Daily adolescent cannabis use is associated with increased risk of anxiety disorder at age 29 years, but not consistently with depression.
Summary
15-year cohort study (n=1943): Daily cannabis use associated with anxiety disorder at age 29 years (OR=2,5; 95%-CI 1,2–5,2); cannabis dependence: OR=2,2 (95%-CI 1,1–4,4). Among weekly adolescent users who used daily by age 29: OR=3,2 (95%-CI 1,1–9,2). Association holds even after cessation of use (no protection through abstinence).
P
PopulationAdolescents and young adults from an Australian representative cohort, n=1943, recruited in secondary school (age 14,9–29,1 years)
I
InterventionCannabis use in adolescence (frequency of use in the last 6 months) and in adulthood (daily, weekly+, DSM-IV cannabis dependence)
O
OutcomeDaily cannabis use associated with anxiety disorder at age 29 years (adj. OR 2,5; 95%-CI 1,2–5,2); cannabis dependence also (adj. OR 2,2; 95%-CI 1,1–4,4); no consistent association with depression
Confidence in the evidence
Very lowLowModerateHigh
Low
The second of four GRADE levels, the effect estimate is of limited reliability.
Quality profile
Sample size★★★★★
Blinding—
Effect sizeMixed
Citations / year★★★★★
Authors
Degenhardt L, Coffey C, Romaniuk H, Swift W, Carlin JB, Hall WD, Patton GC.
<h4>Aims</h4>Debate continues about whether the association between cannabis use in adolescence and common mental disorders is causal. Most reports have focused on associations in adolescence, with few studies extending into adulthood. We examine the association from adolescence until the age of 29 years in a representative prospective cohort of young Australians.<h4>Design</h4>Nine-wave, 15-year representative longitudinal cohort study, with six waves of data collection in adolescence (mean age 14.9-17.4 years) and three in young adulthood (mean age 20.7, 24.1 and 29.1 years).<h4>Participants</h4>Participants were a cohort of 1943 recruited in secondary school and surveyed at each wave when possible from mid-teen age to their late 20s.<h4>Setting</h4>Victoria, Australia.<h4>Measurements</h4>Psychiatric morbidity was assessed with the Revised Clinical Interview Schedule (CIS-R) at each adolescent wave, and as Composite International Diagnostic Interview (CIDI)-defined ICD-10 major depressive episode and anxiety disorder at 29 years. Frequency of cannabis use was measured in the past 6 months in adolescence. Cannabis use frequency in the last year and DSM-IV cannabis dependence were assessed at 29 years. Cross-sectional and prospective associations of these outcomes with cannabis use and dependence were estimated as odds ratios (OR), using multivariable logistic regression models, with the outcomes of interest, major depressive episode (MDE) and anxiety disorder (AD) at 29 years.<h4>Findings</h4>There were no consistent associations between adolescent cannabis use and depression at age 29 years. Daily cannabis use was associated with anxiety disorder at 29 years [adjusted OR 2.5, 95% confidence interval (CI):< 1.2-5.2], as was cannabis dependence (adjusted OR 2.2, 95% CI: 1.1-4.4). Among weekly+ adolescent cannabis users, those who continued to use cannabis use daily at 29 years remained at significantly increased odds of anxiety disorder (adjusted OR 3.2, 95% CI: 1.1-9.2).<h4>Conclusions</h4>Regular (particularly daily) adolescent cannabis use is associated consistently with anxiety, but not depressive disorder, in adolescence and late young adulthood, even among regular users who then cease using the drug. It is possible that early cannabis exposure causes enduring mental health risks in the general cannabis-using adolescent population.