ImportanceAdolescent cannabis use has been consistently posited to contribute to the onset and progression of psychosis. However, alternative causal models may account for observed associations between cannabis use and psychosis risk, including shared vulnerability for both cannabis use and psychosis or efforts to self-medicate distress from psychosis spectrum symptomology.ObjectiveTo test 3 hypotheses that may explain cannabis–psychosis risk associations by modeling psychosis spectrum symptom trajectories prior to and after cannabis initiation across adolescent development (approximately 10-15 years of age).Design, Setting, and ParticipantsThis cohort study used data from 5 waves across 4 years of follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. The ABCD study is an ongoing large-scale, longitudinal study of brain development and mental and physical health of children in the US launched in June 2016. Data are collected from 21 research sites. The study included data from 11 868 adolescents aged 9 to 10 years at baseline. Three participants were excluded from the present analysis owing to missing data. Data analysis was performed from September 2023 to July 2024.Main Outcomes and MeasuresDiscontinuous growth curve modeling was used to assess trajectories of psychosis spectrum symptoms before and after cannabis initiation. Control variables considered for this investigation were age, sex, internalizing and externalizing symptoms, socioeconomic status, parental mental health, and other substance use.ResultsAmong the 11 858 participants at wave 1, the mean (SD) age was 9.5 (0.5) years; 6182 (52%) participants were male. Consistent with a shared vulnerability hypothesis, adolescents who used cannabis at any point during the study period reported a greater number of psychosis spectrum symptoms (B, 0.86; 95% CI, 0.68-1.04) and more distress (B, 1.17; 95% CI, 0.96-1.39) from psychosis spectrum symptoms relative to those who never used cannabis. Additionally, consistent with a self-medication hypothesis, the number of psychosis spectrum symptoms (B, 0.16; 95% CI, 0.12-0.20) and distress (B, 0.23; 95% CI, 0.21-0.26) from psychosis spectrum symptoms increased in the time leading up to cannabis initiation. We observed mixed evidence for an increase in psychosis symptoms after cannabis initiation (ie, contributing risk hypothesis).Conclusion and RelevanceThe findings underscore the importance of accounting for shared vulnerability and self-medication effects when modeling cannabis–psychosis risk associations.

中文翻译：

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青少年开始使用大麻前后的精神病谱系症状


重要性青少年使用大麻一直被认为会导致精神病的发生和进展。然而，替代因果模型可以解释观察到的大麻使用与精神病风险之间的关联，包括大麻使用和精神病的共同脆弱性，或努力自我治疗精神病谱系症状带来的痛苦。目的通过对青少年（大约 10-15 岁）开始使用大麻之前和之后的精神病谱系症状轨迹进行建模，检验可能解释大麻-精神病风险关联的 3 个假设。设计、设置和参与者这项队列研究使用了青少年脑认知发展 （ABCD） 研究 4 年随访中 5 波的数据。ABCD 研究是一项正在进行的大规模纵向研究，旨在研究美国儿童的大脑发育和身心健康，于 2016 年 6 月启动。数据从 21 个研究站点收集。该研究包括来自基线时 11 868 名 9 至 10 岁青少年的数据。由于数据缺失，三名参与者被排除在目前的分析之外。主要结果和措施使用不连续生长曲线模型评估大麻开始前后精神病谱系症状的轨迹。本调查考虑的控制变量是年龄、性别、内化和外化症状、社会经济地位、父母心理健康和其他物质使用。结果在第 1 波的 11 858 名参与者中，平均 （SD） 年龄为 9.5 （0.5） 岁;6182 名 （52%） 参与者为男性。 与共同脆弱性假说一致，在研究期间任何时候使用大麻的青少年报告了更多的精神病谱系症状（B，0.86;95% CI，0.68-1.04）和更多的痛苦（B，1.17;95% CI，0.96-1.39），相对于从未使用过大麻的人。此外，与自我用药假说一致，精神病谱系症状的数量（B，0.16;95% CI，0.12-0.20）和痛苦（B，0.23;95% CI，0.21-0.26）在大麻开始前的时间里增加。我们观察到混合证据表明大麻开始后精神病症状增加（即，促成风险假设）。结论和相关性这些发现强调了在模拟大麻-精神病风险关联时考虑共同脆弱性和自我用药效应的重要性。