# Anxiety and Depression, Not Substance Use, Tracked With

> **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637)
> **Publisher:** CED Clinic (https://cedclinic.com)
> **Canonical URL:** https://cedclinic.com/early-schizophrenia-anxiety-depression-study/
> **Published:** 2026-08-25T11:18:31-04:00 | **Last Modified / Clinically Audited:** 2026-10-14T08:54:41-04:00
> **Clinical Summary:** This early schizophrenia anxiety depression study found mood symptoms correlate with illness severity, while substance use did not in a Northern India cohort.

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CED Clinical Relevance #80 Clinical Evidence Update A cross-sectional observational study of 170 patients with schizophrenia of less than 5 years’ duration, conducted at a tertiary care teaching hospital in Northern India and published August 2026 in Primary Care Companion for CNS Disorders, found substance use, including cannabis (11.8% of the sample), tobacco (31.2%), alcohol (12.9%), and opioids (5.3%), did not correlate highly with PANSS-rated illness severity, while anxiety and depressive symptoms did. It clears the clinical-evidence-update threshold as a peer-reviewed, formally registered human clinical study using validated instruments (PANSS, HAM-A, HAM-D, WHO ASSIST 3.0) that speaks directly to a question cannabis clinicians and psychiatrists managing schizophrenia-spectrum patients are frequently asked, whether ongoing substance use is driving symptom severity, though its cross-sectional, single-site design limits how far the findings can be generalized or read as causal.

Clinical Insight | CED Clinic
A recurring worry in both psychiatric and cannabis-medicine practice is that ongoing substance use, cannabis included, is quietly making a patient’s psychotic symptoms worse, and that assumption often shapes how urgently clinicians push patients to stop. This new cross-sectional study of 170 patients with early-phase schizophrenia in Northern India offers a data point worth sitting with: substance use, aggregated across tobacco, alcohol, cannabis, and opioids, did not correlate strongly with PANSS-rated illness severity, while anxiety and depressive symptoms did, and did so significantly. That does not mean substance use is harmless in this population, and the study was not designed to test cannabis specifically or to establish cause and effect in either direction. But it is a useful, evidence-based check against the reflex assumption that a schizophrenia patient’s substance use is automatically the main driver of how sick they currently look, when in this sample, unaddressed anxiety and depression were the stronger correlates.

SchizophreniaComorbid AnxietyComorbid DepressionSubstance UseCross-Sectional Study

Audience
Psychiatric and primary care clinicians managing patients with schizophrenia-spectrum illness, cannabis clinicians whose patients carry a co-occurring psychotic disorder, and family members of patients with early-phase schizophrenia

Primary Topic
A cross-sectional observational study of 170 patients with schizophrenia of less than 5 years’ duration in Northern India, examining how commonly anxiety, depressive symptoms, and substance use (including cannabis) occurred, and whether each correlated with PANSS-rated illness severity, published in Primary Care Companion for CNS Disorders in August 2026

Source
[Read the study in Primary Care Companion for CNS Disorders](https://doi.org/10.4088/PCC.26m04210)

A cross-sectional study of 170 patients with early-phase schizophrenia in Northern India found that 32.9% had moderate to severe anxiety and 16.5% had moderate to severe depressive symptoms, and that both correlated significantly with PANSS illness-severity scores. Substance use was common, tobacco (31.2%), alcohol (12.9%), cannabis (11.8%), and opioids (5.3%), but did not correlate highly with illness severity as a group. Full text of the study was not accessible for this review; all claims here are confined to what the published abstract states.

What This Study Teaches Us
This study shows that in a cohort of 170 patients with schizophrenia of less than 5 years’ duration, symptoms of anxiety and depression were common (32.9% and 16.5% at moderate-to-severe levels, respectively) and tracked significantly with how severe a patient’s overall illness looked on the PANSS, with anxiety (HAM-A) significantly correlated with PANSS total, negative, and general psychopathology scores, and depression (HAM-D) correlated moderately with all PANSS components (rho = 0.242 to 0.439, P < .001). By contrast, substance use, assessed as a group across tobacco, alcohol, cannabis, and opioids using the WHO ASSIST 3.0 screening tool, was common but did not correlate highly with PANSS severity in this sample. The abstract does not report a cannabis-specific correlation with severity separately from the pooled substance-use variable, so this study cannot be read as testing cannabis on its own.

