Association of cannabis, cannabidiol and synthetic cannabinoid use with mental health in UK adolescents

Br J Psychiatry. 2023 Oct;223(4):478-484. doi: 10.1192/bjp.2023.91.


Background: Cannabis has been associated with poorer mental health, but little is known of the effect of synthetic cannabinoids or cannabidiol (often referred to as CBD).

Aims: To investigate associations of cannabis, synthetic cannabinoids and cannabidiol with mental health in adolescence.

Method: We conducted a cross-sectional analysis with 13- to 14-year-old adolescents across England and Wales in 2019-2020. Multilevel logistic regression was used to examine the association of lifetime use of cannabis, synthetic cannabinoids and cannabidiol with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations.

Results: Of the 6672 adolescents who participated, 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids. After correction for multiple testing, adolescents who had used these substances were significantly more likely to report a probable depressive, anxiety or conduct disorder, as well as auditory hallucinations, than those who had not. Adjustment for socioeconomic disadvantage had little effect on associations, but weekly tobacco use resulted in marked attenuation of associations. The association of cannabis use with probable anxiety and depressive disorders was weaker in those who reported using cannabidiol than those who did not. There was little evidence of an interaction between synthetic cannabinoids and cannabidiol.

Conclusions: To our knowledge, this study provides the first general population evidence that synthetic cannabinoids and cannabidiol are associated with probable mental health disorders in adolescence. These associations require replication, ideally with prospective cohorts and stronger study designs.

Keywords: Anxiety or fear-related disorders; conduct disorders; depressive disorders; psychotic disorders/schizophrenia; substance use disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cannabidiol* / adverse effects
  • Cannabinoids* / adverse effects
  • Cannabis*
  • Cross-Sectional Studies
  • Hallucinations / chemically induced
  • Hallucinations / epidemiology
  • Humans
  • Mental Health
  • Prospective Studies
  • United Kingdom / epidemiology


  • Cannabidiol
  • Cannabinoids