Research paperThe association between lifetime cannabis use and dysthymia across six birth decades
Introduction
Following alcohol and tobacco, cannabis is the most commonly used substance in the United States (Carliner et al., 2017; Center for Behavioral Health Statistics, 2014). Previous reports indicate an increase in the prevalence of cannabis use in recent decades (Grucza et al., 2016, Hasin et al., 2015). These changes have been related to various factors, including: generally permissive attitudes towards cannabis use related to cultural changes, cohort effects, and periodic effects (Hasin et al., 2017, Kerr et al., 2007, Miech and Koester, 2012); and state-level regulation of cannabis use, leading to increased availability and potency, and to perceived safety of the substance (Cerdá et al., 2012, ElSohly et al., 2000, Hasin et al., 2017).
Alongside the increased rates of cannabis use among the general population in recent decades, rates of depression have also been on the rise (Compton et al., 2006, Hasin et al., 2005, Kessler et al., 2009, Twenge et al., 2010). Several cross-sectional studies based on large-scale surveys reported a positive association between cannabis use and mood disorders, primarily major depressive disorders and bipolar depression (Grant et al., 2004, Hasin et al., 2017, Lev-Ran et al., 2013, Stinson et al., 2006).
Despite the recent focus on cannabis use and depression, little is known about the association between cannabis use and dysthymia. Persistent depressive disorder (dysthymia) is a chronic and milder form of depression that is present for most days over a period of two years. DSM-5 diagnostic criteria for dysthymia, requires the occurrence of ≥ 2 symptoms of 6 (criterion B; American Psychiatric Association, 2013). The lifetime prevalence of dysthymia is estimated to be between 3% and 6% (Kessler and Bromet, 2013, Sansone and Sansone, 2009). Furthermore, reports indicate that dysthymia is associated with substantial disability and with an increased burden of disease (accounting for 0.5% of global disability adjusted life years), mainly due to its chronicity and low remission rate (Ferrari et al., 2013). Although past studies have demonstrated an association between dysthymia and comorbid psychiatric disorders (such as major depressive disorders, other mood disorders, personality disorders) and substance use disorders (SUDs) (American Psychiatric Association, 2013, Klein et al., 2000, Sansone and Sansone, 2009), data regarding the association between dysthymia and cannabis use, and the characteristics of dysthymic cannabis users is lacking.
A growing number of reports indicate an increase in the prevalence of cannabis use in recent decades (Grucza et al., 2016, Hasin et al., 2015), with some studies attributing these changes to cohort effects (Kerr et al., 2007, Miech and Koester, 2012). However, studies examining changes in the prevalence of psychiatric disorders across birth cohorts have yielded mixed results. While some studies demonstrated a higher prevalence of certain psychiatric disorders among later birth cohorts (Colligan and Bajuniemi, 1984, Halikas et al., 1972, Newsom et al., 2003), other studies failed to show similar changes across birth cohorts (Costello et al., 2006, Murray et al., 2012, Twenge et al., 2010, Twenge and Nolen-Hoeksema, 2002). Data regarding changes in the prevalence of dysthymia across birth cohorts is scarce. Moreover, there are no reports to-date exploring changes in the association between cannabis use and dysthymia across birth decades. Though repeated cross-sectional studies indicate an association between long-standing depressive symptoms and cannabis use, and despite a well-known increase in prevalence of cannabis use in recent decades, changes in association between cannabis use and dysthymia across birth decades have not yet been explored. Considering that previous studies have shown that individuals who come of age in birth cohorts with less socially restrictive attitudes toward substance use are more likely to use drugs (Talati et al., 2016), we hypothesized that the association between cannabis and dysthymia would be affected by birth cohort.
The aim of this study was to explore associations between cannabis use among individuals with dysthymia and several sociodemographic and clinical characteristics. In addition, we sought to explore changes in the association between cannabis use and dysthymia across six decades of birth. We hypothesized that cannabis use would be associated with increased co-occurring psychiatric disorders among individuals with dysthymia. Furthermore, as studies have indicated a correlation between deviant behavior and psychopathologies (Samek et al., 2014, Talati et al., 2016), and as cannabis use is gradually regarded more normative and less deviant, we predicted that cannabis users born in later birth cohorts would be less prone to dysthymia compared to those born in earlier birth cohorts.
Section snippets
Study sample and design
The study was a cross-sectional observation of participants who completed the National Epidemiological Survey for Alcohol and Related Conditions-III (NESARC-III) interviews. The NESARC-III sample represents the civilian, noninstitutionalized adult population of the United States (aged 18 and older). All NESARC-III respondents were informed in writing about the nature of the survey. Interviews were fielded from April 2012 through June 2013 and included 36,309 participants. The research protocol,
Results
Among individuals with dysthymia included in the study (N = 2016), 47.8% were non-users, 37.7% were included in the non-CUD users group and 14.5% were included in the CUD users group. Among dysthymic individuals who were lifetime non-CUD users, daily use, weekly use and less than weekly use during the period of heaviest use, were reported by 30%, 22% and 48% of the sample, respectively. Among dysthymic CUD users, daily, weekly and less than weekly use, during the period of heaviest use, were
Discussion
In this study, we examined the association between cannabis use and dysthymia across 6 birth cohorts (1940's through 1990's) using a large representative sample. Our results indicate significantly higher rates of several psychiatric disorders among individuals with dysthymia who use cannabis compared to those who do not. Furthermore, our findings indicate a significant decline in the strength of the association between cannabis use, but not Cannabis Use Disorders, and dysthymia across six birth
Acknowledgments
None reported.
Funding/Support
None reported.
Author Contributions
Dr. Livne had full access to all of the data in the study and takes responsibility for the integrity of the data.
All authors played a role in agreement to be accountable for all aspects of the work.
Study concept and design: Lev-Ran S.
Acquisition, analysis, or interpretation of data: Livne O., Razon L.
Drafting of the manuscript: Livne O.
Critical revision of the manuscript: Lev-Ran S, Hasin D, Rehm J.
Intellectual content: All authors.
Statistical analysis: Razon L., Livne O.
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