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. Author manuscript; available in PMC: 2021 Aug 1.
Published in final edited form as: J Sleep Res. 2020 Jan 29;29(4):e12985. doi: 10.1111/jsr.12985

Negative mood as a mediator of the association between insomnia severity and marijuana problems in college students.

Ali M Yurasek 1, Mary Beth Miller 2, Ricarda Pritschmann 1, Ashley F Curtis 2, Christina McCrae 2
PMCID: PMC7387201  NIHMSID: NIHMS1597249  PMID: 31997499

Abstract

Insomnia symptoms have been linked to problematic marijuana use among young adults, but the mechanism underlying this association and whether sex differences exist, remains unclear. Using cross-sectional data, this study examined negative mood as a mediator of the association between insomnia and marijuana problems among college student men and women. Undergraduate students (N=267; 61% female) reporting past month marijuana use completed an online survey assessing insomnia symptoms, negative mood and marijuana problems. Controlling for relevant covariates, negative mood was examined as a mediator of the association between insomnia and marijuana problems using bootstrapped significance tests for indirect effects (n-boot=1,000). Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems. In conclusion, insomnia symptoms are associated with more negative mood among college students who use marijuana, and this effect on negative mood accounts for a large part of the association of insomnia symptoms on marijuana-related problems. Research is needed to determine if these associations are maintained prospectively.

Keywords: Cannabis, Sleep Problems, Depression, Anxiety, Mediation, College Students

Introduction

Young adults attending college are at higher risk of initiating marijuana use than their non-attending peers (Miech et al., 2017). In fact, marijuana is the most commonly used substance among college students other than alcohol, with 48.5% reporting lifetime marijuana use (Johnston et al., 2015). This is concerning because marijuana use is associated with a variety of negative consequences that inhibit academic performance, including cognitive impairment, physical harm, and poor psychological functioning (Arria et al., 2015; Buckner et al., 2010; (Suerken et al., 2016). This may explain, in part, why marijuana use during college is associated with increased drop out, lower GPA, less time studying, and poorer performance on exams and tests (Arria et al., 2015; Suerken et al., 2016).

Sleep problems are also common in college students (Taylor et al., 2011), with approximately 62% of students endorsing clinically relevant sleep difficulties (Becker et al., 2018) and 70% of students indicating at least mild insomnia severity (Gress-Smith et al., 2015). Poor sleep quality has been linked to marijuana use and associated problems among adolescents (Mike et al., 2016) and young adults (Wong et al., 2019), both cross-sectionally and longitudinally. In fact, individuals often report using marijuana to assist with sleep (Walsh et al., 2013), and sleep difficulties occurring both before and after marijuana cessation is associated with relapse and treatment failure (Bolla et al., 2008; Budney et al., 2004).

In addition to sleep problems, stressors commonly associated with college life (e.g., academics, finances) are linked to stress and negative mood among college students (American College Health Associatoin, 2013; Beiter et al., 2015),. For example, 32-47% of students exhibit mental health symptoms, such as depression and anxiety (Acharya et al., 2018; Eisenberg et al., 2013). Notably, insomnia symptoms are also associated with increased risk of other mental health symptoms (Biddle et al., 2018).

Both sleep problems and negative mood have been linked to marijuana use and problems in young adults (Lee et al., 2009; Walters et al., 2018). For example, college students report using marijuana to cope with negative affect and manage sleep difficulties. After controlling for overall marijuana use frequency, Lee and colleagues (2009) found that students who reported using marijuana for coping and sleep-related reasons experienced more consequences related to their marijuana use than students using for other reasons. Likewise, in medical marijuana patients endorsing Post-Traumatic Stress Disorder (PTSD), coping with mood-related difficulties and improving sleep appeared to be the primary motivations for using marijuana (Bonn-Miller et al., 2014).

Despite their independent associations with marijuana problems, the relationship and interplay between poor sleep and mood on consequences of marijuana use is unclear. For example, young adult daily marijuana users report more sleep disturbance and insomnia severity than their non-daily-using peers; however, after accounting for negative mood symptoms (e.g., depression and anxiety), this relationship is no longer significant (Conroy et al., 2016), suggesting that negative mood may play a role in the association between insomnia symptoms and marijuana use. Similarly, among adults who use marijuana medically (i.e., with physician recommendation), high levels of depression are related to problematic marijuana use, but only in the context of good perceived sleep quality (Babson et al., 2013). While these findings are counterintuitive, almost half of this sample was recommended marijuana for insomnia; thus, the authors speculate that those with negative mood symptoms might use marijuana (and experience higher rates of marijuana problems) because of the perceived benefits of marijuana on sleep quality (Babson et al., 2013). This implies that insomnia symptoms contribute to negative mood, which in turn may motivate marijuana use and increase risk for marijuana-related harm.