Why This Matters
Clinicians treating patients with schizophrenia, including cannabis clinicians managing patients who carry a co-occurring psychotic disorder, often have to decide where to direct limited clinical attention: toward pushing a patient to stop substance use, toward screening and treating anxiety and depression, or both. This study’s finding, that substance use as a group did not track closely with illness severity while anxiety and depression did, is a useful evidence-based nudge toward taking comorbid mood and anxiety symptoms as seriously as substance use itself in this population, without this single study settling the question for any individual patient.

Study Snapshot

Study Type
Cross-sectional observational study

Setting
Department of psychiatry, a tertiary care teaching hospital in Northern India

Study Period
November 2023 to May 2025 (18 months)

Population
170 patients aged 18 to 60 years with schizophrenia of less than 5 years’ duration, diagnosed per ICD-11 criteria

Assessment Tools
Positive and Negative Syndrome Scale (PANSS); Hamilton Anxiety Rating Scale (HAM-A); Hamilton Depression Rating Scale (HAM-D); WHO Alcohol, Smoking and Substance Involvement Screening Test, Version 3.0 (WHO ASSIST 3.0)

Moderate-to-Severe Anxiety
32.9% of patients (HAM-A score of 25 or higher)

Moderate-to-Severe Depression
16.5% of patients (HAM-D score of 20 or higher)

Substance Use Prevalence
Tobacco 31.2%, alcohol 12.9%, cannabis 11.8%, opioids 5.3%

Substance Use and Severity
Substance use did not correlate highly with schizophrenia severity as measured by the PANSS

Anxiety and Severity
Significant positive correlations between HAM-A scores and PANSS total, negative, and general psychopathology scores

Depression and Severity
Depressive symptoms (HAM-D) correlated moderately with all PANSS components (rho = 0.242 to 0.439, P < .001)

Trial Registration
[Clinical Trials](https://cedclinic.com/endocannabinoid-system-emotional-memory-ptsd-treatment/) Registry-India, CTRI/2023/11/059495

Journal
Primary Care Companion for CNS Disorders, 2026;28(4):26m04210

DOI
10.4088/PCC.26m04210

PMID
42628038

Authors
Prabhas Pandey, Ajeet Sidana, Prinka Arora

Sourcing Note
This review is based on the published PubMed abstract; full text was not accessible through PubMed Central or an open-access repository at the time of writing

Clinical Bottom Line
In 170 patients with early-phase schizophrenia in Northern India, moderate to severe anxiety (32.9%) and depression (16.5%) correlated significantly with PANSS illness severity, while substance use as a group, including cannabis (11.8%), tobacco (31.2%), alcohol (12.9%), and opioids (5.3%), did not correlate highly with severity. This is one cross-sectional study from a single site, not proof that substance use is clinically irrelevant in schizophrenia or that anxiety and depression are the only drivers of severity worth addressing.

What the Researchers Did

The study team conducted an 18-month cross-sectional observational study, from November 2023 to May 2025, in the psychiatry department of a tertiary care teaching hospital in Northern India, enrolling 170 patients aged 18 to 60 with schizophrenia of less than 5 years’ duration diagnosed under ICD-11 criteria.

Every patient was assessed with the Positive and Negative Syndrome Scale (PANSS) for overall illness severity, the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) for comorbid mood and anxiety symptoms, and the WHO Alcohol, Smoking and Substance Involvement Screening Test, Version 3.0 (WHO ASSIST 3.0) for substance use. The study was formally registered with the [Clinical Trials](https://cedclinic.com/endocannabinoid-system-emotional-memory-ptsd-treatment/) Registry-India (CTRI/2023/11/059495).

