Cannabis use disorder was associated with self-harm, all-cause mortality, unintentional overdose death and homicide among youth with mood disorders, according to a study published in JAMA Pediatrics.

Cynthia A. Fontanella, PhD, assistant professor of clinical psychiatry at Ohio State University, and colleagues conducted a population-based retrospective cohort study using Ohio Medicaid claims data linked with death certificate data. The included 204,780 youths aged between 10 and 24 years with a diagnosis of a mood disorder between July 1, 2010, and Dec. 31, 2017, in their analysis.

The mean age of study participants was 17.2 years. Of the participants, 65% were female (n = 133,081), 66.9% were non-Hispanic white (n = 136,950), 87.6% were enrolled in Medicaid (n = 179,370) and 77.1% were living in a metropolitan location (n = 157,850).

The most common diagnosis among the participants was depressive disorder, with which 72.7% of the individuals were diagnosed (n = 148,970), according to Fontanella and colleagues. Also, 12.4% of the individuals were diagnosed with bipolar disorder (n = 25,352) and 14.9% had an unspecified mood disorder (n = 30,458), the researchers reported.

ADHD was the most commonly reported psychiatric comorbidity, occurring in 12.4% of individuals (n = 25,416), followed by 10.3% of individuals with anxiety (n = 21,102). “Other mental health disorders” were listed for 13.1% of individuals (n = 26,787).

A total of 10.3% of participants received a diagnosis of cannabis use disorder (CUD; n = 21,040), according to the study. Youth diagnosed with bipolar disorders and other mood disorders were at an increased risk for CUD compared with those with a depressive disorder (bipolar: adjusted RR, 1.24; 95% CI, 1.21-1.29; other mood disorders: aRR, 1.2; 95% CI, 1.15-1.25). Those with conduct disorders were more at risk for CUD than those without them (conduct disorder: aRR, 1.46; 95% CI, 1.38-1.53; substance use disorders: aRR, 2.83; 95% CI, 2.73-2.93).

However, the authors reported that those with ADHD, other health disorders and chronic medical conditions had a lower risk for CUD than those without one of these conditions (ADHD: aRR, 0.82; 95% CI, 0.78-0.86; other mental health disorders: aRR, 0.72; 95% CI, 0.69-0.76; and chronic medical conditions: aRR, 0.89; 95% CI, 0.84-0.93).

CUD was associated with prior self-harm, psychiatric hospitalizations, mental health outpatient visits and mental health ED visits were all associated with an increased risk for CUD (self-harm: aRR, 1.66; 95% CI, 1.52-1.82; psychiatric hospitalizations: aRR, 1.66; 95% CI, 1.57-1.76; outpatient: aRR, 1.26; 95% CI, 1.22-1.3; and ED visits: aRR, 1.54; 95% CI, 1.47-1.61).

“Decreasing the rates of cannabis use and cannabis use disorder might reduce risk,” Fontanella told Healio. “Individual and family-based therapy models, including cognitive behavioral therapy and motivational enhancement therapy, have been shown to decrease cannabis use in youth.”

The authors reported that older age groups made up of those aged 14 to 18 years, as well as those aged 19 to 24 years, were at a higher risk for CUD than the youngest age group of those aged 10 to 13 years (14-18 vs. 10-13, aRR, 9.35; 95% CI, 8.57-10.19; and 19-24 vs. 10-13, aRR, 11.22; 95% CI, 10.27-12.26).

Likewise, male participants had a higher risk for CUD than female participants (aRR, 1.79; 95% CI, 1.74-1.84). However, the non-Hispanic Black group had a higher risk than the non-Hispanic white group (aRR, 1.39; 95% CI, 1.35-1.44).

Those eligible for Medicaid through disability were at a low risk (aRR, 0.61; 95% CI, 0.58-0.65). Those in foster care were at a higher risk (aRR, 1.1; 95% CI, 1.02-1.18) for CUD compared with those eligible for Medicaid owing to poverty. Those living in a metropolitan area, were also at an increased risk compared with those who were not (aRR, 1.21; 95% CI, 1.17-1.26).

“The perception is that marijuana is safe to use, but we need to educate parents and kids that there are risks involved, particularly with heavy and high-potency cannabis use,” Fontanella said. “Clinicians also need to effectively treat both cannabis abuse disorders and mood disorders.”

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