Despite these findings, the unique relationship between insomnia, mood, and marijuana use and problems in college students remains unclear. With some states recommending the use of medicinal marijuana for sleep related difficulties (National Academies of Sciences, Engineering and Medicine, 2017), the influence of these variables on the experience of problems related to marijuana use is important to understand and disentangle. Hence, the purpose of the current study was to examine the associations among insomnia severity, negative mood, and marijuana related problems utilizing a cross-sectional dataset. Given the association between insomnia symptoms and negative mood (Babson et al., 2017; Biddle et al., 2018) and, in turn, the association between negative mood and marijuana-related problems (Lee et al., 2009), we hypothesized that negative mood would help explain (mediate) the association between insomnia symptoms and marijuana-related problems among young adults attending college. Moreover, because women tend to report more insomnia (Auer et al., 2018) and negative mood (Bromet et al., 2011) and may differ from men in the extent to which coping motives relate to marijuana use and/or problems (Ali et al., 2015; Bujarski et al., 2012), we hypothesized that sex would moderate the indirect effect of insomnia symptoms on marijuana problems through negative mood, consistent with a moderated mediation model.

Method

Participants and Procedures

Eligible participants were 267 undergraduate students from a large southeastern university (61% female, 67% white, ages 18-25 years) who reported using marijuana at least three times in the past month. Students were recruited using email solicitation, flyers, and online advertisements. Interested participants contacted the researchers via email or phone and were given the link to the screening survey. Eligible participants provided informed consent and completed an online assessment that took approximately 60 minutes to complete. Participants were compensated with a $20 Visa™ card. All procedures were approved by the University of Florida Institutional Review Board.

Measures

Demographic information.

Participants provided information regarding their biological sex, age, and race/ethnicity.

Marijuana Use.

Participants reported their frequency of marijuana use with a single item asking, “In the past month, on how many days did you use marijuana?”

Marijuana-related problems.

Participants were asked to report how many times in the past 30 days they experienced any of 26 consequences (e.g., having low motivation or problems following through on things) while using marijuana or as a result of their marijuana use (Lee et al., in prep.; Patrick et al., 2018). Responses ranged from 0 (0 times) to 4 (more than 10 times) and were summed to create one consequence score.1

Mood related symptoms.

Negative mood was assessed using the Depression, Anxiety, and Stress Scale (DASS-21; Parkitny & McAuley, 2010). The DASS-21 consists of 7 items and 3 subscales measuring past week symptoms of depression, anxiety and stress. Responses ranged on a 4-point Likert scale from 0 (Did not apply to me at all) to 3 (Applied to me very much, or most of the time). The DASS is a reliable and valid measure of depression, anxiety, and stress in college students (Mahmoud et al., 2010). Internal consistency (Cronbach’s alpha) for this scale and subscales (depression, anxiety, stress) in this sample was .94, .91, .82, and .84 respectively.

Insomnia severity.

Symptoms of insomnia were measured using the 7-item Insomnia Severity Index (ISI; Bastien et al., 2001), which assesses difficulties in sleep onset, maintenance, daytime functioning, sleep dissatisfaction and other distress associated with sleep problems in the past 2 weeks. Response options ranged from 0 (none) to 4 (very severe) and were summed to create a continuous variable with higher scores indicative of more severe sleep difficulties. Internal consistency (Cronbach’s alpha) for the ISI in this sample was .87. For descriptive purposes, a cut-off score ≥10 was used to characterize participants as screening positive versus negative for insomnia (Morin et al., 2011).

Data Screening and Analysis

Analyses were conducted in IBM SPSS Statistics 25. Data were screened for missing values, normality, and selection bias prior to analysis. Of the 310 participants, 267 provided data on the primary outcome variable (marijuana problems) and were included in the data analytic sample (See Table 1 for sample descriptives). Skewness and kurtosis estimates for all variables were within the acceptable range (Tabachnick & Fidell, 2013). There were no significant differences between participants included versus excluded from analyses in terms of age, sex, frequency of marijuana use, insomnia severity, or negative mood. Zero-order correlations between study variables are presented in Table 2. Moderated mediation was examined using PROCESS Model 59, which generates bootstrapped significance tests (nboot=5,000) to estimate indirect effects while simultaneously modeling conditional associations on all pathways (see Figure 1; MacKinnon et al., 2004). In the hypothesized model, negative mood was examined as a mediator of the concurrent association between insomnia severity and marijuana problems; and sex was examined as a moderator of the all paths in this model (e.g., direct and indirect associations between insomnia and marijuana problems were examined separately for men and women). Because we were unable to account for the temporal precedence of the independent and mediator variables in these cross-sectional data, we then altered the temporal ordering of variables, such that (a) insomnia severity was also modeled as a mediator of the association between negative mood and marijuana problems and (b) negative mood was modeled as the mediator of the association between marijuana problems and insomnia severity. All analyses controlled for age and frequency of marijuana use.2 In all models, the indirect path (mediated effect) was considered significant if the 95% confidence interval did not include zero.

