Comorbid Cannabis Use Disorder with Major Depression and Generalized Anxiety Disorder: A Systematic Review with Meta-analysis of Nationally Representative Epidemiological Surveys
Abstract
Background Studies have shown a high degree of comorbidity between cannabis use disorder (CUD) and other mental illnesses. However, there is a paucity of research on the comorbidity between CUD with major depression (MD) and generalized anxiety disorder (GAD). This systematic review with meta-analysis aimed to assess the prevalence and strength of association between co-morbid CUD with MD and GAD. Methods An extensive search of Medline, CINAHL, PsycINFO, EMBASE, and grey literature were conducted to cover articles published between January 1 st, 1980, and July 31 st, 2020. Inclusion criteria were publications in English Language, original research, nationally representative samples, and non-clinical randomly selected adult populations. A systematic review and meta-analysis for the prevalence and ORs for comorbid CUD with MD or GAD were done. Results A total of 67 articles were identified by the electronic searches. A full-text review yielded 8 publications on nationally representative epidemiological surveys. 12-month and lifetime comorbidity estimates were extracted and used for the meta-analysis. CUD was strongly associated with MDE (OR 3.22; 2.31 - 4.49) and with GAD (OR 2.99; 2.14 - 4.16). Limitations Limitations of this study include the heterogeneity observed due to the combination of studies from different geographic regions with different modifications of diagnostic criteria and varied response rates. This was addressed with a random-effects model. Conclusion This review confirms the evidence of high prevalence and a 3-fold comorbid association between CUD with MD and CUD with GAD. Implementation of evidence-based policy interventions with effective, integrated management of comorbid CUDs with psychiatric disorders may contribute to positive patient outcomes.
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Risk of anxiety disorders is twofold higher in people who misuse cannabis.
“Risk of anxiety disorders is twofold higher in people who misuse cannabis, threefold to fourfold higher in those with a CUD [42, 45].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [42]
Risk of major depression is twofold for cannabis misusers.
“Regular cannabis use is associated with more depressive symptoms, and heavy cannabis use by youth and young adults predicts an increased risk of major depression [41]; twofold for cannabis misusers and threefold to fivefold for people with a CUD [42].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [42]
Risk of major depression is threefold to fivefold for people with a CUD.
“Regular cannabis use is associated with more depressive symptoms, and heavy cannabis use by youth and young adults predicts an increased risk of major depression [41]; twofold for cannabis misusers and threefold to fivefold for people with a CUD [42].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [42]
Risk of anxiety disorders is threefold to fourfold higher in those with a CUD.
“Risk of anxiety disorders is twofold higher in people who misuse cannabis, threefold to fourfold higher in those with a CUD [42, 45].”
From Cannabis, cannabinoids and health: a review of evidence on risks and medical benefits (2025) · cites this paper as [42]
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References 74 · Cited by 152
- Authors
- Onaemo, V. N., Fawehinmi, T. O., & D'Arcy, C.
- Affiliations
- Saskatchewan Health (CA)
- Government of Nunavut (CA)
- Corresponding author
- Onaemo, Vivian N.
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 281
- Pages
- 467-475
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W3111803383
- Cited by
- 152
- References
- 74
- Citations by year
- 2026: 28 · 2025: 30 · 2024: 33 · 2023: 34 · 2022: 23 · 2021: 4
- FWCI
- 1.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- cannabis use disorder, major depressive disorder, generalized anxiety disorder, psychiatric comorbidity, prevalence, nationally representative surveys, adults
- MeSH terms
- Adult, Anxiety Disorders, Cannabis, Marijuana Abuse, Depression, Major Depressive Disorder, Humans, Comorbidity, Prevalence
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