Cannabis Use Was Extremely Common in South African Teens with First-Episode Psychosis | Research

The takeaway

Among 45 South African adolescents with first-episode psychosis, 56% reported lifetime cannabis use (96% of whom were male), and the average delay from symptom onset to treatment was nearly 7 months.

Read this if you are interested in the relationship between cannabis and psychosis in young people, particularly in African contexts.

56% lifetime cannabis use; 96% of users were male

What the researchers found

Researchers assessed 45 adolescents (mean age 15.9) with first-episode psychosis in KwaZulu-Natal, South Africa. Cannabis use was strikingly prevalent: 56% reported lifetime use, and 96% of cannabis users were male.

The mean duration of untreated psychosis was 27.2 weeks (nearly 7 months), with younger children experiencing longer delays. The prodromal period (early warning signs before full psychosis) was poorly recognized by 49% of patients and caregivers.

Male patients had slightly later onset (15.7 vs. 15.3 years) but dramatically higher cannabis use, suggesting that environmental factors like cannabis use may play different roles in psychosis onset for males versus females.

Why it matters

This study from a low-to-middle income country highlights that cannabis-psychosis associations observed in Western research also appear in African settings, and that delays in treatment are substantial, potentially worsening outcomes.

The numbers in context

45 adolescents; mean age 15.9; 69% male; 56% lifetime cannabis use; 96% of cannabis users were male; mean DUP 27.2 weeks; negative correlation between DUP and age of onset (p<0.05)

How the study worked

Cross-sectional assessment of 45 adolescents with first-episode psychosis using clinical interview, PANSS rating scale, SOS score, WHO ASSIST questionnaire, and urine cannabis testing.

What this study cannot tell us

Small sample (45 patients). Single site in South Africa. Cross-sectional design cannot determine whether cannabis contributed to psychosis onset. Self-reported substance use may be unreliable. No comparison group of adolescents without psychosis.

How to read the evidence

Small cross-sectional clinical study from a single site. Provides important descriptive data but cannot establish causal relationships.

When this study was published

Published in 2015. Cannabis availability and mental health service access in South Africa continue to evolve.

The bigger picture

The near-exclusive association of cannabis use with male adolescent psychosis patients raises questions about whether cannabis is a gendered risk factor or whether boys are simply more likely to use cannabis. Either way, the combination of cannabis use and delayed treatment represents a concerning pattern.

Questions still open

Does cannabis contribute to psychosis onset in this population, or do pre-psychotic symptoms lead to cannabis use? Would earlier recognition of prodromal symptoms reduce the 7-month treatment delay? Why is cannabis use so much more common in male psychosis patients?

Common questions

Does cannabis cause psychosis in teenagers?

This study cannot answer that question. It found very high cannabis use among teen psychosis patients (56%), particularly males, but could not determine whether cannabis contributed to psychosis or whether early psychotic symptoms led to cannabis use.

Why was treatment delayed so long?

The average delay was 27 weeks (7 months). Nearly half of patients and caregivers did not recognize the early warning signs of psychosis. Younger children had even longer delays, possibly because symptoms were attributed to normal developmental behavior.

Read the original research

Clinical correlates of first episode early onset psychosis in KwaZulu-Natal, South Africa.

Journal of child and adolescent mental health, 27(2), 103-11

View on PubMed ↗Publisher’s paper ↗

Citation

Paruk, Saeeda; Jhazbhay, Khadija; Singh, Keshika; Sartorius, Benn; Burns, Jonathan K. (2015). Clinical correlates of first episode early onset psychosis in KwaZulu-Natal, South Africa.. Journal of child and adolescent mental health, 27(2), 103-11. https://doi.org/10.2989/17280583.2015.1080710