Table 1.

Sample demographics (N = 267).

Variable n (%)
Male birth sex 102 (38%)
Positive insomnia screen 113 (42%)
Ethnicity
 White/Caucasian 179 (67%)
 Black/African American 15 (5.6%)
 Asian 44 (16.5%)
 Hispanic/Latino 67 (25%)
 Other 10 (3.7%)
M (SD)
Age 19.9 (1.4)
Frequency of marijuana use 10.3 (7.9)
Negative mood (DASS) 31.2 (26.3)
DASS-Depression 10.1 (10.6)
DASS-Anxiety 8.7 (8.7)
DASS-Stress 12.3 (9.6)
Insomnia severity 8.9 (5.8)
Marijuana problems 18.0 (14.7)
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Note. DASS = Depression Anxiety Stress Scale.

Table 2.

Zero-order correlations between study variables (N = 267).

1. 2. 3. 4. 5. 6. 7. 8. 9.
1. Male sex --
2. Age 0.09 --
3. Frequency of marijuana use −0.05 0.22*** --
4. Negative mood (DASS) −0.10 −0.01 −0.02 --
5. DASS-Depression −0.05 0.03 −0.002 0.90*** --
6. DASS-Anxiety −0.09 −0.01 −0.01 0.91*** 0.69*** --
7. DASS-Stress −0.13* −0.06 −0.04 0.92*** 0.72*** 0.81*** --
8. Insomnia severity −0.12* 0.02 0.05 0.50*** 0.48*** 0.41*** 0.47*** --
9. Marijuana problems 0.06 0.03 0.12* 0.54*** 0.45*** 0.54*** 0.50*** 0.33*** --
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*

Note. p < .05.

**

p < .01.

***

p < .001.

DASS = Depression Anxiety Stress Scale.

Figure 1.

Figure 1

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Conceptual diagram for moderated mediation models. Inconsistent associations are depicted in grey. Non-significant associations are depicted by dashed lines.

Results

Hypothesized Model: Insomnia > Mood > Marijuana Problems

First, we examined negative mood as a mediator of the association between insomnia severity and marijuana problems (see Figure 1 and Table 3). There was a positive association between insomnia severity and negative mood (a-path effect = 2.43, SE = 0.30, p < .001; 95% CI = 1.85, 3.01), and sex did not significantly moderate this association (X*W effect = −0.60, SE = 0.52, p = .25; 95% CI = −1.62, 0.42). There was also a positive association between negative mood and marijuana problems (b-path effect = 0.22, SE = 0.04, p < .001; 95% CI = 0.14, 0.30); however, sex significantly moderated this association (M*W effect = 0.19, SE = 0.07, p = .01; 95% CI = 0.06, 0.32). Follow-up tests of simple slopes indicated that negative mood was associated more strongly with marijuana problems among men (effect = 0.40, SE = 0.05, p < .001; 95% CI = 0.30, 0.51) than women (effect = 0.22, SE = 0.04, p < .001; 95% CI = 0.14, 0.30). The direct and indirect association between insomnia severity and marijuana problems also differed as a function of sex. Specifically, insomnia symptoms were associated directly with marijuana problems among women (effect = 0.42, SE = 0.19, p = .02; 95% CI = 0.06, 0.79), but not men (effect = −0.11, Se = 0.24, p = .66; 95% CI = −0.59, 0.37). In line with this finding, negative mood helped explain more of the association between insomnia severity and marijuana problems among men (effect = 0.74, SE = 0.29; 95% CI = 0.30, 1.29) than women (effect = 0.53, SE = 0.15; 95% CI = 0.27, 0.84).

Table 3.

Statistics for hypothesized and alternative mediation models (N=267).

