Cannabis is the most widely used psychoactive substance among adolescents worldwide, and the age at which consumption begins to decrease. Cannabis use in adolescents is associated with a wide range of adverse consequences in adulthood including increased vulnerability to psychosis and other mental disorders, as well as suicidal ideation and attempt. The aim of this study is to extend understanding of the link between cannabis use and mental illness by examining whether cannabis use at early ages predicts transdiagnostic variables that are precursors to severe clinical diagnoses.
Methods:
A descriptive cross-sectional study was conducted. The sample was made up of 605 adolescents from 7th to 9th grades, with a mean age of 13.2 years (SD = 1.0, 47% girls). The variables evaluated were: anomalous perception of reality, intolerance of uncertainty, rumination, suicide attempt, hopelessness, and symptoms of depression and anxiety. The administration of the questionnaires was carried out in groups of 20 participants under the supervision of a researcher in a unique session of 1 hour.
Results:
Adolescent cannabis users scored higher on all variables assessed: anomalous perception of reality (Cohen’s d = .60), rumination (d = .48), intolerance of uncertainty (d = .11), suicidal attempt (affirmative answer: 25.9% of users vs 7.7% of non-users), hopelessness (d = .85), symptoms of depression (d = .80), and anxiety (d = .39). A binary logistic regression showed that the only variable uniquely related to cannabis use was hopelessness (Wald = 4.560, OR: 1.159, p = .033).
Conclusions:
Among some mental health risk factors, hopelessness appears uniquely related to cannabis use. Adolescents may use cannabis as a coping strategy for negative thoughts and emotions, or it may be a consequence of cannabis use. Future prevention programs should focus on preventing/treating modifiable factors such as hopelessness, and delaying cannabis use in specific subgroups of adolescents who experience pathologies such as depression or suicide attempts.
Alarcó-RosalesR.Sánchez-SanSegundoM.Ferrer-CascalesR.Albaladejo-BlázquezN.Ruiz-RobledilloN.DelvecchioE.Oltra-CucarellaJ. (2019). Relationships between problematic cannabis use and risky behaviors in spanish adolescents. International Journal of Environmental Research and Public Health, 16(17), 3029. https://doi.org/10.3390/ijerph16173029
2.
AldaoA. (2012). Emotion regulation strategies as transdiagnostic processes: A closer look at the invariance of their form and function. Revista de Psicopatología y Psicología Clínica, 17(3), 26, 12–77. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11843
3.
AldaoA.Nolen-HoeksemaS.SchweizerS. (2010). Emotion regulation strategies across psychopathology: a meta-analytic review. Clinical Psychology Review, 30, 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
4.
AdrianM.McCartyC.KingK.McCauleyE.Vander StoepA. (2014). The internalizing pathway to adolescent substance use disorders: Mediation by ruminative reflection and ruminative brooding. Journal of Adolescence, 37, 983–991. https://doi.org/10.1016/j.adolescence.2014.07.010
5.
BeckA. T.WeissmanA.LesterD.TrexlerL. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42(6), 861–865. https://doi.org/10.1037/h0037562
6.
BernardiniF.GobbicchiC.AttademoL.PuchalskiS.TrezziR.MorettiP., . . . LoasG. (2018). Cannabis use, psychotic like experiences and aberrant salience in a sample of Belgian students.The Journal of Nervous and Mental Disorder, 206, 493–500. https://doi.org/10.1097/NMD.0000000000000849
7.
CarletonR. N.NortonM.AsmundsonG. J. (2007). Fearing the unknow: A short version of the intolerance of uncertainty scale. Journal of anxiety disorders, 26, 468–479. https://doi.org/10.13072/midss.249
8.
CapraC.KavanaghD. J.HidesL.ScottJ. G. (2015). Subtypes of psychotic-like experiences are differentially associated with suicidal ideation, plans and attempts in youth adults. Psychiatry Research, 228, 894–898. https://doi.org/10.1016/j.psychres.2015.05.002
9.
ChangE. C. (2017). Hope and Hopelessness as predictors of suicide ideation in Hungarian college students. Death Studies, 41(7), 455–460. https://doi.org/10.1080/07481187.2017.1299255
10.