Anxiety and Depression Were Common, and Tracked With Severity

Moderate to severe anxiety, defined as a HAM-A score of 25 or higher, was present in 32.9% of patients, and moderate to severe depressive symptoms, a HAM-D score of 20 or higher, were present in 16.5%.

Both symptom clusters correlated significantly with how severe a patient’s illness looked on the PANSS. Anxiety scores showed significant positive correlations with PANSS total, negative, and general psychopathology scores, while depressive symptom scores correlated moderately with all PANSS components (rho = 0.242 to 0.439, P < .001).

Substance Use Was Common, Cannabis Included, but Did Not Track With Severity

Substance use was frequent in this cohort: tobacco use in 31.2% of patients, alcohol in 12.9%, cannabis in 11.8%, and opioids in 5.3%, as screened with the WHO ASSIST 3.0.

Despite how common substance use was, the abstract reports that it did not correlate highly with schizophrenia severity as measured by the PANSS. The published abstract presents this as a finding for substance use as a pooled group rather than reporting a separate statistical test for cannabis alone, so this study does not establish that cannabis specifically has no relationship to symptom severity, only that substance use overall did not track closely with severity in this sample.

What the Study Cannot Establish

This is a cross-sectional study, capturing a single point in time for each patient, so it cannot establish whether substance use, anxiety, or depression came before or after increases in illness severity, or rule out that all three are being driven by some shared underlying factor.

The sample was drawn from one tertiary care teaching hospital in Northern India, which limits how confidently these prevalence figures and correlations generalize to other regions, health systems, or patient populations, including [cannabis medicine](https://cedclinic.com/essential-oils-industrial-hemp-antimicrobial-benefits/) patients managed outside a hospital psychiatry setting. Full text of the study was not accessible for this review, so this summary is confined strictly to what the published abstract reports and does not include any dose-response, subgroup, or mechanism detail beyond it.

What the Authors Concluded

The study authors conclude that their findings highlight the critical need for early screening and comprehensive management of anxiety and depressive symptoms in schizophrenia, noting that the presence of these comorbidities significantly correlates with illness severity and may influence long-term functional outcomes.

How Strong Is This Evidence?
This is a formally registered ([Clinical Trials](https://cedclinic.com/endocannabinoid-system-emotional-memory-ptsd-treatment/) Registry-India), peer-reviewed, prospective cross-sectional study of 170 patients using validated, widely used clinical instruments, PANSS, HAM-A, HAM-D, and WHO ASSIST 3.0, published in a peer-reviewed journal. Its focus on early-phase schizophrenia (less than 5 years’ duration) is a meaningful strength, since comorbidity patterns can differ from those in patients with long-standing illness, and the authors report specific correlation coefficients and significance levels rather than only descriptive prevalence.

Where This Paper Deserves Skepticism
A cross-sectional design captures a single moment in each patient’s illness course and cannot establish whether anxiety, depression, or substance use preceded changes in symptom severity, or whether an unmeasured factor is driving both. The sample was drawn from one tertiary hospital in Northern India, and how closely these prevalence rates and correlations would replicate elsewhere, including outside India or outside a hospital psychiatric setting, is not established by this study alone. The abstract reports substance use as a pooled category rather than testing cannabis, tobacco, alcohol, and opioids separately against PANSS severity, so it is not possible from the published abstract to know whether the null finding for substance use overall would hold, or not hold, for cannabis specifically. Full text of the study was not accessible for this review; the summary above is confined to what the abstract itself states.

What This Paper Does Not Show
This study does not show that [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) has no effect on schizophrenia symptom severity; it shows that substance use as a pooled category, encompassing tobacco, alcohol, cannabis, and opioids together, did not correlate highly with PANSS severity in this specific sample. It does not show that anxiety or depression cause worse psychotic symptoms, since a cross-sectional correlation cannot establish direction or causation. It does not show how these findings generalize beyond a single tertiary care hospital in Northern India, and because full text was not accessible for this review, it does not report any dose-response, subgroup, or mechanistic detail beyond what appears in the published abstract.

