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 findings reflect clinically diagnosed psychiatric conditions, not just symptoms, strengthening the evidence base beyond prior research. Clinicians should counsel adolescent patients and their families about these documented psychiatric risks when discussing cannabis use.
#11 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 longitudinal population-based study provides robust evidence quantifying the psychiatric risk associated with adolescent cannabis exposure at a time when legalization is expanding access to this population, enabling clinicians to counsel patients and families with concrete epidemiologic data rather than relying on smaller or cross-sectional studies. The findings establish whether cannabis use during a critical neurodevelopmental period confers differential risk across specific diagnostic categories, which is essential for risk stratification and targeted prevention efforts in clinical practice. Given the increasing prevalence of cannabis use in adolescents and the substantial individual and public health burden of psychotic and mood disorders, demonstrating clear associations can inform clinical screening protocols 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 population-based longitudinal study addresses a clinically important question about adolescent cannabis exposure and subsequent psychiatric diagnoses, moving beyond symptom reporting to actual disorder incidence. The findings warrant attention given increasing cannabis potency, changing legal status, and earlier age of first use in many jurisdictions, though we should note that association does not establish causation and residual confounding by underlying predisposition, socioeconomic factors, or concurrent substance use remains possible despite study design strengths. The adolescent brain’s ongoing maturation during this critical developmental window makes biological plausibility for psychiatric risk higher than in adult populations, yet individual variation in vulnerability, cannabis product type and THC:CBD ratios, and frequency of use patterns complicate straightforward risk stratification. When counseling families with adolescents, clinicians should integrate these findings into a balanced discussion that acknowledges both the emerging evidence linking cannabis to psychiatric risk and the reality that not all adolescent users develop these conditions, while emphasizing that early intervention and psychoeducation remain our most