Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood

Gobbi,  G. et al.| 2019|  Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young AdulthoodA Systematic Review and Meta-analysis| JAMA Psychiatry| Published online February 13, 2019| doi:10.1001/jamapsychiatry.2018.4500

JAMA Psychiatry has published a systematic review and meta-analysis that examined if there was an association between cannabis use as a young person and the risk of depression, anxiety and suicidality between the ages of 18 and 32.

Question  Is adolescent cannabis consumption associated with risk of depression, anxiety, and suicidality in young adulthood?

 

Findings  In this systematic review and meta-analysis of 11 studies and 23 317 individuals, adolescent cannabis consumption was associated with increased risk of developing depression and suicidal behavior later in life, even in the absence of a premorbid condition. There was no association with anxiety.

Meaning  Preadolescents and adolescents should avoid using cannabis as use is associated with a significant increased risk of developing depression or suicidality in young adulthood; these findings should inform public health policy and governments to apply preventive strategies to reduce the use of cannabis among youth.

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Abstract

Importance  Cannabis is the most commonly used drug of abuse by adolescents in the world. While the impact of adolescent cannabis use on the development of psychosis has been investigated in depth, little is known about the impact of cannabis use on mood and suicidality in young adulthood.

Objective  To provide a summary estimate of the extent to which cannabis use during adolescence is associated with the risk of developing subsequent major depression, anxiety, and suicidal behavior.

Data Sources  Medline, Embase, CINAHL, PsycInfo, and Proquest Dissertations and Theses were searched from inception to January 2017.

Study Selection  Longitudinal and prospective studies, assessing cannabis use in adolescents younger than 18 years (at least 1 assessment point) and then ascertaining development of depression in young adulthood (age 18 to 32 years) were selected, and odds ratios (OR) adjusted for the presence of baseline depression and/or anxiety and/or suicidality were extracted.

Data Extraction and Synthesis  Study quality was assessed using the Research Triangle Institute item bank on risk of bias and precision of observational studies. Two reviewers conducted all review stages independently. Selected data were pooled using random-effects meta-analysis.

Main Outcomes and Measures  The studies assessing cannabis use and depression at different points from adolescence to young adulthood and reporting the corresponding OR were included. In the studies selected, depression was diagnosed according to the third or fourth editions of Diagnostic and Statistical Manual of Mental Disorders or by using scales with predetermined cutoff points.

Results  After screening 3142 articles, 269 articles were selected for full-text review, 35 were selected for further review, and 11 studies comprising 23 317 individuals were included in the quantitative analysis. The OR of developing depression for cannabis users in young adulthood compared with nonusers was 1.37. The pooled OR for anxiety was not statistically significant: 1.18. The pooled OR for suicidal ideation was 1.50.

Conclusions and Relevance  Although individual-level risk remains moderate to low and results from this study should be confirmed in future adequately powered prospective studies, the high prevalence of adolescents consuming cannabis generates a large number of young people who could develop depression and suicidality attributable to cannabis. This is an important public health problem and concern, which should be properly addressed by health care policy.

Source: JAMA Pyschiatry

This article is available to Rotherham NHS staff  and can be requested here 

In the news:

The Telegraph Smoking cannabis as teenager increases risk of depression by 40 per cent, Oxford study finds

BBC News Cannabis use in teens linked to depression

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Victimised adolescents more likely to self-harm and have suicidal thoughts

Baldwin, J. R. et al. | 2018| Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study| Journal of the American Academy of Child & Adolescent Psychiatry | Vol.0 |Issue 0| DOI: https://doi.org/10.1016/j.jaac.2018.07.903

Children and young people that are victimised have double the likelihood of self-harm and their risk of suicide  is trebled compared to non-victimised peers according to researchers at King’s College London. The study looked at over 2000 twins born in England and Wales between 1994-95. They studied different forms of adolescent victimisation- including maltreatment, neglect, bullying, crime, sexual victimisation, and family violence- which were identified in interviews with the participants when they turned 18. Among their findings was that over a third of the sample had experienced one severe form of victimisation during their adolescence and 7 per cent had experienced at least three or more severe types of victimisation. Almost 20 per cent (18.9%) had had some form of self-injurious thoughts and behaviours. Victimized adolescents had an increased risk of suicidal ideation and over a quarter had atempted suicide.  

