Developmental Timing of the Reciprocal Prospective Associations Between Cannabis Use and Internalizing and Externalizing Symptoms in Early Adolescence

This paper examines the reciprocal associations between specific internalizing (e.g., depression and anxiety) and externalizing (e.g., Attention Deficit/Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder) disorder symptoms and cannabis use during early adolescence with age differences. We analyzed youth-reported cannabis use, depression, anxiety, Attention Deficit/Hyperactivity Disorder (ADHD), Conduct Disorder (CD), and Oppositional Defiant Disorder (ODD) symptoms in 9- to 15-year-old adolescents enrolled in the longitudinal Adolescent Brain Cognitive Development (ABCD) Study (N=11,868) using data from the baseline visit through the 4-year follow-up. Multilevel regression models, parsing between- and within-youth effects were fit to examine the association between cannabis use and five different mental health disorders prospectively. Moderation by age was tested. In the main analyses, all between-youth reciprocal associations between mental health disorder symptoms (i.e., internalizing and externalizing) and cannabis use were significant, except anxiety. Anxiety was unidirectionally related to cannabis use, where increased anxiety symptoms predicated more cannabis use one year later (β = 0.0810, p = .006) but not vice versa. Strongest between- and within-youth reciprocal associations emerged for depression and conduct disorder symptoms with cannabis use prospectively, with age moderating the associations. In a nationwide sample of adolescents ages 9 to 15 years-old, we found depression and conduct disorder symptoms were most strongly and reciprocally associated with cannabis use prospectively. Further research is necessary to validate and confirm our findings and extend to greater cannabis use frequency and motives for use in the context of increased acceptance of cannabis use as treatment for mental health issues.