ConwayK. P.SwendsenJ.HuskyM. M.Jian-PingH.MerikangasK. R. (2016). Association of lifetime mental disorders and subsequent alcohol and illicit drug use: Results from the National Comorbidity Survey-Adolescent Suplement. Journal of the American of Child & Adolescent Psychiatry, 55(4), 280–288. https://doi.org/10.1016/j.jaac.2016.01.006
11.
DalsgaardS.ThorsteinssonE.TrabjergB. B.SchullehnerJ.Plana-RipollO.BrikellI., . . . PedersenC. B. (2020). Incidence rates and cumulative incidence of the full sprectrum of diagnosed mental disorders in childhood and adolescence. JAMA Psychiatry, 77, 155–164. https://doi.org/10.1001/jamapsychiatry.2019.3523
12.
DemetriouC.OzerB. U.EssauC. A. (2015). Self-report questionnaires. In CautinR. L.LilienfeldS. O. (Eds.), The encyclopedia of clinical psychology (pp. 1–6). John Wiley & Sons. https://doi.org/10.1002/9781118625392.wbecp507
13.
DespinaB.OrriM.Castellanos-RyanN.RenaudJ.MontreuilT.BoivinM., . . . GeoffroyM. (2020). Cannabis use, depression and suicidal ideation in adolescence: direction of associations in a population based cohort. Journal of Affective Disorders, 274, 1076–1083. https://doi.org/10.1016/j.ad.2020.05.136
14.
Di FortiM.MarconiA.CarraE.FraiettaS.TrottaA.BonomoM., . . . MurrayR. M. (2015). Proportion of patiens in south London with first-episode psychosis attributable to use of high potency cannabis: a case-control study. Lancet Psyhiatry, 2, 233–238. https://doi.org/10.1016/S2215-0366(14)00117-5
15.
EpsteinM.HillK. G.NevellA. M.GuttmannovaK.BaileyJ. A.AbbottR. D., . . . HawkinsJ. D. (2015). Trajectories of marijuana use from adolescence into adulthood: Environmental and individual correlates. Developmental Psychology, 51, 1650–1663. https://doi.org/10.1037/dev0000054
16.
FieldA. (2013). Discovering statistics using IBM SPSS statistics. Sage Publications
17.
Fonseca-PedreroE.Lucas-MolinaB.Pérez-AlbénizA.InchaustiF.Ortuño-SierraJ. (2018). Experiencias psicóticas atenuadas y consumo de cannabis en adolescentes de la población general. Adicciones, 32(1), 41–51. https://doi.org/10.20882/adicciones.1149
18.
Fonseca-PedreroE.Ortuño-SierraJ.PainoM.MuñizJ. (2016). Psychotic-like experiences and substance use in college students. Adicciones, 28, 144–153. https://doi.org/10.20882/adicciones.1149
19.
GageS. H.HickmanM.ZammitS. (2016). Association between cannabis and psychosis: Epidemiologic evidence. Biological Psychiatry, 79, 549–556. https://doi.org/10.1016/j.biopsych.2015.08.001
20.
GilletC. B.BilekE. L.HannaG. L.FitzgeraldK. D. (2018). Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clinical Psychology Review, 60, 100–108. https://doi.org/10.1016/j.cpr.2018.01.007
21.
GobbiG.AtkinT.ZytynskiT.WangS.AskariS.BoruffJ., . . . MayoN. (2019). Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry, 76(4), 426–434. https://doi.org/10.1001/jamapsychiatry.2018.4500
22.
HannaR. C.PerezJ. M.GhoseS. (2017). Cannabis and development of dual diagnoses: A literature review. The American Journal of Drug and Alcohol Abuse, 43(4), 442–455. https://doi.org/10.1080/00952990.2016.1213273
23.
HooshmandS.WilloughbyT.GoodM. (2012). Does the direction of effects in the association between depressive symptoms and health-risk behaviors differ by behavior? A longitudinal study across the high school years. Journal of Adolescence Health50, 140–147. https://doi.org/10.1016/j.jadohealth.2011.05.016
24.
KesbyA.MaguireS.BrownlowR.GrishamJ. R. (2017). Intolerance of Uncertainty in eating disorders: An update on the field. Clinical Psychology Review, 56, 94–105. https://doi.org/10.1016/j.cpr.2017.07.002
25.
