Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders

TL;DR

Adolescent cannabis use is linked to a higher risk of developing mental health disorders like psychosis and bipolar disorder by age 26.

Contribution

This study provides large-scale, population-based evidence of the long-term mental health risks associated with adolescent cannabis use.

Findings

Adolescent cannabis use is associated with increased risk of psychotic and bipolar disorders.

The risk of depressive and anxiety disorders also rises with cannabis use, though the effect weakens with age.

Adjusting for past psychiatric conditions slightly reduces the observed associations.

Abstract

This cohort study assesses the association of past-year cannabis use by adolescents with the risk of incident psychiatric, bipolar, depressive, and anxiety disorders by age 26 years.

Is adolescent cannabis use associated with an increased risk of developing psychiatric disorders by young adulthood?

In this cohort study of 463 396 adolescents aged 13 to 17 years who were universally screened for cannabis use, past-year cannabis use was associated with a significantly increased risk of incident psychotic, bipolar, depressive, and anxiety disorders by age 26 years.

This study found that adolescent cannabis use is associated with increased risk of psychiatric disorders in adolescence and young adulthood, highlighting the importance of early prevention efforts, effective public health messaging, and policy development to limit youth exposure as cannabis legalization expands.

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.

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.

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.

Time-varying self-reported past-year cannabis use based on universal, confidential screening during standard pediatric care.

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.

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-reported past-year cannabis use. Past-year cannabis use was associated with an increased risk of incident psychotic (adjusted hazard ratio [AHR], 2.19; 95% CI, 1.97-2.42), bipolar (AHR, 2.01; 95% CI, 1.82-2.22), depressive (AHR, 1.34; 95% CI, 1.30-1.39), and anxiety disorders (AHR, 1.24; 95% CI, 1.21-1.28). The strength of the associations between cannabis use and incident depressive and anxiety disorders decreased as adolescents aged. This pattern was similar but slightly attenuated after additional adjustment for past psychiatric conditions (psychotic disorder: AHR, 1.92; 95% CI, 1.73-2.13; bipolar disorder: AHR, 1.73; 95% CI, 1.57-1.90; depressive disorder: AHR, 1.33; 95% CI, 1.29-1.38; anxiety disorder: AHR, 1.19; 95% CI, 1.16-1.23).

This cohort study found that adolescent cannabis use was associated with increased risk of incident psychiatric disorders, particularly psychotic and bipolar disorders. These results could inform the development of clinical and educational interventions for parents, adolescents, and clinicians, as well as protective policies to prevent or delay adolescent cannabis use in the context of expanding cannabis legalization.

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