Cannabis Use During Adolescence And The Occurrence Of Depression, Suicidality And Anxiety Disorder Across Adulthood: Findings From A Longitudinal Cohort Study Over 30 Years


  • Population-based longitudinal cohort study over 30 years spanning age 19/20 to 49/50
  • Cannabis use in adolescence predicted the occurrence of depression and suicidality in adulthood
  • Association between adolescent cannabis use and adult depression/suicidality hold when adjusted for various covariates, including time-varying pattern of substance abuse in adulthood
  • Younger age at first cannabis use and more frequent use in adolescence related to an particularly increased risk of adult depression


  • Objective

    To examine the association between cannabis use in adolescence and the occurrence of depression, suicidality and anxiety disorders during adulthood.

  • Methods

    A stratified population-based cohort of young adults (n = 591) from Zurich, Switzerland, was retrospectively assessed at age 19/20 for cannabis use in adolescence. The occurrence of depression, suicidality and anxiety disorders was repeatedly assessed via semi-structured clinical interviews at the ages of 20/21, 22/23, 27/28, 29/30, 34/35, 40/41, and 49/50. Associations were controlled for various covariates, including socio-economic deprivation in adolescence as well as repeated time-varying measures of substance abuse during adulthood.

  • Results

    About a quarter (24%) reported cannabis use during adolescence; 11% started at age 15/16 or younger and 13% between the ages of 16/17 and 19/20. In the adjusted multivariable model, cannabis use during adolescence was associated with adult depression (aOR = 1.70, 95%-CI = 1.24–2.32) and suicidality (aOR = 1.65, 95%-CI = 1.11–2.47), but not anxiety disorders (aOR = 1.10, 95%-CI = 0.82–1.48). First use at age 15/16 and younger (as against first use between age 16/17 and 19/20 and no use) and frequent use in adolescence (as against less frequent use and no use) were associated with a higher risk of depression in adult life.

  • Conclusions

    In this longitudinal cohort study over 30-years, cannabis use during adolescence was associated with depression and suicidality in adult life. Young age at first use and high frequency of use in adolescence may particularly increase the risk of depression in adulthood. All associations were independent of cannabis abuse and other substance abuse during adulthood.


An extensive body of evidence suggests that cannabis use in adolescence increases the risk of adult psychotic disorders (Arseneault et al., 2002, Moore et al., 2007, Rossler et al., 2012); based on Mendelian randomization studies it appears that this association may at least partly be causal (Gage et al., 2017, Vaucher et al., 2018). However, it is less clear whether adolescent cannabis use also predicts depression and other affective disorders (Moore et al., 2007). For instance, a recent 35-year longitudinal cohort study of male conscripts found a weak association between cannabis use and an increased risk for depression, but this association disappeared after adjustment for covariates (Manrique-Garcia et al., 2012).

Another prospective population-based study over 3 years including both male and female adults likewise found that cannabis use at baseline weakly increased the risk of depression and anxiety, but once again these associations disappeared after controlling for covariates (comprising alcohol and drug use, education level, and family climate) (Danielsson et al., 2016). In contrast, a longitudinal cohort study of 14-15 year-old students followed over seven years reported a remarkably strong association between early cannabis use and later depression and anxiety that persisted after adjustment for baseline covariates (Patton et al., 2002). Finally, a recent meta-analysis of longitudinal studies found that adolescent cannabis use predicts the development of depression (OR = 1.4), suicidal ideation (OR = 1.5) and suicide attempts (OR = 3.5), but not anxiety (OR = 1.2), in young adulthood (Gobbi et al., 2019).

The aim of the present work was to re-address the association between adolescent cannabis use and later mood and anxiety disorders. We extended previous research by focusing separately on mood disorders, anxiety disorders and suicidality. Moreover, we did not only control for baseline covariates, such as family climate and socio-economic background, but also for concomitant abuse of both alcohol and illicit drugs (including both cannabis and other substances) across the participants’ adult lives. Finally, with a total observation period of 30 years, the present longitudinal study is much longer than most research conducted thus far.

Section snippets

Participants and sampling procedure

The Zurich Study comprised a cohort of 4547 subjects (m = 2201; f = 2346) representative of the canton of Zurich in Switzerland, who were screened in 1978 with the Symptom Checklist 90-Revised (SCL-90-R) (Derogatis, 1977) when males were 19 and females 20 years old. Male and female participants were sampled with different approaches. In Switzerland, every man of Swiss nationality must undertake a military screening test at the age of 19. With the consent of the military authorities, but…


Comprehensive dropout analyses of this cohort have been presented elsewhere (Eich et al., 2003, Hengartner et al., 2016). In short, dropouts appeared to be either extremely low or extremely high scorers on the SCL GSI, but except for a weak gender bias (men were more likely to drop out) there were no baseline characteristics that predicted early study termination. The frequencies of adolescent cannabis use and baseline socio-demographic characteristics are shown in Table 1. In total 143 of 586…


In this 30-year longitudinal cohort-study we examined the associations between cannabis use in adolescence (i.e. before the age of 19/20 years) and the development of depressive disorders, severe suicidality and anxiety disorder during adulthood (i.e. between the ages of 20/21 and 49/50). Our results show that cannabis use in adolescence, independently of substance abuse in adulthood, is significantly related to the occurrence of depressive disorders and severe suicidality, but not to anxiety…


The Zurich Cohort Study was supported by the Swiss National Science Foundation (Grant number 32-50881.97). The donator/sponsor had no further role in the experimental design, the collection, analysis, and interpretation of data, the writing of this report, or the decision to submit this paper for publication…

Author contributions

MPH drafted the manuscript and conducted all statistical analyses; JA and WR contributed to design and conduct of the study, interpretation of the data and critical revision of the manuscript; VAG contributed to interpretation of the data and critical revision. All authors approved the final version of this manuscript…

Source: May 2020

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