Bidirectional associations between depressive symptoms and cigarette, e-cigarette, cannabis, and alcohol use: Cross-lagged panel analyses among young adults before and during COVID-19

Depressive symptoms predict cannabis vaping initiation among young adults

BACKGROUND

Young adults in the United States, including college students, have the highest prevalence of cannabis use compared with other age groups. Although cannabis vaping is increasingly prevalent during young adulthood, little is known about factors contributing to the onset of cannabis vaping during this developmental period.

METHODS

Participants were 3085 cannabis vaping naïve young adults aged 18-25 years (M = 20.60; SD = 1.80), initially recruited from 24 Texas colleges and participating in a multi-wave, longitudinal study. A survival analysis was conducted to determine if participants reporting elevated depressive symptoms had an increased risk of onset of cannabis vaping over six follow-up waves from fall 2015 to spring 2019 compared to their peers with lower levels of depressive symptoms. Socio-demographic characteristics, time-varying past 30 day substance use, and time-varying peer nicotine vaping were included as covariates in the model.

RESULTS

Twenty-five percent of participants initiated cannabis vaping during the four-year study period, with stable initiation rates from 2015 to 2017 but doubling from 2017 to 2019. Analyses, both unadjusted and adjusted for study covariates, indicated that elevated depressive symptoms were significantly associated with an increased risk of cannabis vaping initiation.

CONCLUSION

Findings indicate that initiation of cannabis vaping during young adulthood is common, and particularly more likely among those with greater depressive symptoms, thus underscoring the importance of prevention programs that include mental health support services tailored to young adults.

Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use

BACKGROUND

Few studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis.

METHOD

Cross-sectional online survey of a national convenience sample of 13-40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13-17-, 18-24-, and 25-40-year-olds.

RESULTS

Among 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06-1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28-2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35-1.80; <0.001), cigarettes (aOR = 1.24, 1.04-1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51-2.42; <0.001), and blunts (aOR = 1.22, 1.00-1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %).

CONCLUSIONS

Screening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

Herbal Cannabis and Depression: A Review of Findings Published over the Last Three Years

Public perception contrasts scientific findings on the depression-related effects of cannabis. However, earlier studies were performed when cannabis was predominantly illegal, its production was mostly uncontrolled, and the idea of medical cannabis was incipient only. We hypothesized that recent changes in attitudes and legislations may have favorably affected research. In addition, publication bias against cannabis may have also decreased. To investigate this hypothesis, we conducted a review of research studies published over the last three years. We found 156 relevant research articles. In most cross-sectional studies, depression was higher in those who consumed cannabis than in those who did not. An increase in cannabis consumption was typically followed by an increase in depression, whereas withdrawal from cannabis ameliorated depression in most cases. Although medical cannabis reduced depression in most studies, none of these were placebo-controlled. In clinical studies published in the same period, the placebo also ameliorated depression and, in addition, the average effect size of the placebo was larger than the average effect size of medical cannabis. We also investigated the plausibility of the antidepressant effects of cannabis by reviewing molecular and pharmacological studies. Taken together, the reviewed findings do not support the antidepressant effects of herbal cannabis.

An Examination of Bidirectional Associations Between Alcohol Use and Internalizing Symptoms Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study explores the bidirectional association between internalizing symptoms and alcohol use over three years of the COVID-19 pandemic to examine whether alcohol consumption is associated with higher internalizing symptoms in the next year and vice versa.

METHODS

We used linked data from a sample of 2,136 secondary school students who participated in three consecutive waves (2019-2020 [T1], 2020-2021 [T2], and 2021-2022 [T3]) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour study during the pandemic. A random-intercept cross-lagged panel model was used to characterize reciprocal linear relations between internalizing symptoms and alcohol use.

RESULTS

The findings suggest that students who reported higher levels of alcohol use at T1 experienced increased levels of depression and anxiety in the subsequent year (T2). However, this association was not observed from T2 to T3. Throughout the three-year period, depression and anxiety were not associated with later alcohol use. In males, alcohol use at T1 was a predictor of higher internalizing symptoms at T2 but not from T2 to T3.

DISCUSSION

These results suggest time-sensitive impacts and notable gender differences in the relationship between internalizing symptoms and alcohol use over the pandemic. Given the complexity of impacts, ongoing evaluation of the impact of the pandemic on youth health behaviours is necessary to elucidate these unfolding relationships, especially as the pandemic continues to affect various psychosocial risk factors.

Bidirectional associations between alcohol drinking and depressive symptom scores among US older adults

BACKGROUND

This study examines the bidirectional associations between alcohol drinking and depression in which low to moderate alcohol drinking may reduce the risk of depression, while the occurrence of depression may increase the amount of alcohol drinking as a coping strategy.

METHOD

Data for the community-dwelling older adults from the Medicare Current Beneficiary Survey (MCBS) 2016 to 2019 were analyzed using random intercept cross-lagged panel models to explore the within-individual causal associations for males and females separately. Socioeconomic status (SES), smoking and comorbidities were adjusted in the models.

RESULTS

Among 3388 older adults with three measures for the number of alcohol drinks and Patient Health Questionnaire (PHQ) depression scores, a prior increase in the number of drinks was related to a moderate non-significant decrease in PHQ scores in the follow-up, but a previous increase in the PHQ scores was significantly associated with a decrease in the number of drinks at the follow-up visit in the adjusted models (regression coefficient = -0.144, p = 0.017 for males; and coefficient = -0.11, p < 0.001 for females).

