Clinical Takeaway
Adolescents with depression, generalized anxiety, social anxiety, and panic symptoms were more likely to initiate and increase cannabis use over an 18-month follow-up period. This longitudinal evidence supports the self-medication hypothesis, suggesting that untreated internalizing symptoms in adolescence may drive substance use as a coping mechanism. Clinicians should screen adolescent patients for co-occurring mood and anxiety symptoms when assessing cannabis use risk.
#13 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 longitudinal study elucidates the prospective relationship between specific internalizing psychiatric symptoms and cannabis initiation in adolescents, providing clinicians with evidence to identify high-risk youth who may be self-medicating anxiety and depressive disorders. Understanding these symptom-specific pathways enables earlier intervention and potentially more targeted prevention strategies in primary care and mental health settings. The Chilean cohort data contributes important cross-cultural evidence regarding whether the internalizing pathway to substance use operates consistently across diverse socioeconomic 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 longitudinal study from Chile adds valuable evidence to the self-medication hypothesis by demonstrating that adolescents with baseline internalising symptoms including depression, anxiety, and panic are at increased risk for cannabis initiation and escalated use over 18 months. While the design strengthens causal inference beyond cross-sectional work, important limitations warrant consideration: the sample is restricted to a specific geographic and socioeconomic context, unmeasured confounders such as peer influence and trauma exposure may partly explain the associations, and the study cannot definitively establish whether cannabis use patterns represent true self-medication or reflect common underlying neurobiological vulnerabilities. Clinically, this research underscores the importance of screening adolescents presenting with anxiety or depressive symptoms for early cannabis use and substance experimentation, and suggests that robust mental health treatment addressing the underlying internalising pathology may be a critical component of comprehensive prevention and early intervention strategies in this age group.