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Cited by 6Bipolar Disorder and TreatmentCannabis and Cannabinoid ResearchSubstance Abuse Treatment and Outcomes

The DOI matches its Crossref record; 99 of the 99 references it cites were found in a registry or an index.

The Prevalence of Cannabis Use Disorder Comorbidity in Individuals With Bipolar Disorder: A Systematic Review and Meta-Analysis

Bahji, Anees, Danilewitz, Marlon, Vazquez, Gustavo, Patten, Scott·2021·Canadian Journal of Addiction
DOI 10.1097/cxa.0000000000000123
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Abstract

ABSTRACT Background: Emerging epidemiological evidence suggests an association between cannabis use and bipolar disorder (BD). To date, the prevalence of comorbid cannabis use disorder (CUD) has not been well described, nor has the association between CUD and the clinical course of BD. Aim: To estimate the prevalence of CUD comorbidity among individuals with BD and identify clinical features associated with CUD. Methods: We searched PubMed from inception to December 2020, supplemented by manual searches of reference lists of included articles and prior review for eligible records. We included articles if they (1) were in English, (2) reported on individuals with a diagnosis of BD as a primary study group, (3) reported on the prevalence of CUD, and (4) used an observational study design (eg, cohort or cross-sectional). All abstracts, full-text articles, and other sources were reviewed, and data were extracted for quantitative analyses. We estimated CUD prevalence using a random-effects meta-analysis model, alongside stratification, to characterize heterogeneity. We reported CUD prevalence as a percentage with 95% CIs. We assessed the study-level risk of bias using the Joanna Briggs Institute checklist for observational studies. We estimated heterogeneity using the I 2 statistic. Findings: 48 studies, representing 86,833 participants, met all inclusion criteria. Most participants had Bipolar I Disorder (92%), were Caucasian (74%), female (55%), and the median (SD) age was 37.4 (6.8) years. The overall pooled prevalence of CUD was 17% (95% CI: 13%–20%), with significant heterogeneity between estimates (I 2 = 99%). When stratified by source, the prevalence of CUD was 6% (95% CI: 4%–8%) in population-based samples, 16% in community samples (95% CI: 14%–18%), and 39% in inpatient samples (95% CI: 33%-46%), which were significantly different (P < 0.01). CUD comorbidity was higher in males (odds ratio [OR] = 2.05, 95% CI: 1.69–2.47). The age at BD onset was approximately 3 years earlier in those with CUD (mean difference [MD] = −3.04 yrs, 95% CI: −5.36, −0.73). The lifetime prevalence of psychosis symptoms (OR = 1.94, 95% CI: 1.63–2.31), mixed episodes (OR = 1.50, 95% CI: 1.25–1.80), rapid cycling (OR = 2.06, 95% CI: 1.41–3.01), and suicide attempts (OR = 2.74, 95% CI: 1.39–5.39) was higher among BD patients with comorbid CUD. Conclusions: These findings suggest that CUD appears to be prevalent among individuals with BD cannabis, with the highest prevalence in in-patient populations. Clinicians should be aware of the increased prevalence of CUD in BD populations and its association with more deleterious outcomes and prognosis. Contexte: Des preuves épidémiologiques émergentes suggèrent une association entre la consommation de cannabis et le trouble bipolaire (TB). À ce jour, la prévalence du trouble de consommation de cannabis comorbide (TCC) n’a pas été bien décrite, pas plus que l’association entre le TCC et l’évolution clinique du TB. Objectif: Estimer la prévalence de la comorbidité du TCC chez les personnes atteintes de TB et identifier les caractéristiques cliniques associées au TCC. Méthodes: Nous avons effectué des recherches dans PubMed depuis sa création jusqu’en décembre 2020, complétées par des recherches manuelles dans les listes de références des articles inclus et une revue préalable des enregistrements éligibles. Nous avons inclus des articles s’ils (1) étaient en anglais, (2) portaient sur des individus ayant reçu un diagnostic de TB en tant que groupe d’étude principal, (3) portaient sur la prévalence du TCC et (4) utilisaient une conception d’étude observationnelle (par ex. cohorte ou transversale). Tous les résumés, articles en texte intégral et autres sources ont été examinés et les données ont été extraites pour des analyses quantitatives. Nous avons estimé la prévalence du TCC à l’aide d’un modèle de méta-analyse à effets aléatoires, parallèlement à la stratification, pour caractériser l’hétérogénéité. Nous avons rapporté la prévalence du TCC en pourcentage avec des IC à 95%. Nous avons évalué le risque de biais au niveau de l’étude à l’aide de la liste de contrôle du Joanna Briggs Institute pour les études observationnelles. Nous avons estimé l’hétérogénéité à l’aide de la statistique I2. Résultats: 48 études, représentant 86 833 participants, répondaient à tous les critères d’inclusion. La plupart des participants avaient un trouble bipolaire I (92%), étaient de race blanche (74%), de sexe féminin (55%) et l’âge médian (ET) était de 37,4 (6,8) ans. La prévalence globale regroupée du TCC était de 17% (IC à 95%: 13% à 20%), avec une hétérogénéité significative entre les estimations (I2 = 99%). Une fois stratifiée par source, la prévalence du TCC était de 6% (IC à 95%: 4% à 8%) dans les échantillons de population, de 16% dans les échantillons communautaires (IC à 95%: 14% à 18%) et de 39% dans les échantillons de patients hospitalisés (IC à 95%: 33% à 46%), qui étaient significativement différ

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Research works printed but not linked: 2

  1. Beaulieu, 2012, The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid substance use disorders, Ann Clin Psychiatry, 24, 38
  2. Bahji, 2016, Treatment of cannabis dependence with synthetic cannabinoids: a systematic review, Can J Addict, 7, 8

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Metadata

Authors
Bahji, A., Danilewitz, M., Vazquez, G., & Patten, S.
Affiliations
  • University of Calgary (CA)
  • University of Toronto (CA)
  • Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
ORCID
Venue
Canadian Journal of Addiction
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-09
Volume
12
Issue
3
Pages
22-38
ISSN
  • 2368-4720 (ISSN-L)
  • 2368-4739
DOI
10.1097/cxa.0000000000000123
OpenAlex
W3199340747
Cited by
6
References
99
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 1
FWCI
0.18
Type
journal article
Language
en
Open access
closed
Locations
The Canadian Journal of Addiction (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Health Sciences › Medicine › Pharmacology (medical) › Cannabis and Cannabinoid Research
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords
cannabis use disorder, bipolar disorder, comorbidities, prevalence, bipolar I disorder, age of onset, clinical course, sex differences, substance use disorders, psychiatric comorbidity

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