How This Fits With the Broader Clinical Conversation

Comorbid anxiety, depression, and substance use are well documented across the schizophrenia literature globally, but this study adds a data point from a population, early-phase schizophrenia patients in India, that the authors describe as less studied than schizophrenia comorbidity in general.

For clinicians who split their attention between substance use counseling and mood or anxiety symptom management in patients with psychotic disorders, this study is a reminder that the two are not automatically equivalent in their relationship to how severe a patient’s current presentation looks, at least in this sample and using this study’s measurement approach.

Dr. Caplan’s Take

*I see the appeal of this finding, and I want to be careful not to overstate it. In my own practice, when a schizophrenia-spectrum patient is also using cannabis, the reflexive move is often to treat the substance use as the primary lever to address, sometimes ahead of screening for anxiety and depression. This study is a useful, evidence-based check on that reflex: in this particular cohort, substance use as a group did not track closely with how severe a patient’s illness looked, while anxiety and depression did, and did so with real statistical significance.*

*What I will not do is extend this into a claim that [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) is fine for a patient with schizophrenia, or that substance use can be deprioritized. The abstract does not test cannabis on its own, it is one cross-sectional study from a single hospital, and it cannot tell me whether a specific patient’s [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) is helping, hurting, or unrelated to their symptom trajectory over time. What it does support is treating anxiety and depression screening in schizophrenia-spectrum patients as at least as clinically urgent as substance use counseling, not as an afterthought to it.*

What a Careful Reader Should Take Away
In a cross-sectional study of 170 patients with early-phase schizophrenia in Northern India, anxiety and depressive symptoms correlated significantly with illness severity, while substance use as a group, including cannabis, did not correlate highly with severity. This supports taking comorbid anxiety and depression screening seriously in this population; it does not establish that cannabis or other substance use is clinically irrelevant to schizophrenia, and it cannot be generalized beyond this single-site, single-timepoint sample.

Evidence Interpretation Guide

Table of Contents

- [How to Read a Cross-Sectional Comorbidity Study Without Overreaching](#How_to_Read_a_Cross-Sectional_Comorbidity_Study_Without_Overreaching)[A Four-Step Reading Frame](#A_Four-Step_Reading_Frame)
- [What This Study Means Depending on Who Is Asking](#What_This_Study_Means_Depending_on_Who_Is_Asking)[This Study Does Not Give You a Pass on Substance Use](#This_Study_Does_Not_Give_You_a_Pass_on_Substance_Use)
- [Screen for Anxiety and Depression as Rigorously as Substance Use](#Screen_for_Anxiety_and_Depression_as_Rigorously_as_Substance_Use)
- [A Reason for Caution Before Reading Too Much Into This Finding](#A_Reason_for_Caution_Before_Reading_Too_Much_Into_This_Finding)
- [Comorbidity Burden in Early-Phase Illness Deserves Direct Attention](#Comorbidity_Burden_in_Early-Phase_Illness_Deserves_Direct_Attention)
- [A Pooled Substance-Use Variable Limits What Can Be Concluded](#A_Pooled_Substance-Use_Variable_Limits_What_Can_Be_Concluded)
- [Comorbidity Screening Gaps Are the Real Public Health Signal Here](#Comorbidity_Screening_Gaps_Are_the_Real_Public_Health_Signal_Here)
- [A Null Finding for Substance Use Is Not the Same as Proof of No Relationship](#A_Null_Finding_for_Substance_Use_Is_Not_the_Same_as_Proof_of_No_Relationship)
- [A Well-Instrumented Study With Real Design Limits](#A_Well-Instrumented_Study_With_Real_Design_Limits)
- [Frequently Asked Questions](#Frequently_Asked_Questions)[Related](#Related)

## How to Read a Cross-Sectional Comorbidity Study Without Overreaching

A finding that substance use ‘did not correlate highly’ with illness severity can be misread as proof that substance use does not matter in schizophrenia.

Four checks keep this study’s real, more limited contribution in view.

