Clinical Takeaway
Adolescents with depression and anxiety symptoms show increased likelihood of initiating and escalating cannabis use over time, suggesting internalising disorders may drive substance use as a coping mechanism. Clinicians working with adolescent patients should screen for co-occurring mood and anxiety disorders when evaluating cannabis use risk, particularly in low-income and high-stress school environments.
#12 Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents.
Citation: Stapinski Lexine A et al.. Anxiety, depression and risk of cannabis use: Examining the internalising pathway to use among Chilean adolescents.. Drug and alcohol dependence. 2016. PMID: 27427415.
Design: 5 Journal: 0 N: 4 Recency: 0 Pop: 3 Human: 1 Risk: -2
This study provides longitudinal evidence for the self-medication hypothesis in adolescents, identifying specific internalizing symptoms (depression, generalized anxiety, social anxiety, and panic) that predict cannabis initiation and escalation—critical information for early intervention and risk stratification in clinical settings. Understanding the temporal relationship between psychiatric symptoms and cannabis use in this understudied Latin American population has implications for screening protocols and targeted prevention strategies in adolescent mental health practice. The findings support the clinical necessity of integrated mental health assessment and psychosocial intervention as primary approaches to reducing substance use risk in vulnerable youth populations.
Quality Gate Alerts:
- Preclinical only
Abstract: BACKGROUND: Adolescents who experience internalising symptoms may be susceptible to the use of alcohol and other substances in an attempt to alleviate or cope with these symptoms. We examined the hypothesised internalising pathway from symptoms of depression, generalised anxiety, social anxiety and panic, to incidence and frequency of cannabis use 18 months later. METHOD: Longitudinal cohort study of participants (n=2508; 45% female; mean age 14.5 years) recruited from the 9th grade at 22 low-income secondary schools in Santiago, Chile. Baseline internalising symptoms were assessed using the Beck Depression Inventory and the Revised Child Anxiety and Depression Scale. Frequency of cannabis was assessed at baseline, 6 month and 18 month follow-up. RESULTS: High rates of use were observed in this sample, with 40.3% reporting cannabis use at least once over the study period. Adjusted for baseline cannabis use, symptoms of depression, panic and generalised anxiety were associated with greater cannabis use frequency 18 months later. When all predictors were considered simultaneously, only generalised anxiety symptoms showed an independent association with subsequent cannabis use frequency (OR: 1.23, 95% CI: 1.08-1.41). Generalised anxiety symptoms were also associated with a 25% increased risk of transitioning from non-user to use of cannabis during the study (OR: 1.25, 95% CI: 1.09-1.44). CONCLUSIONS: Internalising symptoms, and in particular symptoms of generalised anxiety, increase risk of cannabis use during adolescence. Targeted interventions that promote adaptive anxiety management among high-risk adolescents may represent a promising strategy to prevent uptake of cannabis use during adolescence.
🧠 This Chilean longitudinal study adds important evidence to a clinically relevant question: whether adolescent internalizing symptoms like depression and anxiety drive cannabis initiation and frequency, rather than simply co-occurring. The prospective design and 18-month follow-up strengthen causal inference compared to cross-sectional work, though the study population is limited to Chilean ninth-graders and may not generalize to other developmental contexts or healthcare systems. Clinicians should recognize that while internalizing pathology appears to increase cannabis use risk in adolescents, the relationship is likely bidirectional and confounded by peer influence, family factors, access, and the neurobiological vulnerability of the developing brain—factors the study methodology cannot fully disentangle. The practical takeaway is straightforward: screening for depression, generalized anxiety, social anxiety, and panic in adolescent patients should prompt direct counseling about cannabis risks as a maladaptive coping strategy, paired with evidence-based treatment of the underlying mood or anxiety disorder itself.