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 for a meaningful link between early cannabis exposure and serious mental health outcomes. Clinicians should counsel patients and families that cannabis use during adolescent brain development carries measurable psychiatric risk.
#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 population-based longitudinal study provides robust evidence of cannabis use as a modifiable risk factor for developing clinically diagnosed psychiatric disorders in adolescents, moving beyond symptom-level associations to establish clinically relevant outcomes. Given the expanding legal access to cannabis and its increasing use among adolescents, these findings directly inform clinical screening, counseling, and prevention strategies in primary care and psychiatric settings. The identification of specific psychiatric disorder risks attributable to adolescent cannabis use enables more targeted informed consent discussions and evidence-based intervention planning for at-risk youth.
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 critical gap in our evidence base by examining clinically diagnosed psychiatric disorders rather than symptom scales alone, which is valuable given cannabis’s increasing accessibility to adolescents. However, several important confounders warrant careful interpretation: genetic vulnerability to psychosis and mood disorders, concurrent use of other substances, socioeconomic factors, and the reverse causality problem whereby undiagnosed psychiatric symptoms may drive cannabis initiation rather than result from it. The study’s strength lies in its size and diagnostic rigor, yet we must remain cautious about attributing causation from observational data, particularly given that adolescent brains are still developing and self-selection bias inevitably affects substance use studies. For clinical practice, these findings reinforce the importance of detailed substance use screening during adolescent mental health assessments and frank conversations about cannabis risks during this developmentally sensitive period, while recognizing that individual risk varies considerably based on family history, baseline mental health status, and other contextual factors.
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