:10.56726/IRJMETS66668.

27. Kabir R, Bai AC, Syed HZ, Hasan MR, Vinnakota D, Kar SK, Singh R, Sathian B, Arafat SY. The effect of COVID-19 on the mental health of the people in the Indian subcontinent: a scoping review. Nepal Journal of Epidemiology. 2023 Aug 31;13(2):1268.

28. Tejedor-Cabrera, C., & Cauli, O. (2019). Alcohol and Cannabis Intake in Nursing Students. Medicina (Kaunas, Lithuania), 55(10), 628. https://doi.org/10.3390/medicina55100628

29. Hasan MR, Rogers W, Egbury G, Muna MA, Pendlebury S. Exploring Major Mental Health Challenges and Social Stigma Faced by Healthcare Professionals in Clinics and Hospital Facilities in South Asia: A Comprehensive Content Analysis. Int J Adv Multidisc Res Stud. 2025;5(1):274-84.

30. Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379(9810):55–70.

31. Hasan MR, Yusuf MA. Microbial Dysbiosis in Diabetic Children with Enteric Hepatitis: The Global Phenomenon and Bangladesh's Contextual Significance. Bangladesh Journal of Infectious Diseases. 2023 Dec 31;10(2):56-8.

32. Thu MS, Campbell BJ, Hirankarn N, Nopsopon T, Ondee T, Hall SR, Jagota A, Fothergill JL, Pongpirul K. Cannabis and cannabinoid-microbiome interactions in varied clinical contexts: A comprehensive systematic review. Biomedicine & Pharmacotherapy. 2025 Jan 1;182:117764.

33. Hasan, M.R., Rogers, W., Rahman, S., Muna, M.A., Rabu, K.F., & Hassan, S. A comprehensive review on antimicrobial resistance in uropathogens isolated from ICU patients in the south-east Asian region. International Journal of Science and Research Archive, 2025, 14(02), 527-542.Article DOI: https://doi.org/10.30574/ijsra.2025.14.2.0340.

34. Thu MS, Ondee T, Hall SR, Nopsopon T, Jagota A, Hirankarn N, Pongpirul K. Cannabis-Microbiome Interactions in Varied Clinical Contexts: A Comprehensive Systematic Review.

35. Hasan MR. Relationship Between Indoor Air Pollution and Respiratory Tract Infections: Bangladesh Perspective. Bangladesh Journal of Infectious Diseases. 2022;9(2):38-9.

36. Milad, N., Fantauzzi, M. F., McGrath, J. J. C., Cass, S. P., Thayaparan, D., Wang, P., Afkhami, S., Aguiar, J. A., Ask, K., Doxey, A. C., Stampfli, M. R., & Hirota, J. A. (2023). Cannabis smoke suppresses antiviral immune responses to influenza A in mice. ERJ open research, 9(6), 00219-2023. https://doi.org/10.1183/23120541.00219-2023

37. Hasan MR, Yusuf MA, Moureen A, Ahsan S, Egbury G. Epidemiology, Trends, Risk Factors and Clinical Outcomes of Dengue Fever among Adolescents and Young Adults in Dhaka City of Bangladesh. Bangladesh Journal of Infectious Diseases. 2025 Oct 28;12(1):3-17.

38. Tharmalingam, J., Gangadaran, P., Rajendran, R. L., & Ahn, B. C. (2024). Impact of Alcohol on Inflammation, Immunity, Infections, and Extracellular Vesicles in Pathogenesis. Cureus, 16(3), e56923. https://doi.org/10.7759/cureus.56923

39. Hasan MR, Yusuf MA, Rogers WT, Egbury G, Muna MA. Global Patterns and Emerging Challenges of Human Monkeypox Virus: An In-Depth Narrative Review and Analysis. Bangladesh Journal of Medical Microbiology. 2024;18(2):120-30.

