Casual cannabis use in youth increases risk for depression, suicidal thoughts

Key takeaways:

• Youth with nondisordered cannabis use also had a greater risk for aggression, difficulty concentrating and truancy.
• The findings underscore the vulnerability of adolescents with nondisordered cannabis use.

Adolescents who casually used cannabis had two to four times greater odds of negative psychosocial events, including depression and suicidal thoughts, than those who did not use cannabis, according to a recent study.

“Perceptions exist among youth, parents, and educators that casual cannabis use is benign,” Ryan Sultan, MD, an assistant professor of clinical psychiatry at Columbia University, said in a press release. “We were surprised to see that cannabis use had such strong associations to adverse mental health and life outcomes for teens who did not meet the criteria for having a substance use condition.”

Sultan and colleagues wrote in JAMA Network Open that prior research has identified negative psychosocial associations with cannabis use among adolescents, but it did not discern risks between cannabis use disorder (CUD) and nondisordered cannabis use (NDCU).

To learn more, the researchers performed a cross-sectional study using 2015 to 2019 National Survey on Drug Use and Health responses from 68,263 youth aged 12 to 17 years.

Of the respondents, 10.2% and 2.5% were classified as having NDCU and CUD, respectively, while 87.3% were classified as cannabis nonusers. NDCU was defined as cannabis use within the last month to year, but not meeting the Diagnostic and Statistical Manual of Mental Disorders CUD criteria.

Compared with nonusers, Sultan and colleagues reported that the unadjusted odds for major depression were greater in those with NDCU (OR = 2.4; 95% CI, 2.15-2.67) and CUD (OR = 3.48; 95% CI, 2.95-4.11).

Additionally, recent suicide ideations were significantly greater in those with NDCU (OR = 2.63; 95% CI, 2.39-2.9) and CUD (OR = 4.01; 95% CI, 3.42-4.7) compared with nonusers.

Following adjustments, those with NDCU vs. nonusers had higher odds for:

• major depression ([adjusted OR] aOR = 1.86; 95% CI, 1.67-2.08);
• suicidal ideations (aOR = 2.08; 95% CI, 1.88-2.29);
• slower thoughts (aOR = 1.76; 95% CI, 1.58-1.96);
• difficulty concentrating (aOR = 1.81; 95% CI, 1.65-2);
• truancy (aOR = 1.9; 95% CI, 1.67-2.16);
• arrest (aOR = 4.15; 95% CI, 3.17-5.43);
• fighting (aOR = 2.04; 95% CI, 1.80-2.31); and
• aggression (aOR = 2.16; 95% CI, 1.79-2.62).

The prevalence of adverse psychosocial events was greatest among adolescents with CUD — which ranged from 12.6% to 41.9% — followed by those with NCUD (5.2% to 30.4%) and nonusers (0.8% to 17.3%).

Sultan and colleagues reported that the significant associations of depression and suicidal ideations in both cannabis use groups “could be due to unexamined factors, such as anxiety.”

“Cannabis use in adolescence may represent self-treatment to ameliorate mood symptoms and is also associated with developing major depression,” they wrote. “Recent studies have suggested that while cannabis use may ameliorate mood symptoms, ongoing use worsens mood symptoms.”

Given the public perception on cannabis use for depression treatment, the researchers wrote that “future longitudinal research is necessary to better describe this association.”

Because substance use disorders continue to be underdiagnosed, specifically within youth, the researchers said the associations of NDCU with psychosocial risks underscores the vulnerability of those with NDCU.

“If we assume that adolescents with NDCU, which is more common than CUD among adolescents, have sufficient adverse effects associated with their cannabis use to meet criteria for pathological use, then many U.S. adolescents are not being identified in community practice,” they wrote.

Sultan and colleagues concluded that “with growing U.S. acceptance of cannabis in both medicinal and recreational settings, clinicians should be vigilant to screen, evaluate, and treat cannabis use in adolescents.

References:

• Casual cannabis use by adolescents raises risk of depression, suicidality. https://www.eurekalert.org/news-releases/988473. Published May 6, 2023. Accessed May 8, 2023.
• Sultan R, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.11294.