Clinical Takeaway
Adolescent cannabis use is associated with increased risk of developing psychotic, bipolar, depressive, and anxiety disorders in adolescence and young adulthood, based on large population-level longitudinal data tracking clinically diagnosed conditions. These findings go beyond self-reported symptoms to document real psychiatric diagnoses, strengthening the evidence that cannabis exposure during brain development carries measurable mental health consequences. Clinicians should counsel adolescent patients and their families that cannabis is not risk-free, particularly during this critical developmental window.
#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 epidemiological evidence quantifying the specific psychiatric risks associated with adolescent cannabis use, filling a critical evidence gap beyond prior symptom-focused research that informs clinical risk assessment and patient counseling. Understanding the magnitude of risk for distinct diagnostic categories (psychotic, bipolar, depressive, and anxiety disorders) enables clinicians to provide evidence-based guidance to adolescents and families regarding cannabis exposure during a developmentally vulnerable period. These findings support informed psychiatric screening protocols and intervention strategies for at-risk youth in an era of increasing cannabis accessibility and reduced perceived harm.
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 an important gap by examining clinically diagnosed psychiatric disorders rather than symptom scales, which strengthens the relevance to clinical practice. However, several limitations warrant careful interpretation: adolescent cannabis use typically correlates with other risk factors including peer influences, socioeconomic stress, and possible underlying prodromal symptoms that may drive both substance use and psychiatric outcomes, making causal attribution challenging. The potency and frequency of cannabis exposure are not standardized across users, and the study cannot account for individual genetic vulnerabilities or protective factors that influence psychiatric risk. Given these complexities, the most practical clinical implication is to use findings not as definitive causal evidence but as support for discussing cannabis use as one modifiable risk factor during routine adolescent mental health screening, while maintaining a comprehensive approach that addresses the full constellation of biological, social, and environmental contributors to psychiatric illness.
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