### A Four-Step Reading Frame

**Separate ‘did not correlate with severity’ from ‘is harmless’**The study measured a statistical association with PANSS severity scores at a single point in time, not whether substance use affects relapse risk, treatment adherence, functioning, or other outcomes it did not measure.

**Notice substance use was analyzed as one pooled group**Tobacco, alcohol, cannabis, and opioids were assessed together against severity in the abstract; this study does not report a cannabis-specific correlation separately.

**Remember cross-sectional means one snapshot in time**The design cannot establish whether anxiety, depression, or substance use came first, or whether all three trace back to a shared underlying cause.

**Hold the single-site limitation in view**All 170 patients were drawn from one tertiary care teaching hospital in Northern India, which limits how confidently the findings generalize elsewhere.

The Research Question
How common are anxiety, depressive symptoms, and substance use in patients with early-phase schizophrenia, and do these factors correlate with how severe a patient’s illness currently looks?

The Patient Question
If I have schizophrenia and I use cannabis or another substance, does this study mean my substance use is not something my care team needs to address?

The Bottom Line
This study found anxiety and depression, not substance use as a group, correlated with illness severity in one hospital-based sample; it does not establish that substance use, including cannabis, is safe or irrelevant for people living with schizophrenia.

CED Perspective Lens

## What This Study Means Depending on Who Is Asking

Patients, clinicians, and researchers may read a null finding for substance use very differently. These perspectives examine what this single-site comorbidity study supports for each audience without extending it beyond what the abstract states.

Lens Overview
Eight perspectives keep a single-site, cross-sectional comorbidity study from being oversold as proof that substance use does not matter in schizophrenia, or dismissed because it did not find what many clinicians might expect.

#### This Study Does Not Give You a Pass on Substance Use

If you live with schizophrenia and also use cannabis or another substance, this study does not mean your substance use is fine or unimportant to your care team; it found that in one hospital-based sample, substance use as a group did not track closely with illness severity, while anxiety and depression did.

If you are experiencing anxiety or low mood alongside a schizophrenia diagnosis, this study is a reminder that those symptoms deserve direct attention from your care team, not just secondary attention behind substance use counseling.

Lens takeaway
Ask your care team to screen for anxiety and depression directly, and keep substance use conversations going regardless of this study’s findings.

#### Screen for Anxiety and Depression as Rigorously as Substance Use

For primary care clinicians co-managing patients with schizophrenia, this study supports building routine anxiety and depression screening into visits with the same rigor typically applied to substance use screening, rather than treating mood and anxiety symptoms as secondary.

The correlation coefficients reported here (rho = 0.242 to 0.439 for depression) are moderate, not dramatic, and this remains one cross-sectional study, so it should inform screening priorities rather than replace an individualized clinical assessment.

Lens takeaway
Build structured anxiety and depression screening into routine care for schizophrenia-spectrum patients, alongside, not instead of, substance use assessment.

#### A Reason for Caution Before Reading Too Much Into This Finding

Cannabis clinicians who see patients with a co-occurring schizophrenia-spectrum diagnosis should be careful not to read this study as reassurance that cannabis use is unrelated to symptom severity; the abstract analyzed substance use as a pooled category, not cannabis specifically, so no cannabis-specific conclusion can be drawn from it.

What is clinically useful here is the reminder that anxiety and depression screening deserves equal weight to substance use discussions in this population, since untreated mood and anxiety symptoms correlated significantly with how severe a patient’s presentation looked.

Lens takeaway
Treat this as evidence to add anxiety and depression screening to schizophrenia-spectrum patient visits, not as evidence that cannabis use can be deprioritized.

#### Comorbidity Burden in Early-Phase Illness Deserves Direct Attention

For psychiatric clinicians, the prevalence figures alone are clinically relevant: roughly a third of patients within 5 years of a schizophrenia diagnosis had moderate to severe anxiety, and about one in six had moderate to severe depression, in a sample where these comorbidities significantly tracked with overall illness severity.