KhakpoorS.Mohammadi BaytmarJ.SaedO. (2019). Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial. Research in Psychotherapy: Psychopathology, Process and Outcome, 22(3), 402–412. https://doi.org/10.4081/ripppo.2019.379
26.
KuepperR.van OsJ.LiebR.WittchenH. U.HoflerM.HenquetC. (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. BMJ, 342, d738. https://doi.org/10.1136/bmj.d738
27.
KunduP.BensonB. E.RosenD.FrangouS.LeibenluftE.LuhW. M., . . . ErnstM. (2018). The integration of functional brain activity from adolescence to adulthood. The Journal of Neuroscience, 38, 3559–3570. https://doi.org/10.1523/JNEUROSCI.1864-17.2018
28.
LevineA.ClemenzaK.RynnM.LiebermanJ. (2017). Evidence for the risks and consequences of adolescent cannabis exposure. Journal of the American Academy of Child & Adolescent Psychiatry, 56(3), 214–225. https://doi.org/10.1016/j.jaac.2016.12.014
29.
MahoneyA. E.McEvoyP. M. (2012) Trait versus situation-specific intolerance of uncertainty in a clinical sample with anxiety and depressive disorders. Cognitive Behaviour Therapy, 41(1), 26–39.
30.
MalmbergM.KleinjanM.VermulstA. A.OverbeekG.MonshouwerK.LammersJ.EngelsR. C. M. E. (2012). Do substance use risk personality dimensions predict the onset of substance use in early adolescence? A variable –an person- centered approach. Journal of Youth and Adolescence, 41(11), 1512–1525. https://doi.org/10.1007/s10964-012-9775-6
31.
MalmbergM.OverbeekG.MonshouwerK.LammersJ.VolleberghW. A.EngelsR. C. (2010). Substance use risk profiles and associations with early substance use in adolescence. Journal of Behavioral Medicine, 33, 474–485. https://doi.org/10.1007/s10865-010-9278-4
32.
Martínez-FernándezL. C.Delgado-UrrechoJ. M.Moreno-MínguezA. (2018). PISA 2015 en España: oportunidad y límites para una evaluación territorializada del sistema educativo. Ería. Revista Cuatrimestral de Geografía, 3(3), 267–285. https://doi.org/10.17811/er.3.2018.267-285
33.
McLaughlinK. A.Nolen-HoeksemaS. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49, 186–193. https://doi.org/10.1016/j.brat.2010.12.006
34.
MeierM. H.BeardsleeJ.PardiniD. (2020). Associations between recent and cumulative cannabis use and internalizing problems in boys from adolescence to young adulthood. Journal of Abnormal Child Psychology, 48(6), 1–12. https://doi.org/10.1007/s10802-020-00641-8
35.
MenardS. (1995). Applied logistic regression analysis. Sage University Paper Series on Quantitative Applications in the Social Sciences, 07-106. Sage
36.
MoserK.PearsonM. R.HustadJ. T.BorsariB. (2014). Drinking games, tailgating, and pregaming: Precollege predictors of risky college drinking. American Journal of Drug and Alcohol Abuse, 40, 367–373. https://doi.org/10.3109/00952990.2014.936443
37.
MyersR. (1990). Classical and modern regression with applications (2nd ed.). Duxbury.
38.
National Academies of Sciences, Engineering, and Medicine (2019). The Promise of adolescence: Realizing opportunity for all youth. The National Academy Press.
39.
Nolen-HoeksemaS.WatkinsE. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6, 589–609. https://doi.org/10.1177/1745691611419672
40.
OglesbyM. E.AlbaneseB. J.ChavarriaJ.SchmidtN. B. (2014). Intolerance of Uncertainty in Relation to Motives for Alcohol Use. Cognitive Therapy and Research, 39(3), 356–365. https://doi.org/10.1007/s10608-014-9665-1
41.
OECD (2016). PISA 2015 Results (Volume I): Excellence and equity in education. PISA, OECD Publishing.
42.
OrtinA.ElkingtonK. S.EisenbergR.MirandaR.CaninoG.BirdH.DuarteC. S. (2019). Suicide attempts and course of suicidal ideation among Puerto Rican early adolescents. Journal of Abnormal Child Psychology, 47(10), 1723–1734. https://doi.org/10.1007/s10802-019-00554-1
43.
