Abstract
Between 2013 and 2021, national survey data in the United States indicated increases in youth-reported persistent sadness, hopelessness, and suicidal ideation, with partial stabilization in 2023. During portions of this period, adolescent cannabis prevalence did not demonstrate a consistent upward trajectory. Observational research reports associations between early and frequent cannabis use and increased psychosis risk, as well as co-occurrence between cannabis use disorder and internalizing disorders. Independent research also identifies housing instability, adverse childhood experiences, family mental illness, and socioeconomic stress as factors associated with psychiatric risk. Methodological limitations across studies complicate isolation of individual causal pathways. This review summarizes current evidence and measurement constraints without drawing policy conclusions.
Pull Quote: National trend comparisons do not establish individual-level causal relationships.
National Youth Mental Health Trends
Data from the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey indicate increases in persistent feelings of sadness or hopelessness among high school students between 2013 and 2021, with a slight decline observed in 2023. Reports of suicidal ideation increased during much of this interval.
These findings describe population-level trends. National trend comparisons do not establish individual-level causal relationships.
Youth Cannabis Prevalence
National survey data report that past-30-day marijuana use among adolescents did not consistently increase between 2013 and 2023. In several years within that period, prevalence declined.
Trend comparisons alone cannot determine causality.
Cannabis-Related Psychiatric Associations
Observational research identifies associations between cannabis use and certain psychiatric outcomes.
Findings include:
- Associations between early and frequent cannabis use and increased risk of psychotic disorders, particularly among individuals with preexisting vulnerability.
- Co-occurrence between cannabis use disorder and depression, anxiety, and suicidal behaviors.
- Retention of certain associations after statistical adjustment in some longitudinal models.
- Attenuation of suicidality associations in some sibling and familial-control studies.
These findings represent associations observed within observational and cohort research designs.
Cannabis Potency Context
Available data indicate that average tetrahydrocannabinol (THC) concentrations in cannabis products have increased over time. Legal market conditions have expanded access to higher-potency flower and concentrated products. Individual-level potency exposure is inconsistently captured in national surveys.
The magnitude of population-level psychiatric impact attributable specifically to potency variation remains uncertain.
Environmental and Familial Risk Factors
Independent research identifies associations between several environmental and familial variables and increased psychiatric risk, including:
- Housing instability and internalizing symptoms.
- Eviction-related stress and anxiety or depression.
- Adverse childhood experiences (ACEs) and increased risk of psychiatric disorders.
- ACE exposure and earlier or heavier cannabis use trajectories.
- Family history of mental illness and increased psychiatric vulnerability.
- Socioeconomic hardship and barriers to mental health care.
These variables are not uniformly measured across cannabis-related psychiatric studies.
Methodological Considerations
Across available literature, several methodological limitations are observed:
- Reliance on self-report survey data.
- Inconsistent definitions of heavy or frequent cannabis use.
- Incomplete measurement of baseline mental health status prior to cannabis exposure.
- Socioeconomic status frequently assessed using proxy indicators.
- Inconsistent measurement of environmental stress load.
- Limited capture of product potency and type in exposure assessment.
These factors limit precision in isolating independent effects within multi-factor models.
Conclusion
Current evidence indicates overlapping associations among cannabis use, environmental stressors, familial vulnerability, and psychiatric outcomes. Observational and longitudinal research identifies associations but cannot fully eliminate residual confounding.
Available research does not establish cannabis as a singular driver of national youth mental health trends. It also does not demonstrate that environmental variables fully account for observed associations.
Uncertainty remains regarding the relative contribution of individual variables within multi-factor risk models.
No policy conclusions are drawn.
References (AMA Style with Official Links)
- Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. Atlanta, GA: CDC; 2024.
https://www.cdc.gov/healthyyouth/data/yrbs/index.htm - Monitoring the Future Study. National Survey Results on Drug Use, 1975–2024: Secondary School Students.Ann Arbor, MI: Institute for Social Research, University of Michigan; 2024.
https://monitoringthefuture.org - Young-Wolff KC, et al. Cannabis use and mental health outcomes in adolescents: longitudinal analysis. JAMA Health Forum. 2026.
https://jamanetwork.com/journals/jama-health-forum - Addictive Behaviors Reports. Sibling-comparison analysis of cannabis use and suicidality. Addict Behav Rep. 2025.
https://www.sciencedirect.com/journal/addictive-behaviors-reports - National Institute on Drug Abuse. Cannabis (Marijuana) Potency Data 1995–2022. Bethesda, MD: NIDA; 2023.
https://nida.nih.gov/research/research-data-measures-resources/cannabis-potency-data - ElSohly MA, Mehmedic Z, Foster S, et al. Changes in cannabis potency over time in the United States. Front Public Health. 2024.
https://www.frontiersin.org/journals/public-health - JAMA Network Open. Housing instability and internalizing symptoms among youth. 2025.
https://jamanetwork.com/journals/jamanetworkopen - JAMA Network Open. Eviction-related stress and adolescent mental health outcomes. 2025.
https://jamanetwork.com/journals/jamanetworkopen - Silins E, Horwood LJ, Patton GC, et al. Adverse childhood experiences and cannabis use trajectories. Lancet Public Health. 2023;8(6):e421-e430.
https://www.thelancet.com/journals/lanpub