The finding that substance use did not correlate as strongly invites further, more granular research, including studies that separate cannabis from other substances, rather than a conclusion that substance use can be set aside in comorbidity assessment.

Lens takeaway
Prioritize structured anxiety and depression assessment in early-phase schizophrenia care, and treat this study’s substance-use finding as a hypothesis for further research, not a settled answer.

#### A Pooled Substance-Use Variable Limits What Can Be Concluded

[Addiction medicine](https://cedclinic.com/cognitive-flexibility-alcohol-cocaine-misuse-effects/) clinicians will likely want more granularity than this abstract provides; tobacco, alcohol, cannabis, and opioids carry different risk profiles and are used at different rates (31.2%, 12.9%, 11.8%, and 5.3%, respectively) in this cohort, and pooling them into one substance-use variable obscures whether any single substance behaves differently from the group average.

This study is a call for future research that tests each substance separately against illness severity, rather than a finding that substance use in general can be treated as clinically neutral in schizophrenia.

Lens takeaway
Read the pooled substance-use finding as a limitation to address in future research, not as evidence that any specific substance, including cannabis, is unrelated to illness severity.

#### Comorbidity Screening Gaps Are the Real Public Health Signal Here

The public health takeaway from this study is less about substance use specifically and more about the scale of undertreated anxiety and depression in early-phase schizophrenia, present in roughly a third and one-sixth of patients respectively in this sample.

Coverage that frames this as ‘cannabis does not worsen schizophrenia’ would overstate what a pooled, cross-sectional, single-site finding can support; the more defensible message is that mood and anxiety comorbidity in schizophrenia needs more systematic screening.

Lens takeaway
Public-facing messaging should emphasize the comorbidity screening gap this study documents, not draw conclusions about any single substance.

#### A Null Finding for Substance Use Is Not the Same as Proof of No Relationship

A cross-sectional study finding that substance use ‘did not correlate highly’ with PANSS severity is a null or weak finding, not evidence of absence; with 170 patients and substance use rates as low as 5.3% for opioids, statistical power to detect a real cannabis-specific association may simply have been limited.

The abstract does not report confidence intervals, effect sizes, or the specific statistical test used for the substance-use comparison, which makes it difficult to judge how strong or weak this null finding actually is from the published abstract alone.

Lens takeaway
Treat the substance-use finding as inconclusive rather than as evidence that substance use, including cannabis, has no relationship to schizophrenia severity.

#### A Well-Instrumented Study With Real Design Limits

This study’s strengths are real: a registered protocol, validated instruments (PANSS, HAM-A, HAM-D, WHO ASSIST 3.0), a focus on early-phase illness, and reported correlation statistics rather than only descriptive prevalence.

Its limitations are also real: a single-site, cross-sectional design; a pooled rather than substance-specific analysis of substance use; and, for this review, abstract-only sourcing, since full text was not accessible through PubMed Central or an open-access repository at the time of writing. Any dose-response, subgroup, or mechanistic detail that may exist in the full paper is not reflected here.

Lens takeaway
A methodologically sound but limited single-site study; treat its substance-use finding as preliminary pending substance-specific and multi-site replication.

Join the Conversation

Have a question about how this applies to your situation? [Ask Dr. Caplan](https://benjamincaplan.com/ask-dr-caplan)

Want to discuss this topic with other patients and caregivers? [Join the forum discussion](https://cedclinic.com/interact/discussion-forums/)

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Source: [Pandey P, Sidana A, Arora P. Prevalence of Anxiety, Depressive Symptoms, and Substance Use in Schizophrenia. Prim Care Companion CNS Disord. 2026;28(4):26m04210. DOI: 10.4088/PCC.26m04210. PMID: 42628038.](https://doi.org/10.4088/PCC.26m04210)

Related Reading at CED Clinic
Continue exploring the evidence

[Cannabis Use and the Age-Related Acceleration of Psychosis Onset: What a New 149-Study Meta-Analysis Shows](https://cedclinic.com/cannabis-use-age-at-onset-psychosis-meta-analysis/)

A CED review of a large meta-analysis on cannabis use and age at onset of psychosis, useful context on the broader evidence base connecting cannabis and psychotic disorders.

