The relationship between anxious-depressive symptoms and harmful cannabis use: Multiple mediation models via rumination, negative urgency, protective behavioral strategies and refusal self-efficacy

Background: Distressful and negative affective states can be associated with limited self-regulation capacities, while emotion regulation processes (e.g., rumination, negative urgency) might contribute to further depletion of self-control capacities which in turn can lead to diminished control over cannabis use. 

Aims: The mediating functions of rumination (i.e., brooding and reflection), negative urgency (NU) and constructs of cannabis use regulation (i.e., cannabis protective behavioral strategies [CPBS] and cannabis refusal self-efficacy [CRSE]) were examined on the associations between anxious-depressive symptoms and cannabis use outcomes (i.e., frequency, harmful use). 

Methods: The cross-sectional study used a sample of cannabis users showing signs of harmful consumption (N = 750; Males: 70.13% [N = 526]; Age: M = 29.11 [SD = 7.45]). Standardized questionnaires measured anxious-depressive symptoms, rumination, NU, CRSE, CPBS, frequency of cannabis use and harmful cannabis use. A linear regression-based, double-mediation model was performed. 

Results: Five significant indirect effects were demonstrated in the mediation model. Single-mediation effects were shown between anxious-depressive symptoms and harmful cannabis use via CRSE and via CPBS. Double-mediation effects were presented between anxious-depressive symptoms and harmful cannabis use via reflection and CPBS, via reflection and CRSE, and via NU and CRSE. 

Conclusions: Emotion and cannabis use regulation pathways explained the associations between anxious-depressive symptoms and harmful cannabis use. The mediation model provided new details on how anxious-depressive symptoms, rumination and NU might lead to harmful cannabis use via regulation of cannabis use. Limited self-regulation capacities and similarities between emotion and cannabis use regulation processes might explain the identified indirect effects.