Table 1.
Characteristics and Main Findings of 24 Included Studies.
| Study and Country | Study Population | n | Baseline Age | Follow-up Length | Cannabis Measure | Anxiety Measure | Control Variables | Main Findings at Last Follow-up | Adjusted OR (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
| Weller and Halikas24; USA | General population | 147 | 18+ | 6 to 7 Years | Cannabis use over 50 times in the past 6 months | Interview similar to DIS | Heavy cannabis use was not associated with greater prevalence of anxiety disorder at follow-up | ||
| Fergusson, et al.25; New Zealand | Birth cohort | 927 | 15 | 1 Year | Self-report and parental reports of lifetime cannabis use | DISC, DIS | Gender, family functioning, association with delinquent or substance using peers, cigarette smoking, family history of alcohol/drug abuse/dependence, alcohol use, offending, conduct/oppositional disorders, childhood conduct problems, truancy, IQ, plans for future secondary education, intention to enter university, baseline anxiety disorders depression and suicidal ideation | Cannabis use was not significantly associated with development of anxiety disorders at age 16 | 1.2 (0.5 to 2.8) |
| Fergusson and Horwood26; New Zealand | Birth cohort | 935 | 15 | 3 Years | Frequency of use between age 15 and 16 | CIDI | Maternal age, family SES, gender, changes of parents, parental history of offending, childhood sexual abuse, IQ, conduct problems, self-esteem, novelty seeking, mood disorder (14 to 16), anxiety disorder (14 to 16) | Frequent cannabis use was significantly associated with anxiety disorder at 16 to 18 but not after covariates were controlled | |
| Brook et al.27; USA | Youth in upstate New York | 698 | 13 (avg) | 6 Years | Self-report converted to light, moderate, and heavy use | DISC-I (Supplemental Material) | Age, gender, adolescent psychiatric disorder | Adolescent cannabis use was not associated with anxiety disorders in young adulthood | 1.16 (1.00 to 1.35) |
| Windle and Wiesner28; USA | High school students | 1,205 | 15 | 5 Years | Self-report converted to trajectory groups | CIDI | Not available | Cannabis trajectory group membership was not associated with lifetime anxiety disorder prevalence in young adulthood | |
| van Laar et al.29; the Netherlands | Adults | 3,854 | 18 to 64 | 3 Years | Lifetime use more than 5 times | CIDI | Age, gender, education, urbanicity, employment, partner status, neuroticism, parental psychiatric history, childhood trauma, lifetime alcohol use disorders or other substance use disorders, lifetime mood disorders, lifetime psychotic symptoms | Cannabis use was not significantly associated with incidence of anxiety disorders | 1.18 (0.71 to 1.97) |
| Cannabis use was not significantly associated with incidence of GAD | 1.83 (0.97 to 3.44) | ||||||||
| Cannabis use was not significantly associated with incidence of PD | 1.29 (0.61 to 2.71) | ||||||||
| Cannabis use was not significantly associated with incidence of SAD | 0.80 (0.36 to 1.79) | ||||||||
| Zvolensky et al.30; USA | High school students | 1,709 | 14 to 18 | 8 Years | Lifetime consumption, abuse, dependence | DSM-IV | Smoking, noncannabis drug dependence comorbidity | Lifetime history of cannabis dependence was not significantly associated with development of PD | 1.6 (0.45 to 5.8) |
| Fröjd et al.31; Finland | High school students | 2,070 | 15 to 16 | 2 Years | Frequency of use (over 5 times) in the past 2 years | Single question for GAD, SPIN | Sex, family structure, parental education levels, baseline depression | Cannabis use was not significantly associated with incidence of GAD | 0.4 (0.1 to 3.3) |
| Cannabis use was not significantly associated with incidence of SAD | 0.7 (0.2 to 2.2) | ||||||||
| Brook et al.32; USA | African American and Puerto Rican youth | 837 | 14 (avg) | 15 Years | Self-report converted to trajectory groups | SCL (items for anxiety) | Sex, ethnicity, differing baseline schools | Chronic use group was significantly associated with anxiety symptoms when compared with non- or low-use groups | 2.3 (1.3 to 4.0) |
| Degenhardt et al.33; Australia | High school students | 1,756 | 14 to 15 (avg) | 15 Years | Frequency of use in the past 6 months, maximum use in the past year, CIDI for DSM-IV | CIDI-Short Form | Sex, school location, low parental education, parental divorce/separation, concurrent alcohol/illicit substances, adolescent anxiety/depression | Weekly cannabis use since adolescence was significantly associated with increased odds of anxiety disorder at 29 years | 3.2 (1.1 to 9.2) |
| Albertella and Norberg34; Australia | Adolescents receiving residential treatment | 132 | 14 to 18 | 3 Months | BTOM items; SDS | BSI | Not available | Reduction of cannabis quantity/frequency was associated with reduction of anxiety symptom | |
| Caldeira et al.35; USA | College students | 973 | 17 to 20 | 6 Years | Self-report converted to trajectory groups | BAI | Baseline BAI score, sex, race, ethnicity, income, alcohol, and tobacco use trajectory group | Chronic use group had more anxiety symptoms than nonuse or low-stable use groups at follow-up | |
