Clinical Takeaway
Adolescents with higher levels of depression and anxiety symptoms were more likely to initiate and use cannabis more frequently over the following 18 months. This longitudinal evidence supports the self-medication hypothesis, suggesting internalizing symptoms function as a meaningful risk factor for adolescent cannabis use. Clinicians working with anxious or depressed youth should screen proactively for substance use as part of routine mental health assessment.
#12 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 demonstrates a prospective association between specific internalising symptoms and adolescent cannabis initiation, which could inform clinical screening protocols for substance use risk in psychiatric populations. Identifying depression, generalised anxiety, social anxiety, and panic as distinct predictive pathways to cannabis use enables targeted prevention and early intervention strategies in adolescent mental health settings. The findings suggest that clinicians should incorporate substance use counselling into anxiety and depression treatment protocols, particularly in adolescent populations where self-medication patterns may establish problematic use trajectories.
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 Chilean study adds valuable evidence to the self-medication hypothesis in adolescents, suggesting that internalizing symptoms like depression and anxiety may precede cannabis initiation rather than follow it. However, several important caveats warrant consideration: the study captures only an 18-month window during a particularly dynamic developmental period, relies on self-reported psychiatric and substance use measures that may be subject to recall bias, and the Chilean context may have limited generalizability to other populations with different cannabis availability, potency profiles, and cultural attitudes. The cross-cultural applicability is further complicated by the fact that modern cannabis products are substantially more potent than those available during earlier research periods, potentially altering risk trajectories. Clinically, this work reinforces the importance of screening adolescent patients with anxiety or depressive symptoms for cannabis use patterns and substance use risk, while recognizing that the relationship is bidirectional and that early intervention on mental health may reduce problematic cannabis trajectories in vulnerable youth.