[Read the psychosis age-of-onset review](https://cedclinic.com/cannabis-use-age-at-onset-psychosis-meta-analysis/)

[Cannabinoids for Mental Health and Addiction: What 200 Studies Actually Show](https://cedclinic.com/cannabinoids-mental-health-addiction-meta-analysis/)
A CED review of a large systematic review and meta-analysis of cannabinoids across mental health and addiction outcomes, relevant background for clinicians weighing substance use and psychiatric comorbidity together.

[Read the mental health and addiction meta-analysis review](https://cedclinic.com/cannabinoids-mental-health-addiction-meta-analysis/)

[Comparative Efficacy of Non-Pharmacological Interventions for Individuals With Cannabis Use Disorder](https://cedclinic.com/comparative-efficacy-of-non-pharmacological-interventions-for-individuals-with-cannabis-use-disorder-2/)
A CED review of a systematic review and network meta-analysis protocol on non-pharmacological interventions for [cannabis use disorder](https://cedclinic.com/sex-differences-cannabis-stress-reactivity-oxytocin/), useful companion reading on treating comorbid cannabis use.

[Read the cannabis use disorder interventions review](https://cedclinic.com/comparative-efficacy-of-non-pharmacological-interventions-for-individuals-with-cannabis-use-disorder-2/)

## Frequently Asked Questions

What did this study examine?

A cross-sectional observational study of 170 patients aged 18 to 60 with schizophrenia of less than 5 years’ duration, conducted at a tertiary care teaching hospital in Northern India, examined how common anxiety, depressive symptoms, and substance use were, and whether each correlated with illness severity measured by the PANSS.

How common were anxiety and depression in this sample?

Moderate to severe anxiety (HAM-A score of 25 or higher) was present in 32.9% of patients, and moderate to severe depressive symptoms (HAM-D score of 20 or higher) were present in 16.5%.

Did anxiety and depression correlate with illness severity?

Yes. Anxiety scores showed significant positive correlations with PANSS total, negative, and general psychopathology scores, and depression scores correlated moderately with all PANSS components (rho = 0.242 to 0.439, P < .001).

How common was substance use, including cannabis?

Substance use was common: tobacco in 31.2% of patients, alcohol in 12.9%, cannabis in 11.8%, and opioids in 5.3%, screened using the WHO ASSIST 3.0.

Did substance use correlate with illness severity?

No. The study reports that substance use, assessed as a pooled group across tobacco, alcohol, cannabis, and opioids, did not correlate highly with schizophrenia severity as measured by the PANSS.

Does this mean cannabis use does not affect schizophrenia symptoms?

No. The published abstract analyzed substance use as one combined category rather than testing cannabis separately, so this study cannot establish a cannabis-specific conclusion, only that substance use overall did not correlate strongly with severity in this sample.

Can this study show that anxiety or depression cause worse psychotic symptoms?

No. This is a cross-sectional study capturing a single point in time, so it can show correlation but cannot establish which came first or rule out a shared underlying cause.

How generalizable are these findings?

The findings come from one tertiary care teaching hospital in Northern India, so how well the prevalence rates and correlations generalize to other regions, health systems, or patient populations is not established by this single-site study.

Was the full text of this study reviewed for this article?

No. Full text was not accessible through PubMed Central or an open-access repository at the time of writing, so this review is based strictly on the published PubMed abstract, and no dose-response, subgroup, or mechanistic detail beyond the abstract is included.

What do the study authors recommend?

The authors conclude that their findings highlight the critical need for early screening and comprehensive management of anxiety and depressive symptoms in schizophrenia, since these comorbidities significantly correlated with illness severity and may influence long-term functional outcomes.

 

### Related

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### Verification & Medical Governance

- **Lead Clinical Author:** Benjamin Caplan, MD
- **Credentials:** Board Certified in Family Medicine (ABFM), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House).
- **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`).
- **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/).
- **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637).
- **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).