Medical and non-medical Cannabis use in depression: Longitudinal associations with suicidal ideation, everyday functioning, and psychiatry service utilization
Bahorik et al.·Journal of Affective DisordersImpact 4.3
HarmGRADEHigh55 citations
Samplen = 307 Pat.
Duration12 months
ControlNo cannabis use
EndpointSuicidal ideation /…
Blindingunklar
DesignRCT
”Key finding
Non-medical cannabis use was associated with higher suicidal ideation, poorer mental functioning, fewer psychiatric visits and less improvement in depressive symptoms over time.
Summary
Prospective cohort study in n=307 outpatient depression patients over 12 months; 40% cannabis use (71,7% non-medical, 28,2% medical). Non-medical use associated with higher suicidality at baseline (B=1,08, p=0,002), poorer mental functioning (B=-3,79, p=0,015) and fewer psychiatric visits (B=-0,69, p=0,009). Over time less improvement in depressive symptoms (B=1,49, p=0,026) and suicidality (B=1,08, p=0,003) vs. non-users.
P
PopulationPsychiatric outpatients with depression and substance use, n=307
I
InterventionMedical or non-medical cannabis use (self-reported, past 30 days)
C
ControlNo cannabis use (reference group)
O
OutcomeNon-medical use associated with higher suicidal ideation (B=1,08; p=0,002), poorer mental functioning (B=-3,79; p=0,015) and fewer psychiatric visits (B=-0,69; p=0,009); over time less improvement in depressive symptomatology (B=1,49; p=0,026) and suicidal ideation (B=1,08; p=0,003) vs. non-users
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Background: Cannabis use is clinically problematic in depression, and non-medical and medical use may both contribute to barriers to care in this population. Among outpatients with depression, we examined the differential impact of medical or non-medical Cannabis use, relative to no-use, on psychopathology and service use over time.
Method: Participants were 307 psychiatry outpatients participating in a trial of drug/alcohol use treatment for depression. Measures of past 30-day Cannabis use, depression/anxiety symptoms, psychiatry visits, and functional data related to health status were collected at baseline, 3, 6, and 12 months. Regressions (baseline and 1 year) and growth models (over time) predicted clinical and psychiatry visit outcomes, from medical or non-medical Cannabis use (no-use = reference).
Results: At baseline, 40.0% of the sample used Cannabis and more reported non-medical (71.7%) than medical (28.2%) use. Relative to non-users at baseline, patients using medically had worse mental/physical health functioning (p's < 0.05), and non-medical use was associated with higher suicidal ideation (B = 1.08, p = .002), worse mental health functioning (B = -3.79, p = .015), and fewer psychiatry visits (B = -0.69, p = .009). Patients using non-medically over time improved less in depression symptoms (B = 1.49, p = .026) and suicidal ideation (B = 1.08, p = .003) than non-users.
Limitations: Participants were psychiatry outpatients, limiting generalizability.
Conclusions: Cannabis use, especially non-medical use, among patients with depression may impede depression symptom improvement while lessening the likelihood of psychiatry visits. Cannabis use and associated barriers to care should receive consideration by depression treatment providers.