QuinnH.ThissenD.LiuY.MagnusB.LaiJ. S.AmtmannD.… DeWaltD. A. (2014). Using item response theory to enrich and expand the PROMIS pediatric self-report banks. Health and Quality Life Outcomes, 12(1), 160. https://doi.org/10.1186/s12955-014-0160-x
44.
RialA.BurkhartG.IsornaM.BarreiroC.VarelaJ.GolpeS. (2019). Cannabis use among adolescents: Risk pattern, implications and posible explanatory variables. Adicciones, 31, 64–77. https://doi.org/10.20882/adicciones.1212
45.
RicarteJ. J.AizpurúaE.RosL.LatorreJ. M.RaesF. (2018). Psychometric properties of the Spanish Short Depressive Rumination Scale in a nonclinical sample. The Spanish Journal of Psychology, 21, e34. https://doi.org/10.1017/sjp.2018.35
46.
RibeiroJ. D.HuangX.FoxK. R.FranklinJ. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. The British Journal of Psychiatry, 212, 279–286. https://doi.org/10.1192/bjp.2018.27
47.
Rueda-JaimesG. E.Castro-RuedaV. A.Rangel-Martínez-VillalbaA. M.Moreno-QuijanoC.Martínez-SalazarG. A.CamachoP. A. (2016). Validación de la Escala de Desesperanza de Beck en pacientes con riesgo suicida. Revista de Psiquiatría y Salud Mental, 11(2), 86–93. https://doi.org/10.1016/j.rpsm.2016.09.004
48.
SAMHSA (2018). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Substance Abuse and Mental Health Services Administration.
49.
SerafiniG.PompiliM.InnamoratiM.RihmerZ.SherL.GirardiP. (2012). Can cannabis increase the suicide risk in psychosis? A critical review. Current Pharmaceutical Design, 18, 5165–5187. https://doi.org/10.2174/138161212802884663
50.
SimpsonA. K.MagidV. (2016). Cannabis use disorder in adolescence. Child and adolescent psychiatric clinics of North America, 25(3), 431–443. https://doi.org/10.1016/j.chc.2016.03.003
51.
SinghS.BalharaY. P. S.GuptaP.ChristodoulouN. G. (2019). Primary and secondary strategies against illicit drug use among adults aged 18-25: a narrative review. Australasian Psychiatry, 28(1), 1–7. https://doi.org/10.1177/1039856219875048
52.
SunM.WangD.JingL.XiC.DaiL.ZhouL. (2020). Psychometric properties of the 15-item positive subscale of the community assessment of psychic experiences. Schizophrenia Research, 222, 160–166. https://doi.org/10.1016/j.schres.2020.06.003
53.
TaliaferroL. A.BorowskyI. W. (2011). Perspective: physician education: a promising strategy to prevent adolescent suicide. Academic Medicine, 86, 342–347. https://doi.org/10.1097/ACM.0b013e31820984ad
54.
Van DroogenbroeckF.SpruytB.KeppersG. (2018). Gender differences in mental health problems among adolescent and the role of social support: results from the Belgian health interview surveys 2008 and 2013. BMC Psychiatry, 18(6), 1–9. https://doi.org/10.1186/s12888-018-1591-4
55.
VarniJ. W.MagnusB.StuckyB. D.LiuY.QuinnH.ThissenD., . . . DeWaltD. A. (2014). Psychometric properties of the PROMIS pediatric scales: precision, stability, and comparison of different scoring and administration options. Quality of Life Research, 23, 1233–1243. https://doi.org/10.1007/s11136-013-0544-0
56.
WillenL.BijttebierP.ClaesL.RaesF. (2011). Rumination subtypes in relation to problematic substance use in adolescence. Personality and Individual Differences, 50, 695–699. https://doi.org/10.1016/j.paid.2010.12.020
57.
WilsonE. J.StapinskiL.DueberD. M.RapeeR. M.BurtonA. L.AbbottM. J. (2020). Psychometric properties of the Intolerance of Uncertainty Scale-12 in generalized anxiety disorder: Assessment of factor structure, measurement properties and clinical utility. Journal of Anxiety Disorders, 76, 1–8. https://doi.org/10.1016/j.janxdis.2020.102309
58.
World Drug Report. Vienna, Austria: United National Office on Drugs and Crime; 2017
