Among over 10,000 secondary school students, cannabis use was linked to mental health problems, but the association was largely explained by other risk factors like truancy, alcohol use, and adverse life events.
Read this if you want to understand whether teen cannabis use causes mental health problems or simply signals them.
4.5x higher odds of mental health problems with cannabis use, but not after adjusting for other factors
What the researchers found
In a survey of 10,324 secondary school students aged 11 to 16, past-month cannabis use was associated with a 4.5-fold increase in the odds of clinically relevant mental health problems as measured by the Strengths and Difficulties Questionnaire. However, when researchers adjusted for a comprehensive list of other risk factors, cannabis was no longer significantly associated with poor mental health.
The risk factors that explained the association included low educational track, alcohol use, cigarette smoking, hard drug use, frequent truancy, unfavorable school evaluation, feeling unsafe at school, victimization, frequent illness-related absence, having a mentally ill parent, parental abuse, financial problems, and distress from adverse events. Many of these factors were also independently associated with cannabis use itself.
Why it matters
This study reframes cannabis use in adolescence not as a direct cause of mental health problems but as an indicator or marker that a young person may be experiencing multiple risk factors simultaneously. This distinction matters for how schools and public health systems approach prevention.
The numbers in context
Among 10,324 students (ages 11-16), past-month cannabis use had an unadjusted odds ratio of 4.46 (95% CI: 3.46-5.76) for clinically relevant SDQ scores. After adjusting for all other risk factors, the association was no longer statistically significant.
How the study worked
Cross-sectional survey of 10,324 students aged 11-16 participating in a Public Health Service School Survey in the Netherlands. Students reported on demographics, substance use, school factors, and stressful life events and completed the Strengths and Difficulties Questionnaire. Logistic regression models examined the cannabis-mental health association before and after adjusting for other risk factors.
What this study cannot tell us
Cross-sectional design cannot determine temporal ordering or causation. Self-reported data may be subject to underreporting, especially for substance use. The study was conducted in the Netherlands, where cannabis policies differ from many other countries. A trend-level association remained after full adjustment, suggesting cannabis may still play some role.
How to read the evidence
Large population-based sample with comprehensive adjustment for confounders, though cross-sectional design limits causal conclusions.
When this study was published
Published in 2013. The debate about cannabis as cause vs. indicator of adolescent mental health risk continues.
The bigger picture
The finding that cannabis use functions as a risk indicator rather than an independent cause aligns with research showing that adolescent substance use typically clusters with other behavioral and environmental risk factors. Interventions focused solely on cannabis prevention may miss the broader picture.
Questions still open
- Does cannabis use contribute to mental health risk beyond what confounders explain, or is it purely an indicator? Would longitudinal tracking show cannabis use preceding the development of mental health problems in some cases? Do these findings hold in countries with different cannabis policy environments?
Common questions
Does teen cannabis use cause mental health problems?
What other factors explained the link between cannabis and mental health in teens?
Read the original research
Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools.
Psychological medicine, 43(9), 1849-56
Citation
van Gastel, W A; Tempelaar, W; Bun, C; Schubart, C D; Kahn, R S; Plevier, C; Boks, M P M. (2013). Cannabis use as an indicator of risk for mental health problems in adolescents: a population-based study at secondary schools.. Psychological medicine, 43(9), 1849-56. https://doi.org/10.1017/S0033291712002723
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide