Cannabis use disorder, alcohol use disorder, and suicidal ideation within a social determinants of mental health framework: Insights from a network analysis.

Giugovaz A.; Marchetti I. · The British journal of clinical psychology · 2026

**Background & Methods** This cross-sectional secondary analysis examined data from 44,360 participants in the 2021 National Survey on Drug Use and Health to explore relationships between cannabis use disorder (CUD), alcohol use disorder (AUD), psychological distress, and suicidal ideation using network analysis. A mixed graphical model was employed and partitioned into three communities: psychological factors, sociodemographic variables, and social determinants of mental health (SDMH). **Key Findings** - Cannabis use disorder and psychological distress emerged as critical bridging nodes connecting sociodemographic and structural domains to suicidal ideation and alcohol use disorder, suggesting they represent key pathways translating contextual risk into psychological vulnerability. - Sociodemographic variables (age, sexual orientation) demonstrated more direct connections to mental health outcomes, while social determinants (housing instability, employment) occupied more distal network positions, indicating distinct mechanistic roles in the network. - Bridge centrality and odds ratio analyses identified that targeting interventions toward key bridging nodes—particularly CUD and psychological distress—alongside policies addressing adverse social conditions may optimize prevention and intervention effectiveness. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This study provides moderate-quality evidence with several important limitations. As a cross-sectional secondary analysis, it cannot establish causality or temporal relationships between variables. The use of nationally representative survey data (NSDUH) is a strength, providing generalizable insights to the U.S. population; however, reliance on self-reported substance use and mental health outcomes may introduce recall bias and underestimation of sensitive constructs. Network analysis is an innovative methodological approach that reveals complex interconnections but does not directly measure causal pathways. The study's structural framework helpfully distinguishes between proximal and distal factors but may oversimplify the bidirectional influences between constructs. Findings suggest theoretical pathways requiring validation through longitudinal studies with objective measures and experimental designs to establish causality. Despite limitations, this research advances understanding of how individual psychological factors and structural inequities interact to influence mental health outcomes.

More recent cannabis research