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Abstract

Objective

Victimized adolescents have elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors.


Method

Participants were 2,232 British children followed from birth to age 18 as part of the Environmental Risk (E-Risk) Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber-victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the age 18 assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at age 18.

Results

Victimized adolescents had an increased risk of suicidal ideation, self-harm, and suicide attempt. Co-twin control and propensity-score matching analyses showed that these associations were largely accounted for pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest elevation in risk for suicidal ideation.

Conclusion

Risk for self-injurious thoughts and behaviors in victimized adolescents is only partly explained by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

The article is in press but may be requested through interlibrary loan by Rotherham NHS staff 

In the news:

BBC News Teenage victims ‘more likely to self-harm’

Young people bullied online are twice as likely to self-harm

A new systematic review with meta analyses examines  the relationship between cyberbullying and self- harm (SH) and suicidal behaviour. The researchers reviewed the evidence and found victims of cyber bullying are twice as likely to self harm than their peers. They also noted perpetrators are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. 

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ABSTRACT

Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people.

Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations.

Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted.

Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators.

Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

Full reference:

The full article can be read at JMIR 

Related: Science Daily Young victims of cyberbullying twice as likely to attempt suicide and self-harm, study finds

Almost half of trans young people in Australia try to end their lives

new study released today has found trans young people in Australia are experiencing extraordinarily high levels of mental health difficulties, including depression, anxiety, self-harm and suicide attempts | The Conversation

Trans and gender diverse young people identify with a gender that does not match their sex assigned at birth. We use trans to be inclusive of people who identify as transgender, non-binary, genderqueer, genderfluid, male, female, and other terms.

There is existing evidence that trans young people in Australia experience high levels of distress compared to the general population. This new study, called Trans Pathways, delved deeper into what might contribute to mental health issues, to understand how mental health and medical services respond to trans young people seeking support.

Perhaps the most confronting finding was that almost half of trans young people has attempted to end their life by suicide. This statistic alone demonstrates the urgent need for all Australians to act and do more to support trans young people. Support is needed from peers, parents, schools, health professionals and government.

Read the full blog post here

Sexual orientation and suicidal behaviour

Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors | The British Journal of Psychiatry

Aims: To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.

Method: A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12–26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.

Results: Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60–3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21–4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.

Conclusions: Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Full reference: Miranda-Mendizábal, A. et al. (2017) Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis. The British Journal of Psychiatry. Vol. 211 (no. 2) pp. 77-87. 

Sexual orientation and suicidal behaviour in young people

Lesbian, gay, and bisexual (LGB) young people have been found to be at greater risk of suicidal behaviour | The British Journal of Psychiatry

National prevention strategies have identified the need to reduce suicide risk in this population. However, research on specific risk factors for LGB young people that might inform suicide prevention programmes are at an early stage of development.

Full reference:  Meader, N. & Chan, M.K.Y. (2017) Sexual orientation and suicidal behaviour in young people. The British Journal of Psychiatry. Vol. 211 (no. 2) pp. 63-64

Suicide by Children and Young People

Suicide in young people is rarely caused by one thing; it usually follows a combination of previous vulnerability and recent events | University of Manchester

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Image source: University of Manchester

The stresses we have identified before suicide are common in young people; most come through them without serious harm.

Important themes for suicide prevention are support for or management of family factors (e.g. mental illness, physical illness, or substance misuse), childhood abuse, bullying, physical health, social isolation, mental ill-health and alcohol or drug misuse.

Specific actions are needed on groups we have highlighted:

  1. support for young people who are bereaved, especially by suicide
  2. greater priority for mental health in colleges and universities
  3. housing and mental health care for looked after children
  4. mental health support for LGBT young people.

Read the full report here