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

Background: Alcohol and cannabis use disorders are among the most prevalent substance use disorders worldwide. They frequently co-occur and show high comorbidity with psychological distress and suicidal ideation. Although these relationships are well established, their underlying structure remains unclear, as mental health is embedded within a complex network of individual, social and environmental factors. The aim of this study was to explore the interplay between alcohol and cannabis use disorders, psychological distress and suicidal ideation within the context of sociodemographic factors and social determinants of mental health using network analysis. Design: Cross-sectional secondary analysis of nationally representative survey data. Methods: Data were drawn from the 2021 National Survey on Drug Use and Health (N = 44,360). A mixed graphical model was estimated and partitioned into three communities (psychological, sociodemographic, social determinants of mental health). Bridge centrality and odds ratio analyses were conducted to identify key nodes and quantify associations. Results: Sociodemographic variables (e.g., age, sexual orientation) showed more direct connections to mental health outcomes, whereas social determinants (e.g., housing instability, employment) occupied more distal positions. Cannabis use disorder and psychological distress emerged as key bridging nodes linking sociodemographic and structural domains to broader mental health outcomes, including suicidal ideation and alcohol use disorder, suggesting pathways through which contextual risk translates into psychological vulnerability. Conclusions: Mental health outcomes are shaped by both individual and structural factors. Targeting key bridging nodes (e.g., cannabis use disorder and psychological distress) may improve prevention and intervention, alongside policies addressing adverse social conditions.