Abstract

Background Adolescent marijuana use has risen sharply in the United States alongside increasing rates of psychological distress and suicide-related behaviors. Despite growing concern, few descriptive studies have mapped these relationships across use modalities and mental health indicators in nationally representative samples. Methods Using cross-sectional, survey-weighted data from 16,100 U.S. adolescents aged 12–17 years, this descriptive study estimated the prevalence of marijuana use, psychological distress, and suicide-related outcomes. Logistic regression models quantified associations between distress and specific marijuana modalities (smoking, vaping, dabbing, edibles, and others), adjusting for demographic and behavioral covariates. Results One in four adolescents (24.7%) reported marijuana use in the past month, with inhaled routes—smoking and vaping—being predominant. Psychological distress was reported by 38% of respondents and was strongly associated with marijuana use across nearly all modalities (aOR range: 1.55–2.73, all p < 0.001). Adolescents with distress had a 61% predicted probability of any marijuana use compared with 32% among those without distress. Suicide-related outcomes were markedly elevated among adolescents with both distress and marijuana use: suicidal ideation (23.1%) and suicide attempts (9.8%) versus 6.2% and 2.7% among non-distressed non-users. Frequent inhaled use correlated with higher respiratory complaints (aOR = 2.12, 95% CI 1.45–3.10) and co-use with nicotine and alcohol. Conclusion Adolescents experiencing psychological distress are substantially more likely to engage in frequent and inhaled marijuana use, which coincides with greater suicide risk, polysubstance involvement, and respiratory symptoms. Findings underscore the importance of early screening for distress, substance co-use, and suicide risk as part of integrated adolescent health strategies.