Insomnia > Mood > MJ problems Coeff. BSE LLCI ULCI
Constant 5.62 10.86 −15.76 27.00
Age −0.12 0.55 −1.20 0.97
MJ frequency 0.27 0.10 0.08 0.46
Male sex 2.77 2.89 −2.92 8.46
Negative mood (b-path) 0.22 0.04 0.14 0.30
Negative mood by sex (M*W) 0.19 0.07 0.06 0.32
Insomnia severity by sex (X*W) −0.53 0.31 −1.13 0.07
Insomnia direct effect (c’-path) --- --- --- ---
 Men −0.11 0.24 −0.59 0.37
 Women 0.42 0.19 0.06 0.79
Insomnia indirect (mediated) effect --- --- --- ---
 Men 0.74 0.25 0.30 1.29
 Women 0.53 0.15 0.27 0.84
MJ problems > Mood > Insomnia Coeff BSE LLCI ULCI
Constant 2.12 4.56 −6.85 11.09
Age 0.12 0.23 −0.33 0.57
Marijuana frequency 0.02 0.04 −0.06 0.10
Male sex 0.98 1.06 −1.12 3.06
Negative mood (b-path) 0.10 0.02 0.07 0.13
Negative mood by sex (M*W) −0.01 0.03 −0.07 0.05
MJ problems by sex (X*W) −0.10 0.05 −0.20 0.004
MJ problems direct effect (c’-path)
 Men −0.01 0.04 −0.09 0.06
 Women 0.08 0.03 0.01 0.15
MJ problems indirect (mediated) effect
 Men 0.08 0.03 0.03 0.14
 Women 0.11 0.03 0.06 0.16
Mood > Insomnia > MJ problems Coeff BSE LLCI ULCI
Constant 5.62 10.86 −15.76 27.00
Age −0.12 0.55 −1.20 0.97
Marijuana frequency 0.27 0.10 0.08 0.46
Male sex 2.77 2.89 −2.92 8.46
Insomnia severity (b-path) 0.42 0.19 0.06 0.79
Insomnia severity by sex (M*W) −0.53 0.31 −1.13 0.07
Negative mood by sex (X*W) 0.19 0.07 0.06 0.32
Negative mood direct effect (c’-path)
 Men 0.40 0.05 0.30 0.51
 Women 0.22 0.04 0.14 0.30
Negative mood indirect (mediated) effect
 Men −0.01 0.03 −0.07 0.06
 Women 0.05 0.02 0.01 0.09
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Note. Bold font indicates significance (p<.05). LLCI = lower limit confidence interval. ULCI = upper limit confidence interval. MJ = marijuana.

Alternative Model 1: Marijuana Problems > Mood > Insomnia

Given the potential bidirectional association between insomnia severity and marijuana problems, we then examined a model with reverse predictor and outcome variables. Specifically, we examined negative mood as a mediator of the association between marijuana problems and insomnia severity (see Table 3). Similar to the hypothesized model, there was a positive association between marijuana problems and negative mood (a-path effect = 1.07, SE = 0.13, p < .001; 95% CI = 0.82, 1.32); however, sex did not significantly moderate this association (X*W effect = −0.15, SE = 0.18, p = .42; 95% CI = −0.51, 0.21). There was also a positive association between negative mood and insomnia severity (b-path effect = 0.10, SE = 0.02, p < .001; 95% CI = 0.07, 0.13), and again, sex did not significantly moderate this association (M*W effect = −0.01, SE = 0.03, p = .78; 95% CI = −0.07, 0.05). There was a direct association between marijuana problems and insomnia severity (effect = 0.08, SE = 0.03, p = .02; 95% CI = 0.02, 0.15) that was marginally moderated by sex (X*W effect = −0.10, SE = 0.05, p = .06; 95% CI = −0.20, 0.004). The direct association between marijuana problems and insomnia severity was significant for women (effect = 0.08, SE = 0.03, p = .02; 95% CI = 0.02, 0.15), but not for men (effect = −0.01, SE = 0.04, p = .71; 95% CI = −0.09, 0.06). However, marijuana problems were associated with insomnia severity indirectly through negative mood among both men (effect = 0.08, SE = 0.03; 95% CI = 0.03, 0.14) and women (effect = 0.11, SE = 0.03; 95% CI = 0.06, 0.16).

Alternative Model 2: Mood > Insomnia > Marijuana Problems

Finally, to examine the possibility of alternative temporal ordering, we examined insomnia severity as a mediator of the association between negative mood and marijuana problems (see Table 3). Consistent with the other models, there was a positive association between negative mood and insomnia severity (a-path effect = 0.12, SE = 0.01, p < .001; 95% CI = 0.09, 0.15), and sex did not significantly moderate this association (X*W effect = −0.04, SE = 0.03, p = .15; 95% CI = −0.08, 0.01). There was also a positive association between insomnia severity and marijuana problems (b-path effect = 0.42, SE = 0.19, p = .02; 95% CI = 0.05, 0.793), and sex did not significantly moderate this association (M*W effect = −0.53, SE = 0.31, p = .08; 95% CI = −1.13, 0.07). The association between negative mood and marijuana problems was moderated by sex (X*W effect = 0.19, SE = 0.07, p = .01; 95% CI = 0.06, 0.32). As noted for the hypothesized model, negative mood was associated more strongly with marijuana problems among men (effect = 0.40, SE = 0.05, p < .001; 95% CI = 0.30, 0.51) than women (effect = 0.22, SE = 0.04, p < .001; 95% CI = 0.14, 0.30). Insomnia severity helped explain the association between negative mood and marijuana problems among women (effect = 0.05, SE = 0.02; 95% CI = 0.01, 0.09) but not men (effect = −0.01, SE = 0.03; 95% CI = −0.07, 0.06).

