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Meta-Analysis
, 76 (4), 426-434

Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis

Affiliations
Meta-Analysis

Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis

Gabriella Gobbi et al. JAMA Psychiatry.

Erratum in

  • Error in Discussion Section.
    JAMA Psychiatry. 2019 Apr 1;76(4):447. doi: 10.1001/jamapsychiatry.2019.0464. JAMA Psychiatry. 2019. PMID: 30865235 No abstract available.

Abstract

Importance: Cannabis is the most commonly used drug of abuse by adolescents in the world. While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood.

Objective: To provide a summary estimate of the extent to which cannabis use during adolescence is associated with the risk of developing subsequent major depression, anxiety, and suicidal behavior.

Data sources: Medline, Embase, CINAHL, PsycInfo, and Proquest Dissertations and Theses were searched from inception to January 2017.

Study selection: Longitudinal and prospective studies, assessing cannabis use in adolescents younger than 18 years (at least 1 assessment point) and then ascertaining development of depression in young adulthood (age 18 to 32 years) were selected, and odds ratios (OR) adjusted for the presence of baseline depression and/or anxiety and/or suicidality were extracted.

Data extraction and synthesis: Study quality was assessed using the Research Triangle Institute item bank on risk of bias and precision of observational studies. Two reviewers conducted all review stages independently. Selected data were pooled using random-effects meta-analysis.

Main outcomes and measures: The studies assessing cannabis use and depression at different points from adolescence to young adulthood and reporting the corresponding OR were included. In the studies selected, depression was diagnosed according to the third or fourth editions of Diagnostic and Statistical Manual of Mental Disorders or by using scales with predetermined cutoff points.

Results: After screening 3142 articles, 269 articles were selected for full-text review, 35 were selected for further review, and 11 studies comprising 23 317 individuals were included in the quantitative analysis. The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37 (95% CI, 1.16-1.62; I2 = 0%). The pooled OR for anxiety was not statistically significant: 1.18 (95% CI, 0.84-1.67; I2 = 42%). The pooled OR for suicidal ideation was 1.50 (95% CI, 1.11-2.03; I2 = 0%), and for suicidal attempt was 3.46 (95% CI, 1.53-7.84, I2 = 61.3%).

Conclusions and relevance: Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Gobbi received a grant (which was not related to this meta-analysis) for the study of cannabidiol in neuropathic pain by the Quebec Ministry of Economy, Science and Innovation with the participation of Aurora Cannabis Inc. As of July 1, 2018, Dr Ware has been employed by Canopy Growth Corporation, a Canadian-licensed cannabis producer; this affiliation was disclosed at the time of the appointment, and his involvement in the study was prior to all discussions about this appointment. No other conflicts were reported.

Figures

Figure 1.
Figure 1.. Selection Process for Study Inclusion in the Systematic Review and Meta-analysis
Figure 2.
Figure 2.. Forest Plot Showing Adjusted Odds Ratio (OR) and 95% CIs for Depression and Anxiety in Young Adulthood According to Cannabis Use in Individual Studies
Figure 3.
Figure 3.. Forest Plot Showing Adjusted Odds Ratio (OR) and 95% CIs for Suicidal Ideations and Attempts According to Cannabis Use in Individual Studies

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