40. Maggirwar, S. B., & Khalsa, J. H. (2021). The Link between Cannabis Use, Immune System, and Viral Infections. Viruses, 13(6), 1099. https://doi.org/10.3390/v13061099

41. Hasan MR, Yusuf MA, Rogers W, Muna MA. Exploring Dengue Transmission Trends, Public Health Challenges, and Intervention Efficacy Among Adolescents in Dhaka City: An Observational Study. Asian Journal of Public Health and Nursing. 2025 Apr 1;2(1).

42. Frisher M, White S, Varbiro G, Voisey C, Perumal D, Crome I, Khideja N, Bashford J. The role of cannabis and cannabinoids in diabetes. The British Journal of Diabetes & Vascular Disease. 2010 Nov;10(6):267-73.

43. Hasan MR. Understanding diabetes care barriers through community voices: A brief qualitative report from Jefferson County, Kentucky. Asian Journal of Public Health and Nursing. 2025 Aug 1;2(2):1-7.

44. Hayatbakhsh MR, O'Callaghan MJ, Mamun AA, Williams GM, Clavarino A, Najman JM. Cannabis use and obesity and young adults. The American journal of drug and alcohol abuse. 2010 Nov 1;36(6):350-6.

45. Hasan MR, Harrison A. Development and Preliminary Evaluation of a Behavioral Lifestyle Assessment Tool: A Methodological Case Study with Graduate-Level Women. ASIDE Health Sciences. 2025 Jun 10;1(1):1-1.

46. Bonn-Miller MO, Boden MT, Bucossi MM, Babson KA. Self-reported cannabis use characteristics, patterns, and helpfulness among medical cannabis users. Am J Drug Alcohol Abuse. 2014;40(1):23–30.

47. Hasan MR, Mclessey L, Haque A, Muna MA, Haq ZU. A Multilevel Perspective on PrEP Adherence in HIV Prevention: An Integrative Review Guided by the Socioecological Model. British Journal of Nursing Studies. 2025 Oct 7;5(3):23-43.

48. Kabir R, Vinnakota D, Dehghani L, Sathian B, Padhi BK, Hasan MR. HIV and Violence among Female Sex Workers in India: A Scoping. Women's Health Problems: A Global Perspective. 2024 Sep 11;3.

49. Tyurina A, Krupitsky E, Cheng DM, Coleman SM, Walley AY, Bridden C, Gnatienko N, Zvartau E, Raj A, Samet JH. Is cannabis use associated with HIV drug and sex risk behaviors among Russian HIV-infected risky drinkers?. Drug and alcohol dependence. 2013 Sep 1;132(1-2):74-80.

50. Behavioral and Psychosocial Determinants of Long-Acting Pre-Exposure Prophylaxis (PrEP) Continuity: A Descriptive Study from an Urban U.S. Setting. (2025). European Journal of Medical and Health Sciences, 7(6), 37-44. https://doi.org/10.24018/ejmed.2025.7.6.2441

51. Han BH, Palamar JJ. Trends in cannabis use among older adults in the United States, 2015–2018. JAMA Intern Med. 2020;180(4):609–611.

52. Myran, D. T., Pugliese, M., McDonald, A. J., Xiao, J., Fischer, B., Finkelstein, Y., Tanuseputro, P., Firth, J., Pakpour, A., Hsu, C. W., Chang, W. C., &Solmi, M. (2025). Cannabis Use Disorder Emergency Department Visits and Hospitalizations and 5-Year Mortality. JAMA network open, 8(2), e2457852. https://doi.org/10.1001/jamanetworkopen.2024.57852

53. Fordjour E, Manful CF, Khalsamehta TS, Armah A, Cheema M, Thomas R. Cannabis‐infused foods: phytonutrients, health, and safe product innovations. Comprehensive Reviews in Food Science and Food Safety. 2024 Sep;23(5):e70021.

54. Hinckley, J. D., Mikulich-Gilbertson, S. K., He, J. P., Bhatia, D., Ellingson, J. M., Nguyenkhoa Vu, B., Ries Merikangas, K., & Sakai, J. T. (2023). Cannabis Use Is Associated With Depression Severity and Suicidality in the National Comorbidity Survey-Adolescent Supplement. JAACAP open, 1(1), 24–35. https://doi.org/10.1016/j.jaacop.2023.02.002.