| Gage et al.36; UK | Birth cohort | 1,682 | 16 | 2 Years | Frequency of use in the past year | CIS-R | Gender, family history of depression, maternal education, urban living, borderline personality traits, victimization, peer problems, alcohol use, other illicit drug use | Cannabis use was not significantly associated with incidence of SAD | 1.06 (0.73 to 1.53) |
| Bechtold et al.37; USA | Young men | 386 | 12 to 16 | 20+ Years | SUQ converted to trajectory groups | DIS for DSM-IV | SES at age 36; past year use of alcohol, cigarettes, and illicit drugs; health problems at age 14 | Cannabis trajectory group membership was not associated with differences in lifetime anxiety | |
| Danielsson et al.38; Sweden | Adults | 8,598 | 20 to 64 | 3 Years | Ever use of cannabis | SCL (items for anxiety) | Age, sex, ethnicity, other illicit drug use, alcohol use, education, place of upbringing, childhood adverse circumstances | Cannabis use was associated with RR of 1.09 (95% CI, 0.98 to 1.20) for anxiety at follow-up | |
| Feingold et al.39; USA | General population | 34,653 | 18+ | 3 Years | AUDADIS-IV; lifetime cannabis use and past-year use | DSM-IV | Sex, age, educational level, household income, marital status, urbanity, and region | Cannabis dependence was not significantly associated with new diagnosis of any anxiety disorder | 0.99 (0.65 to 1.5) |
| Cannabis dependence was not significantly associated with new diagnosis of GAD | 1.08 (0.61 to 1.93) | ||||||||
| Cannabis dependence was not significantly associated with new diagnosis of PD | 1.69 (0.88 to 3.25) | ||||||||
| Cannabis dependence was not significantly associated with new diagnosis of SAD | 1.75 (0.95 to 3.23) | ||||||||
| Otten et al.40; the Netherlands | Adolescents | 1,424 | 13 | 5 Years | Frequency of use in the last 12 months | YSR Anxiety Problems Scale | Sex, age, alcohol use and tobacco use, baseline anxiety | Cannabis use was significantly associated with higher levels of anxiety at follow-up (significant association was found in short 5-HTTLPR allele carriers but not in noncarriers) | |
| Guttmannova et al.41; USA | Youth from high-crime areas | 808 | 14 | 20 Years | Self-report converted to trajectory groups | DIS for DSM-IV | Gender, ethnicity, childhood poverty, average frequency of tobacco, and alcohol use during adolescence | Chronic cannabis use was significantly associated with increased IRR of 1.57 (95% CI, 1.08 to 2.28) for GAD | |
| Hser et al.42; USA | Adults with cannabis dependence | 302 | 18 to 50 | 12 Weeks | Frequency of use in past 7 days | HADS | Age, sex, race/ethnicity, treatment condition, time-varying tobacco, and alcohol use | Reduction of cannabis use was associated with improvement in anxiety | |
| Thompson, et al.43; Canada | Adolescents | 662 | 12 to 18 | 10 Years | Self-report converted to trajectory groups | BCFPI | Sex, SES, age, and respective assessments at baseline | Chronic cannabis use was associated with higher levels of anxiety symptoms than abstainer and decreaser groups | |
| Hawes et al.44; USA | Adolescents | 401 | 14 to 17 | 2 Years | DUHQ converted to trajectory groups | Computerized DISC-IV symptom count | Sex and race/ethnicity, parental education, general intelligence | Cannabis trajectory membership was not associated with differences in anxiety level at follow-up | |
| Duperrouzel et al.45; USA | Junior high/high school students | 250 | 14- to 17 | 1 Year | Frequency of use in the past 30 days | DASS-21 (anxiety subscale) | Sex, depression, use of alcohol and nicotine | Higher level of cannabis use was associated with more persisting self-reported anxiety at follow-up | |
| Tucker et al.46; USA | Adolescents | 2429 | Grade 6 to 7 | 10 Years | Frequency of use in the past 30 days | GAD-7 | Age, gender, race/ethnicity, mother’s education, intervention group at wave 1 | Cannabis and tobacco couse was associated with higher GAD scores, but not cannabis only use | |
| Hines et al.47; UK | General population | 1,087 | 24 | 1 Year | Self-report of type of cannabis most commonly used in the past year (high/low potency) | CIS-R | Childhood sociodemographic factors, prospective mental health measures, frequency of cannabis use | High potency cannabis use was associated with increased likelihood of GAD | 1.92 (1.11 to 3.32) |
Note. AUDADIS = Alcohol Use Disorder and Associated Disabilities Interview Schedule; Avg = average; BAI = Beck Anxiety Inventory; BCFPI = Brief Child and Family Phone Interview; BSI = Brief Symptom Inventory; BTOM = Brief Treatment Outcome Measure; CI = confidence interval; CIDI = Composite International Diagnostic Interview; CIS-R: Clinical Interview Schedule-Revised; DASS = Depression, Anxiety, Stress Scale; DIS = Diagnostic Interview Schedule; DISC = Diagnostic Interview Schedule for Children; DSM = Diagnostic and Statistical Manual; DUSQ = Drug Use History Questionnaire; GAD = generalized anxiety disorder; HADS = Hospital Anxiety and Depression Scale; IQ = intelligence quotient; IRR = incidence risk ratio; OR= odds ratio; PD = panic disorder; RR = relative risk; SAD = social anxiety disorder; SCL = Symptom Checklist; SES = socioeconomic status; SDS = Severity of Dependence Scale; SPIN = Social Phobia Inventory; SUQ = Substance Use Questionnaire; WISC-R = Wechsler Intelligence Scale for Children-Revised; YSR = Youth Self-Report.