Clinical Takeaway
Adolescent cannabis use is associated with significantly increased risk of developing psychotic, bipolar, depressive, and anxiety disorders in adolescence and young adulthood, based on large-scale longitudinal population data. These are clinically diagnosed conditions, not just symptoms, which strengthens the clinical relevance of the findings. Patients and families should understand that cannabis is not without serious mental health risk, particularly when use begins during adolescent brain development.
#12 Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders.
Citation: Young-Wolff Kelly C et al.. Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders.. JAMA health forum. 2026. PMID: 41719031.
Design: 0 Journal: 4 N: 0 Recency: 3 Pop: 3 Human: 1 Risk: 0
This large population-based longitudinal study provides critical evidence that adolescent cannabis use is associated with increased risk of clinically diagnosed psychiatric disorders, moving beyond prior research limited to symptom assessment and filling a significant gap in the literature on cannabis’s psychiatric sequelae during a developmentally vulnerable period. These findings are clinically important as they inform risk stratification and counseling for adolescents and families, particularly given cannabis’s increasing accessibility and evolving legal status. Understanding the specific psychiatric outcomes associated with adolescent cannabis exposure enables clinicians to provide evidence-based guidance on prevention and early intervention strategies.
Methodological Considerations:
- Self-reported outcomes — recall and social-desirability bias risk
Abstract: IMPORTANCE: As cannabis becomes more accessible and socially accepted, concerns have grown about its potential implications for adolescent mental health. While prior research has linked adolescent cannabis use to psychiatric symptoms, few large, population-based, longitudinal studies have examined associations with clinically diagnosed psychiatric disorders. OBJECTIVE: To evaluate whether adolescent cannabis use is associated with an increased risk of incident psychotic, bipolar, depressive, and anxiety disorders during adolescence and young adulthood. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included adolescents aged 13 to 17 years who were screened for past-year cannabis use at Kaiser Permanente Northern California from 2016 to 2023. Adolescents were followed up through age 25 years or until December 31, 2023. Data were analyzed from February 21, 2024, to August 27, 2025. EXPOSURE: Time-varying self-reported past-year cannabis use based on universal, confidential screening during standard pediatric care. MAIN OUTCOMES AND MEASURES: Incident clinician-diagnosed psychotic, bipolar, depressive, and anxiety disorders, which were identified through electronic health records using International Classification of Disease codes. Cox proportional hazards regression models were used to measure the strength of associations between adolescent cannabis use and incident psychiatric diagnoses, with adjustments for sex, race and ethnicity, neighborhood deprivation index, insurance type, and time-varying alcohol and other substance use. RESULTS: Of 463 396 adolescents (234 114 males [50.5%]; mean [SD] age, 14.5 [1.3] years) included in the sample, 136 708 were Hispanic individuals (29.5%), 93 737 were non-Hispanic Asian individuals (20.2%), 35 346 were non-Hispanic Black individuals (7.6%), 153 102 were non-Hispanic White individuals (33.0%), and 18 795 individuals were multiracial or of other races or ethnicities (4.1%). At baseline, 26 345 adolescents (5.7%) self-rep
🧠 This large longitudinal study contributes important evidence that adolescent cannabis use carries measurable risk for subsequent psychiatric diagnosis, particularly psychotic disorders, though clinicians should recognize several important limitations when counseling families. The population-based design and clinical diagnoses rather than symptom screening strengthen the findings, yet unmeasured confounders, reverse causality (early psychiatric symptoms driving cannabis use), and variations in cannabis potency and exposure patterns across the study period complicate interpretation of causality. Additionally, the generalizability may be limited by cohort demographics and changes in the cannabis market since data collection. When discussing cannabis with adolescent patients and families, providers can reference this evidence to support conversations about genuine neurodevelopmental risks during a critical period of brain maturation, while remaining clear that not all adolescent users develop psychiatric illness and that individual vulnerability factors likely play important moderating roles.