CONCLUSION

Prior depression may lead to reduced drinking in the follow up visits, but no bidirectional association was found among US older adults.

Exploring the reciprocal associations between body appreciation, body image flexibility, and body acceptance by others in the context of the COVID-19 pandemic in Germany: Results from cross-lagged panel analyses among women and men

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

Psychosocial predictors of trajectories of dual cigarette and e-cigarette use among young adults in the US

INTRODUCTION

Young adults have the highest prevalence of cigarette and e-cigarette use, warranting research to identify psychosocial correlates of their use trajectories.

METHODS

Repeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette trajectories across 5 waves of data (2018-2020) among 3,006 young adults (Mage = 24.56 [SD = 4.72], 54.8% female, 31.6% sexual minority, 60.2% racial/ethnic minority). Multinomial logistic regression models examined associations among psychosocial factors (i.e., depressive symptoms, adverse childhood experiences [ACEs], personality traits) and trajectories of cigarette and e-cigarette use, controlling for sociodemographics and past 6-month alcohol and cannabis use.

RESULTS

RMLPAs yielded a 6-profile solution, which were uniquely associated with predictors: stable low-level or nonusers of cigarettes and e-cigarettes (66.3%; referent group), stable low-level cigarette and high-level e-cigarette use (12.3%; greater depressive symptoms, ACEs, openness; male, White, cannabis use), stable mid-level cigarette and low-level e-cigarette use (6.2%; greater depressive symptoms, ACEs, extraversion; less openness, conscientiousness; older age, male, Black or Hispanic, cannabis use), stable low-level cigarette and decreasing e-cigarette use (6.0%; greater depressive symptoms, ACEs, openness; younger age, cannabis use), stable high-level cigarette and low-level e-cigarette use (4.7%; greater depressive symptoms, ACEs, extraversion; older age, cannabis use), and decreasing high-level cigarette and stable high-level e-cigarette use (4.5%; greater depressive symptoms, ACEs, extraversion, less conscientiousness; older age, cannabis use).

CONCLUSIONS

Cigarette and e-cigarette prevention and cessation efforts should be targeted both toward specific trajectories of use and their unique psychosocial correlates.

Emotion dysregulation in relation to cannabis use and mental health among young adults

BACKGROUND

Emotion dysregulation (ED) is a transdiagnostic variable that accounts for the onset and maintenance of mental health disorders. The interplay between ED, cannabis use and mental health has not been appraised in the young adult population and whether there are sex-dependent effects has yet to be examined. This study looked at whether ED mediates the association between past-month cannabis use and mental health, while considering sex as a moderator.

METHODS

2,762 (64.2% women) undergraduate Spanish students completed an online battery. Among others, they fulfilled the Depression Anxiety Stress Scale-21 (DASS-21) and the Difficulties in Emotion Regulation Scale (DERS-28). A two-way ANOVA assessed the effects of sex and past-month cannabis use on participants' DASS-21 scores. A set of moderated mediations tested whether the indirect effect of past-month cannabis use on DASS-21 through DERS differed by sex.

RESULTS

Past-month cannabis female users showed higher levels of depression, anxiety and stress (M = 51.10, SD = 26.72) than did men [(M = 33.76, SD = 20.31); F(1, 2758) = 5.119, p =.024, η²p =.002]. In female young adults only, the effect of past-month cannabis use on mental health was mediated by ED (total score), non-acceptance of emotional responses, lack of emotional control, difficulties in engaging in goal-directed behavior, and lack of emotional clarity (all p's < 0.005) CONCLUSIONS: Findings indicate the importance of considering ED in assessment and intervention practices. Interventions targeting ED may be particularly effective for female young adult cannabis users.

E-Cigarette Use Is Associated with Increased Psychological Distress among Youth: A Pooled Cross-Sectional Analysis of State-Level Data from 2019 and 2021

A crisis of worsening youth mental health in recent years across the United States has created alarm among health professionals. As a result, health professionals have sought to improve methods of identifying youth in need of treatment services. Cigarette, cannabis, and alcohol use each consistently serve as behavioral markers of risk for youth mental health problems. Despite the recent growth of electronic cigarette (e-cigarette) use among youth, few studies have examined whether e-cigarettes follow the same associational pattern with mental health problems in the context of other substance use. Additionally, the COVID-19 pandemic may have altered the associations between youth substance use and mental health problems due to both reduced overall use and increased mental health problems after the onset of the pandemic. The current study examined associations between youth substance use and psychological distress before and after the onset of the COVID-19 pandemic using two state-representative samples of youth in grades 8, 10, and 12 from 2019 (N = 58,689) and 2021 (N = 46,823) from Utah. Pooled cross-sectional linear and negative binomial regression models clustered by grade, stratified by school district, and weighted to represent population characteristics estimated associations between recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use and two measures of psychological distress-depressive symptoms and mental health treatment needs. After controlling for sociodemographic factors and recent uses of other substances, results indicated that psychological distress increased from 2019 to 2021 and that recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use were each significantly associated with increased levels on both measures of psychological distress. Compared to other substances, e-cigarette use showed the strongest standardized associations. The association of e-cigarette use with depressive symptoms strengthened significantly from 2019 to 2021. Given the youth mental health crisis paired with the widespread adoption of e-cigarettes, health professionals should consider recent e-cigarette use an increasingly important behavioral marker for risks of mental health problems among youth. Results suggest that future research studies examining the temporal ordering of substance use and mental health among youth should include e-cigarettes.