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Rising cannabis use amongst adults with severe psychological distress linked to increased psychiatric care

In a recent study posted to the medRxiv pre-print* server, a team of researchers analyzed trends in cannabis use amongst United States (U.S.) adults with/without severe psychological distress (SPD) (2009-2019) and its link to psychiatric hospitalizations and outpatient mental health care.

Study: Disproportionate increase in cannabis use amongst individuals with serious psychological distress and association with psychiatric hospitalization and outpatient service use within the National Survey on Drug Use and Health 2009-2019. Image Credit: solarseven / Shutterstock

*Essential notice: medRxiv publishes preliminary scientific reports that are usually not peer-reviewed and, due to this fact, shouldn’t be considered conclusive, guide clinical practice/health-related behavior, or treated as established information.


The World Health Organization (WHO) reports that 147 million people, or 2.5% of the whole population, use cannabis, and its growing popularity poses a risk, especially for those with mental health problems. Its use is related to a better risk of psychosis and negative symptoms in schizophrenia, in addition to recently noted links to anxiety and mood disorders. SPD Individuals with high incidences of cannabis and substance use disorders are at greater risk for serious mental illness, health deterioration, and more severe drug abuse. SPD individuals used barely more cannabis between 2008 and 2016, but the following impact on psychiatric services continues to be unclear. Nonetheless, with legalization and attitudinal change, further research is required on changing cannabis use patterns to make clear their effect on mental health.

In regards to the study 

Data for the current study was sourced from the National Survey on Drug Use and Health (NSDUH) public use files spanning 2009 to 2019. A comprehensive cross-sectional survey conducted in america collects detailed data on demographics, substance use, mental health disorders, and health service utilization. The NSDUH excludes a small variety of specific populations from its sample, corresponding to prison inmates or homeless individuals who live outside the community where they grew up into maturity. From the whole of 619,411 respondents, the study focused on 444,947 adults aged 18 and above.

The first metric evaluated was the frequency of cannabis use, divided into two categories: Any use over the past 12 months. One-weekly or more frequent use only. The study also measured using outpatient and inpatient mental health services. The central variable for evaluation was SPD previously 12 months, determined using the Kessler Serious Psychological Distress scale (K6). This scale identifies SPD based on scores, with a threshold distinguishing significant psychiatric disorders.

The study accounted for changes in substance use over time, incorporating survey years into its model. Other predictors within the evaluation included demographic aspects corresponding to sex, income, race, age, marital status, education level, and heavy alcohol use. As for those with SPD, the quantity of cannabis used was a vital think about analyzing psychiatric service use.

Statistical procedures included chi-squared tests, logistic regression models with interaction terms, and predictive margins method for understanding nonlinear model interactions. Weights were adjusted for non-response and consistency with U.S. Census Bureau data within the determination of sampling weights. p<0.05 was considered to point significance, and all analyses were performed using Stata (version 16).

Study results 

Within the detailed evaluation of people with and without SPD, it was found that those with SPD exhibited higher rates of cannabis use. Specifically, 27.4% of people with SPD engaged in any cannabis use in comparison with 11.7% without SPD, and 13.9% used cannabis weekly or more, versus 5.6% amongst those without SPD. Notably, significant differences were observed between these groups across various demographic and socioeconomic characteristics.

Analyzing how cannabis use has modified over time, especially between 2009 and 2019, produced clear trends. An analogous trend was shown by unadjusted rates as much as and including 2014. Nonetheless, since 2015, the speed of increase in cannabis use amongst individuals with SPD increased markedly. Specifically, there was a rise of 5.0 % higher than the control group in 2019 for many who already had SPD; that’s to say that cannabis use had accelerated even faster amongst these latter individuals over this newer period.

Moreover, it was even true when narrowing the main focus to weekly or more cannabis use. The findings showed an equivalent rise within the two groups as much as 2014, but those with SPD rose way more sharply from then onwards. This trend indicates that the habits of cannabis use have gotten farther and wider apart between those with SPD, who account for many smokers, versus non-SPD users.

The study also explored the connection between using cannabis and benefiting from psychiatric services for people with SPD. Controlling for various independent variables, there may be a better incidence of inpatient psychiatric hospitalization amongst cannabis users than non-users; less frequent and weekly-plus categories each have significantly heightened probabilities. As well as, there was no apparent difference in the danger of hospitalization between less frequent and more frequent cannabis users.

As for outpatient psychiatric care, lower than weekly cannabis users and people with not less than a weekly habit were each more more likely to receive it in comparison with non-users. As well as, users who’ve fewer than weekly outpatient clinic visits have more hospital visits.

An exploratory evaluation was conducted to grasp if perceptions of risk related to cannabis use could explain the observed differences in use amongst those with and without SPD. This evaluation, which included perceptions of the danger of monthly and weekly cannabis use, showed that while risk perceptions partially influenced the connection between SPD and cannabis use, they didn’t fully account for the differences observed within the changes in rates of use between the 2 groups. This finding suggests that other aspects may additionally influence these trends.

*Essential notice: medRxiv publishes preliminary scientific reports that are usually not peer-reviewed and, due to this fact, shouldn’t be considered conclusive, guide clinical practice/health-related behavior, or treated as established information.

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