Discussion

The purpose of this study was to determine whether negative mood mediated the relationship between insomnia severity and marijuana-related problems among men and women using a cross-sectional dataset . Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems but more strongly so for men. These findings extend prior work by suggesting that negative mood may underlie the association between sleep difficulties and marijuana-related problems

Consistent with our hypothesis, we found that mood partially mediated the relationship between insomnia symptoms and marijuana related problems. Our results extend prior research by examining the relationship between sleep difficulties and both mood and marijuana related outcomes among women and men, thus uncovering a potential pathway leading to the experience of marijuana-related problems. Specifically, our findings indicated that insomnia severity was more strongly associated with marijuana problems among women compared to men, whereas negative mood was more strongly associated with marijuana problems among men than women.

Notably, based on the small and marginally significant regression coefficients, our alternative model suggests that insomnia seems to play less of a role in explaining the association between negative mood and marijuana problems in this sample. Despite the cross-sectional nature of this study, this seems to indicate that insomnia symptoms may precipitate negative mood, as opposed to vice versa. Moreover, the lack of a direct association between insomnia symptoms and marijuana problems among men, suggests that insomnia symptoms may be associated with marijuana problems because of their influence on negative mood.

There are several potential explanations for the mediating role of negative mood in the association between insomnia symptoms and marijuana problems. First, negative mood has been associated with marijuana-related coping motives, which have been linked directly to marijuana problems in college-aged adults (Bonn-Miller et al., 2014; Simons et al., 2005). Thus, it is possible that individuals with more severe insomnia were using marijuana to cope with the associated negative mood, and this coping motivation led to worse marijuana-related problems. Second, given research suggesting associations between negative mood, negative urgency (tendency to engage in rash action due to negative affect), and marijuana problems (Gunn et al., 2018), it is possible that negative mood as a result of more severe insomnia may have predisposed individuals to act more impulsively, leading to more consequences related to their marijuana use. Finally, neuroimaging findings have linked both insomnia and marijuana use with reductions in prefrontal activity (Babson & Bonn-Miller, 2014; Drummond et al., 2004), which has been shown to be associated with decreased top down control of the amygdala, disrupted mood regulation, and persistence of negative affect (for a review see Palagini et al., 2019). This dysregulated neural system has been associated with poor decision making and problem behaviors in individuals with insomnia (Palagini et al., 2019). Thus, it is possible that these alterations in associated brain regions play a key role in the manifestation of marijuana-related problems and may provide an additional explanation for our findings.

Alternatively, it may be that marijuana problems lead to insomnia, again in part to their influence on negative mood. Prior studies have shown that marijuana can decrease sleep onset latency in young adults (Nicholson et al., 2004). Because both models examined in this study (insomnia > marijuana problems and marijuana problems > insomnia) were significant, research is needed to determine which of these variables precedes the other or if there is a bidirectional effect. Regardless, data from this study indicate that negative mood seems to play a role in the relationship between insomnia and marijuana problems.

Collectively, our findings have several implications for the etiology and treatment of problematic marijuana use. First, these results are clinically significant as the negative affect experienced as a result of insomnia may increase the likelihood of college students using marijuana as a coping mechanism. This, in turn, places them at increased risk to experience problems related to their use (Simons et al., 2005) and for the development of marijuana use disorder (Moitra et al., 2015). Thus, individuals who use marijuana may benefit from intervention programs that target negative mood as well as sleep. Additionally, results from the current study have implications for the proper use of medical marijuana for sleep difficulties and how the potential risks and benefits of its use is communicated to prospective patients. Although some reports suggest that marijuana has beneficial effects on sleep, the effect of marijuana on sleep depends on a number of variables (e.g., composition of the plant, timing and mode of administration), and tolerance to the sleep-enhancing effects of marijuana develops quickly (Babson et al., 2017). If tolerance develops, individuals may be tempted to use more marijuana to get the sleep-enhancing effects, which may increase their risk of marijuana-related problems (Babson et al., 2017). Together, data from this study and others suggest that certain forms of marijuana use may be contraindicated for insomnia, based not only on their sleep effects but also on their potential effect on mood.

