Psychological distress, distress tolerance, and cannabis-related problems among university students in Türkiye: a mixed-methods study.

Background: Cannabis use among university students has been increasingly linked to psychological distress; however, most evidence comes from Western contexts, and little is known about how cannabis use intersects with emotional functioning in non-Western settings. In Türkiye, where cannabis use remains illegal and highly stigmatized, students who use cannabis may represent a particularly vulnerable group. This study examined the associations between cannabis-related problems, psychological distress, and distress tolerance among Turkish university students, and explored students' lived psychological experiences of cannabis use. Methods: A sequential explanatory mixed-methods design was employed. In the quantitative phase, 512 university students from Istanbul, Ankara, and Izmir completed self-report measures assessing cannabis-related problems (Cannabis Use Problems Identification Test), depressive symptoms (Beck Depression Inventory-II), anxiety symptoms (Beck Anxiety Inventory), and distress tolerance (Distress Tolerance Scale). In the qualitative phase, semi-structured interviews were conducted with a purposively selected subsample of 43 students with elevated cannabis-related problems and/or psychological distress. Quantitative data were analyzed using descriptive and correlational analyses, while qualitative data were examined using reflexive thematic analysis. Findings were integrated at the interpretation level. Results: Greater cannabis-related problem severity was moderately associated with higher levels of depressive and anxiety symptoms and with lower distress tolerance. Qualitative analyses yielded four overarching themes: (1) psychological effects of cannabis use, (2) cannabis use as a distress regulation strategy, (3) perceived loss of control and ambivalence, and (4) academic and interpersonal consequences. Integration of quantitative and qualitative findings suggested a cyclical pattern in which psychological distress motivates cannabis use for short-term relief, which in turn undermines distress tolerance and contributes to further psychological and functional difficulties. Conclusions: Cannabis use among Turkish university students appears closely intertwined with emotional distress and reduced capacity to tolerate negative affect. Rather than being solely recreational, cannabis use often functions as a maladaptive coping strategy. Interventions targeting emotion regulation and distress tolerance may be particularly beneficial in this population. These findings highlight the importance of integrated mental health and substance-use approaches within university settings, especially in culturally conservative contexts.