Cannabis use did not significantly worsen anxiety disorder outcomes after accounting for baseline differences
A 3-year population study of 3,723 people with anxiety disorders found that while cannabis users had lower remission rates in raw numbers, these differences disappeared after adjusting for baseline factors, suggesting pre-existing characteristics rather than cannabis use explain poorer outcomes.
Quick Facts
What This Study Found
Researchers analyzed data from 3,723 individuals with diagnosed anxiety disorders (social anxiety, panic disorder, generalized anxiety disorder, specific phobias) from the National Epidemiologic Survey on Alcohol and Related Conditions.
In unadjusted analysis, remission rates from anxiety disorders decreased with increasing levels of cannabis use, suggesting cannabis worsened outcomes.
However, after adjusting for baseline confounders, the association between cannabis use and lower remission rates was no longer statistically significant. This means that pre-existing differences between cannabis users and non-users, not cannabis itself, likely explained the poorer outcomes.
Two specific exceptions emerged: individuals with cannabis use disorders were significantly more likely to report breaking up from a romantic relationship (OR 3.85) and repeatedly quitting school (OR 6.02) compared to non-users, even after adjustment.
Key Numbers
3,723 individuals with anxiety disorders. Unadjusted: lower remission with more cannabis use. Adjusted: no significant difference in remission. Cannabis use disorder linked to relationship breakup (OR 3.85) and quitting school (OR 6.02).
How They Did This
Longitudinal analysis of Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Focused on 3,723 individuals with any anxiety disorder at Wave 1. Cannabis users and those with cannabis use disorders compared to non-users on remission, functioning, and quality of life at Wave 2 (approximately 3 years later), controlling for baseline confounders.
Why This Research Matters
This finding challenges the assumption that cannabis use worsens anxiety disorders. The disappearance of the association after controlling for baseline factors suggests that people who use cannabis already differ from non-users in ways that predict worse outcomes, independent of their cannabis use.
The Bigger Picture
This adds to a growing body of research suggesting that many observed associations between cannabis use and psychiatric outcomes may reflect shared vulnerabilities rather than direct cannabis effects. The methodology of adjusting for baseline confounders is critical for interpreting observational studies on cannabis and mental health.
What This Study Doesn't Tell Us
Observational design cannot fully rule out residual confounding even after adjustment. Self-reported cannabis use and diagnostic assessments are subject to bias. The 3-year follow-up may be too short to detect longer-term effects. Cannabis use patterns (frequency, potency, cannabinoid profile) were not detailed.
Questions This Raises
- ?What specific baseline factors account for the apparent cannabis-anxiety association?
- ?Would longer follow-up reveal effects not captured in 3 years?
- ?Does the type of anxiety disorder matter for cannabis effects on outcomes?
Trust & Context
- Key Stat:
- Cannabis-anxiety association disappeared after adjusting for baseline factors
- Evidence Grade:
- Large population-based longitudinal study (NESARC) with baseline confounder adjustment provides moderate evidence, though observational design limits causal inference.
- Study Age:
- Published in 2018 using NESARC data. Cannabis potency and use patterns have changed since the original survey.
- Original Title:
- Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study.
- Published In:
- Depression and anxiety, 35(6), 490-501 (2018)
- Authors:
- Feingold, Daniel(12), Rehm, Jürgen(12), Factor, Hagai, Redler, Avigayil, Lev-Ran, Shaul
- Database ID:
- RTHC-01653
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does cannabis make anxiety disorders worse?
In raw numbers, cannabis users had lower remission rates. But after accounting for pre-existing differences between users and non-users, the association disappeared. This suggests it is the characteristics of people who use cannabis, not the cannabis itself, that predict worse outcomes.
Were there any negative effects found?
Yes. People with cannabis use disorders (problematic, heavy use) were nearly 4 times more likely to break up from a relationship and 6 times more likely to repeatedly quit school, even after adjustment.
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Cite This Study
https://rethinkthc.com/research/RTHC-01653APA
Feingold, Daniel; Rehm, Jürgen; Factor, Hagai; Redler, Avigayil; Lev-Ran, Shaul. (2018). Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study.. Depression and anxiety, 35(6), 490-501. https://doi.org/10.1002/da.22735
MLA
Feingold, Daniel, et al. "Clinical and functional outcomes of cannabis use among individuals with anxiety disorders: A 3-year population-based longitudinal study.." Depression and anxiety, 2018. https://doi.org/10.1002/da.22735
RethinkTHC
RethinkTHC Research Database. "Clinical and functional outcomes of cannabis use among indiv..." RTHC-01653. Retrieved from https://rethinkthc.com/research/feingold-2018-clinical-and-functional-outcomes
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.