Association of cannabis, cannabidiol and synthetic cannabinoid use with mental health in UK adolescents

James Hotham, Rebecca Cannings-John, Laurence Moore, Jemma Hawkins, Chris Bonell, Matthew Hickman, Stanley Zammit, Lindsey A Hines, Linda Adara, Julia Townson, James White

Research output: Contribution to journalArticlepeer-review

2 Citations (SciVal)


BACKGROUND: Cannabis has been associated with poorer mental health, but little is known of the effect of synthetic cannabinoids or cannabidiol (often referred to as CBD).

AIMS: To investigate associations of cannabis, synthetic cannabinoids and cannabidiol with mental health in adolescence.

METHOD: We conducted a cross-sectional analysis with 13- to 14-year-old adolescents across England and Wales in 2019-2020. Multilevel logistic regression was used to examine the association of lifetime use of cannabis, synthetic cannabinoids and cannabidiol with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations.

RESULTS: Of the 6672 adolescents who participated, 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids. After correction for multiple testing, adolescents who had used these substances were significantly more likely to report a probable depressive, anxiety or conduct disorder, as well as auditory hallucinations, than those who had not. Adjustment for socioeconomic disadvantage had little effect on associations, but weekly tobacco use resulted in marked attenuation of associations. The association of cannabis use with probable anxiety and depressive disorders was weaker in those who reported using cannabidiol than those who did not. There was little evidence of an interaction between synthetic cannabinoids and cannabidiol.

CONCLUSIONS: To our knowledge, this study provides the first general population evidence that synthetic cannabinoids and cannabidiol are associated with probable mental health disorders in adolescence. These associations require replication, ideally with prospective cohorts and stronger study designs.

Original languageEnglish
Pages (from-to)478-484
Number of pages7
JournalThe British Journal of Psychiatry
Issue number4
Early online date24 Jul 2023
Publication statusPublished - 31 Oct 2023

Bibliographical note

Funding Information:
This work was supported by the National Institute of Health Research (NIHR) Public Health Research programme (grant number NIHR PHR 17/97/02) at the Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), a UK Clinical Research Collaboration Public Health Research Centre of Excellence. Joint funding was received from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the Welsh Government and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration (MR/KO232331/1); and since April 2020, the Welsh Government through Health and Care Research Wales, the Medical Research Council (MC_UU_00022/1) and the Chief Scientist Office (SPHSU16). S.Z. is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. L.A.H. is funded by the Wellcome Trust (grant number 209158/Z/17/Z). For the purpose of open access, the authors have applied a CC-BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health and Social Care. The funder had no role in the design, or conduct of the study; collection, management, analysis or interpretation of the data; preparation, review or approval of the manuscript; or decision to submit the manuscript for publication.

Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.


  • Anxiety or fear-related disorders
  • conduct disorders
  • depressive disorders
  • psychotic disorders/schizophrenia
  • substance use disorders

ASJC Scopus subject areas

  • Psychiatry and Mental health


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