This study had several relevant limitations. First, although examination of alternate temporal ordering of predictor variables provides some potential insight into directionality of the relationship between our variables, true directionality cannot be determined because of the cross-sectional nature of the study. Thus, future prospective research is needed to evaluate these constructs across time. Second, the results may not be representative of young adults who are not in college. Third, the assessment measures used had varying time frames (e.g., past month marijuana problems, past 2-weeks insomnia symptoms) which may hinder interpretation of our proposed pathways. Finally, given that data collected on marijuana use, problems, mood, and insomnia were assessed via self-report measures, it may be important for future work to assess objective measures of these constructs.

The present study suggests that marijuana-problems may be in part related to insomnia-related negative mood. Given that sleep difficulties are a common symptom of marijuana withdrawal (Babson & Bonn-Miller, 2014; Budney et al., 2004) as well as a risk factor for poor response to marijuana interventions (Babson & Bonn-Miller, 2014), results highlight the importance of considering the potential consequences of marijuana use in college students with insomnia. Furthermore, results suggest that individuals with insomnia may be at greater risk of negative consequences associated with marijuana use and should be monitored for potential risk of marijuana use disorder. This may be especially important when working with men. Prospective studies are needed to further explore specific temporal relationships between insomnia, negative mood, and marijuana-related problems among men and women. Studies examining marijuana problems as a function of insomnia-related motives for use, impulsivity, and neurocognitive dysfunction are encouraged.

Acknowledgments

This research was supported by a Southeastern Conference (SEC) Visiting Faculty Travel Grant between the University of Florida and the University of Missouri (PI: Yurasek). Ali Yurasek’s contribution to the manuscript was supported by National Institute on Drug Abuse (NIDA) grant K23 DA046565-01. Mary Beth Miller’s contribution was supported by National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant K23 AA026895-01. NIDA and NIAAA had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication

Footnotes

The authors declare no conflict of interest

1

“Trouble sleeping” was included as an item on the marijuana-related problems scale. Because this represents a potential confound between predictor and outcome variables, analyses were conducted both including and excluding the “trouble sleeping” item. Exclusion of this item did not alter the pattern of results; given this finding, the “trouble sleeping” item was retained in the measure to maintain the integrity of the scale.

2

In post hoc analyses, we did not find significant direct or indirect associations between insomnia severity, negative mood, and frequency of marijuana use.

