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Meta-Analysis
. 2021 Feb;66(2):126-138.
doi: 10.1177/0706743720952251. Epub 2020 Sep 10.

Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies: Usage du cannabis et association prospective à long terme avec l'anxiété: une revue systématique et une méta-analyse d'études longitudinales

Siqi Xue  1 , M Ishrat Husain  1   2 , Haoyu Zhao  2 , Arun V Ravindran  1   2
Affiliations
Meta-Analysis

Cannabis Use and Prospective Long-Term Association with Anxiety: A Systematic Review and Meta-Analysis of Longitudinal Studies: Usage du cannabis et association prospective à long terme avec l'anxiété: une revue systématique et une méta-analyse d'études longitudinales

Siqi Xue et al. Can J Psychiatry. 2021 Feb.

Abstract
in English, French

Objectives: Cannabis use is proposed as a risk factor for psychosis and is associated with depressive disorders. However, the relationship between recreational cannabis use and its longitudinal implications on anxiety conditions is less studied. The aim of this investigation is to systematically evaluate published literature and perform a meta-analysis of the data.

Methods: A systematic search was performed of MEDLINE, Embase, and PsychINFO from inception to May 31, 2020, in addition to a hand search. Longitudinal studies that evaluated the relationship of cannabis use and development of anxiety were included. Where applicable, adjusted odds ratios (ORs) were extracted, pooled, and evaluated using random-effects meta-analysis.

Results: After screening of unique abstracts (n = 6835), the final evaluation included 24 studies, of which 10 reported ORs that were analyzed quantitatively. Cannabis use was significantly associated with increased odds of developing any anxiety conditions (OR = 1.25; 95% CI, 1.01 to 1.54). Cannabis use was not significantly associated with developing generalized anxiety disorder, panic disorder, or social anxiety disorder. Review of studies not reporting OR revealed mixed results but are suggestive of a link between cannabis use and increased rates/severity of anxiety.

Conclusions: Published evidence suggests that cannabis use is likely associated with increased risk of anxiety in the long term but variability of study designs precludes declaration of a causal relationship. Awareness of this association is of relevance for both clinical practice and mental health policy implementation.

Objectifs:: L’usage du cannabis est proposé comme facteur de risque de psychose et est associé aux troubles dépressifs. Cependant, la relation entre l’usage récréatif du cannabis et ses implications longitudinales sur les conditions d’anxiété fait moins l’objet d’étude. La présente recherche vise à évaluer systématiquement la littérature publiée et à réaliser une méta-analyse des données.

Méthodes:: Une recherche systématique a été menée dans MEDLINE, Embase et PsychINFO, du début au 31 mai 2020, en plus d’une recherche manuelle. Les études longitudinales qui évaluaient la relation entre l’usage du cannabis et le développement de l’anxiété ont été incluses. Le cas échéant, les rapports de cotes (RC) ajustés ont été extraits, regroupés et évalués à l’aide d’une méta-analyse à effets aléatoires.

Résultats:: Après dépistage des résumés uniques (n = 6 835), l’évaluation finale comprenait 24 études, dont 10 présentaient des RC qui ont été analysés quantitativement. L’usage du cannabis était significativement associé à des probabilités accrues de développer une condition d’anxiété [RC = 1,25; IC à 95% 1,01 à 1,54]. L’usage du cannabis n’était pas significativement associé au développement d’un trouble d’anxiété généralisée, d’un trouble panique ou d’un trouble d’anxiété sociale. L’examen des études qui ne comportaient pas de RC a révélé des résultats mixtes mais suggère un lien entre l’usage du cannabis et des taux d’anxiété plus graves.

Conclusions:: Les données probantes publiées suggèrent que l’usage du cannabis est probablement associé à un risque accru d’anxiété à long terme mais la variabilité des méthodologies des études empêche de déclarer une relation causale. La connaissance de cette association est pertinente tant pour la pratique clinique que pour la mise en œuvre des politiques de santé mentale.

Keywords: anxiety; cannabis use disorders; cohort study; meta-analysis; systematic reviews.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MIH is a PI for a trial sponsored by COMPASS Pathways Limited for which he receives salary support. The other authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow chart for literature search process. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Forest plots showing pooled odds ratio of developing (A) any anxiety, (B) generalized anxiety disorder, (C) panic disorder, and (D) social anxiety disorder with baseline cannabis use.
Figure 3.
Figure 3.
Funnel plot testing for publication bias.
See this image and copyright information in PMC

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