References

  1. Acharya L, Jin L, & Collins W (2018). College life is stressful today – Emerging stressors and depressive symptoms in college students. Journal of American College Health, 66(7), 655–664. 10.1080/07448481.2018.1451869 [DOI] [PubMed] [Google Scholar]
  2. Ali B, Seitz-Brown CJ, & Daughters SB (2015). The interacting effect of depressive symptoms, gender, and distress tolerance on substance use problems among residential treatment-seeking substance users. Drug and Alcohol Dependence, 148, 21–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. American College Health Association (2013). National College Health Assessment II: Reference Group Executive Summary. Spring 2013) National College Health Assessment. Hanover, MD: American College Health Association. [Google Scholar]
  4. Arria AM, Caldeira KM, Bugbee BA, Vincent KB, & O’Grady KE (2015). The academic consequences of marijuana use during college. Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors, 29(3), 564–575. 10.1037/adb0000108 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Auer M, Frauscher B, Hochleitner M, & Hogl B (2018). Gender-specific differences in access to polysomnography and prevalence of sleep disorders. Journal of Women’s Health, 27, 525–530. [DOI] [PubMed] [Google Scholar]
  6. Babson KA, & Bonn-Miller MO (2014). Sleep Disturbances: Implications for Marijuana Use, Marijuana Use Cessation, and Marijuana Use Treatment. Current Addiction Reports, 1(2), 109–114. 10.1007/s40429-014-0016-9 [DOI] [Google Scholar]
  7. Babson KA, Boden MT, & Bonn-Miller M (2013). Sleep Quality Moderates the Relation between Depression Symptoms and Problematic Marijuana Use among Medical Marijuana Users. The American Journal of Drug and Alcohol Abuse, 39(3), 211–216. 10.3109/00952990.2013.788183 [DOI] [PubMed] [Google Scholar]
  8. Babson KA, Sottile J, & Morabito D (2017). Marijuana, cannabinoids, and sleep: A review of the literature. Current psychiatry reports, 19, 1–12 [DOI] [PubMed] [Google Scholar]
  9. Bastien CH, Vallières A, & Morin CM (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307. Retrieved from https://www.sciencedirect.com/science/article/pii/S1389945700000654 [DOI] [PubMed] [Google Scholar]
  10. Bujarski SJ, Norberg MM, & Copeland J (2012). The association between distress toelrance and cannabis use-related problems: The mediating and moderating roles of coping motives and gender. Addictive Behaviors, 37, 1181–1184. [DOI] [PubMed] [Google Scholar]
  11. Becker SP, Jarrett MA, Luebbe AM, Garner AA, Burns GL, & Kofler MJ (2018). Sleep in a large, multi-university sample of college students: sleep problem prevalence, sex differences, and mental health correlates. Sleep Health, 4(2), 174–181. 10.1016/j.sleh.2018.01.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, & Sammut S (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90–96. 10.1016/j.jad.2014.10.054 [DOI] [PubMed] [Google Scholar]
  13. Biddle DJ, Kelly PJ, Hermens DF, & Glozier N (2018). The association of insomnia with future mental illness: is it just residual symptoms? Sleep Health, 4(4), 352–359. [DOI] [PubMed] [Google Scholar]
  14. Bolla KI, Lesage SR, Gamaldo CE, Neubauer DN, Funderburk FR, Cadet JL, … Benbrook AR (2008). Sleep disturbance in heavy marijuana users. Sleep, 91(6), 901–908. 10.1093/sleep/31.6.901 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Bonn-Miller M, Babson KA, & Vandrey R (2014). Using marijuana to help you sleep: heightened frequency of medical marijuana use among those with PTSD. Drug and Alcohol Dependence, 136, 162–165. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, & Kessler RC (2011). Cross-national epidemiology of DSM-IV major depressive episode. BMC Medicine, 9, 1–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Buckner JD, Ecker AH, & Cohen AS (2010). Mental health problems and interest in marijuana treatment among marijuana-using college students. Addictive Behaviors, 35(9), 826–833. 10.1016/j.addbeh.2010.04.001 [DOI] [PubMed] [Google Scholar]
  18. Budney AJ, Hughes JR, Moore BA, & Vandrey R (2004). Review of the Validity and Significance of Marijuana Withdrawal Syndrome. American Journal of Psychiatry, 161(11), 1967–1977. 10.1176/appi.ajp.161.11.1967 [DOI] [PubMed] [Google Scholar]
  19. Conroy DA, Kurth ME, Strong DR, Brower KJ, & Stein MD (2016). Marijuana use patterns and sleep among community-based young adults. Journal of Addictive Diseases, 35(2), 135–143. 10.1080/10550887.2015.1132986 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Drummond SP, Smith MT, Orff HJ, Chengazi V, & Perlis ML (2004). Functional imaging of the sleeping brain: review of findings and implications for the study of insomnia. Sleep Medicine Reviews, 8(3), 227–242. Retrieved from https://www.sciencedirect.com/science/article/pii/S108707920300087X [DOI] [PubMed] [Google Scholar]
  21. Eisenberg D, Hunt J, & Speer N (2013). Mental health in American colleges and universities: variation across student subgroups and across campuses. Journal of Nervous and Mental Disease, 201(1), 60–67. 10.1097/NMD.0b013e31827ab077 [DOI] [PubMed] [Google Scholar]
  22. Gress-Smith JL, Roubinov DS, Andreotti C, Compas BE, & Luecken LJ (2015). Prevalence, Severity and Risk Factors for Depressive Symptoms and Insomnia in College Undergraduates. Stress and Health, 31(1), 63–70. 10.1002/smi.2509 [DOI] [PubMed] [Google Scholar]
  23. Gunn RL, Jackson KM, Borsari B, & Metrik J (2018). Negative urgency partially accounts for the relationship between major depressive disorder and marijuana problems. Borderline Personality Disorder and Emotion Dysregulation, 5(1), 10 10.1186/s40479-018-0087-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE, & Miech RA (2015). Monitoring the Future national survey results on drug use, 1975–2015: Volume II, college students and adults ages 19–55. Ann Arbor: Institute for Social Research, The University of Michigan. Retrieved from https://deepblue.lib.umich.edu/bitstream/handle/2027.42/137906/mtf-vol2_2015.pdf
  25. Lee CM, Neighbors C, Hendershot CS, & Grossbard JR (2009). Development and Preliminary Validation of a Comprehensive Marijuana Motives Questionnaire. Journal of Studies on Alcohol and Drugs, 70(2), 279–287. 10.15288/jsad.2009.70.279 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Lee C, Kilmer J, Laux D, Neighbors C, Walter T, Fairilie A, & Patrick M (in preparation). Beyond the munchies: Young adult marijuana consequences and implications for brief motivational intervention research. [DOI] [PMC free article] [PubMed]
  27. MacKinnon DP, Lockwood CM, & Williams J (2004). Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods. Multivariate Behavioral Research, 39(1), 99–128. 10.1207/s15327906mbr3901_4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Mahmoud JSR, Hall LA, & Staten R (2010). The psychometric properties of the 21-Item Depression Anxiety and Stress Scale (DASS-21) among a sample of young adults. Southern Online Journal of Nursing Research, 10. [Google Scholar]
  29. Miech RA, Patrick ME, O’Malley PM, & Johnston LD (2017). The Influence of College Attendance on Risk for Marijuana Initiation in the United States: 1977 to 2015. American Journal of Public Health, 107(6), 996–1002. 10.2105/AJPH.2017.303745 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Mike TB, Shaw DS, Forbes EE, Sitnick SL, & Hasler BP (2016). The hazards of bad sleep—Sleep duration and quality as predictors of adolescent alcohol and marijuana use. Drug and Alcohol Dependence, 168, 335–339. 10.1016/j.drugalcdep.2016.08.009 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Moitra E, Christopher PP, Anderson BJ, & Stein MD (2015). Coping-motivated marijuana use correlates with DSM-5 cannabis use disorder and psychological distress among emerging adults. Psychology of Addictive Behaviors, 29(3), 627. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Morin CM, Belleville G, Belanger L, & Ivers H (2011). The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. SLEEP, 34, 601–608. Retrieved from https://academic.oup.com/sleep/article-abstract/34/5/601/2281474 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. National Academies of Sciences, Engineering, and Medicine. (2017). The Health Effects of Marijuana and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington, DC: The National Academies Press; [PubMed] [Google Scholar]
  34. Nicholson AN, Turner C, Stone BM, & Robson PJ (2004). Effect of Delta-9-tetrahydrocannabinol and cannabidiol on nocturnal sleep and early-morning behavior in young adults. Journal of Clinical Psychopharmacology, 24, 305–313. [DOI] [PubMed] [Google Scholar]
  35. Palagini L, Bastien CH, Marazziti D, Ellis JG, & Riemann D (2019). The key role of insomnia and sleep loss in the dysregulation of multiple systems involved in mood disorders: A proposed model. Journal of Sleep Research, e12841 10.1111/jsr.12841 [DOI] [PubMed] [Google Scholar]
  36. Parkitny L, & McAuley J (2010). The Depression Anxiety Stress Scale (DASS). Journal of Physiotherapy, 56(3), 204 Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20795931 [DOI] [PubMed] [Google Scholar]
  37. Patrick ME, Fairlie AM, & Lee CM (2018). Motives for simultaneous alcohol and marijuana use among young adults. Addictive Behaviors, 76, 363–369. 10.1016/J.ADDBEH.2017.08.027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Simons JS, Gaher RM, Correia CJ, Hansen CL, & Christopher MS (2005). An affective-motivational model of marijuana and alcohol problems among college students. Psychology of Addictive Behaviors, 19(3), 326–334. 10.1037/0893-164X.19.3.326 [DOI] [PubMed] [Google Scholar]
  39. Suerken CK, Reboussin BA, Egan KL, Sutfin EL, Wagoner KG, Spangler J, & Wolfson M (2016). Marijuana use trajectories and academic outcomes among college students. Drug and Alcohol Dependence, 162, 137–145. 10.1016/J.DRUGALCDEP.2016.02.041 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Tabachnick BG, & Fidell LS (2013). Using multivariate statistics (6th Ed.) https://www.pearsonhighered.com/assets/preface/0/1/3/4/0134790545.pdf [Google Scholar]
  41. Taylor DJ, Gardner CE, Bramoweth AD, Williams JM, Roane BM, Grieser EA, & Tatum JI (2011). Insomnia and Mental Health in College Students. Behavioral Sleep Medicine, 9(2), 107–116. 10.1080/15402002.2011.557992 [DOI] [PubMed] [Google Scholar]
  42. Walsh Z, Callaway R, Belle-Isle L, Capler R, Kay R, Lucas P, & Holtzman S (2013). Marijuana for therapeutic purposes: Patient characteristics, access, and reasons for use. International Journal of Drug Policy, 24(6), 511–516. 10.1016/j.drugpo.2013.08.010 [DOI] [PubMed] [Google Scholar]
  43. Walters KS, Bulmer SM, Troiano PF, Obiaka U, & Bonhomme R (2018). Substance Use, Anxiety, and Depressive Symptoms Among College Students. Journal of Child & Adolescent Substance Abuse, 27(2), 103–111. 10.1080/1067828X.2017.1420507 [DOI] [Google Scholar]
  44. Wong MM, Craun EA, Bravo AJ, Pearson MR, & Protective Strategies Study Team. (2019). Insomnia symptoms, marijuana protective behavioral strategies, and hazardous marijuana use among U.S. college students. Experimental and Clinical Psychopharmacology. 10.1037/pha0000273 [DOI] [PMC free article] [PubMed] [Google Scholar]

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