Systematic Review Background Information :

Background Information:

Cannabis is the most widely abused drug by young people all over the world with its ranking of third place among drugs of concerns in addiction facilities (1,2). In 2017, it was estimated that
3.8 percent of the global population used cannabis . These figures are expected to grow as cannabis becomes legal in more countries and is viewed as a “new” recreational drug (3). Even though cannabis is commonly used around the world and its consumption is prevalent especially among patients with depression and anxiety, there is just a handful of research that concludes whether or not cannabis use increases depression and anxiety (4). Also, the stigma attached to cannabis use limits to research, especially among young adults.
The pharmacologically active I ngredient in Cannabis is Tetrahydrocannabinol (THC). THC is a psychoactive ingredient that affects serotonin and other neurotransmitters in the body (3,4). It regulates one’s moods and emotions and can also produce depressive symptoms. Some studies also suggest that cannabis has antidepressant properties (2), hence why it may be used by young adults who are facing any form of stress.
This is why my research project aims to look into the connection between cannabis use and the prevalence of depression and anxiety in young adults who are under stress. In other words, my research aims to determine if cannabis use causes depression and/or anxiety in young adults especially during times of stress. I decided to address this topic because of the lack of substantial evidence supporting if cannabis use may increase the risk for depression and/or anxiety. The possible relationship between cannabis use and these mental health conditions is of a huge clinical importance.
Finally, understanding the connection between these mental illnesses and cannabis use can help us arrive at a definitive conclusion about the direction of causality.

Systematic Review Question :

Clinical questions often address four main elements: population, intervention, comparison (which is not always necessary), and outcome (Lou & Durando, 2008). For my systematic review question, these components will be determined as follows:

Population: Young adults of all gender between the ages of (18-30)

Intervention: Cannabis use

Comparison: none

Outcome: Depression and anxiety

Question Development :

Search Strategy:

• Databases selected:
o Why chosen?
 Medline: I chose this database because it is a great source for peer-reviewed medical and biomedical literature and research. It provides features to help simplify and organize one’s search. It also has various limits to help strategize one’s search and to also make it specific.
 Psychinfo: I chose this database because it provides scholarly journal articles from the field of psychology and life sciences. It is also a great source for my research considering I’ll be looking into mental-health illnesses. It is It also has features to help organize, save and export one’s project.
o
• Initial search concepts:

o MeSH: : “Cannabis use”, “Marijuana use”, Marijuana smoking, Emotions, Depression Chemical, Cortical Spreading Depression, inbreeding Depression, Performance Anxiety, Anxiety Separation, Test Anxiety Scale, Anxiety Disorders, Physiological stress, Human Stress, Mechanical Stress, Psychological Depression
o Keywords: Cannabis, marijuana, depression, anxiety, stress.
• Limits:
o Age? My search included an age limit for Adults (18yrs and older) and young adults (19-29) but it was more focused on young adults.
o Date? Date was not a criteria/limit used for my search.
o Language? I limited my search to articles that were fully written in the English language.

Inclusion Criteria/Exclusion Criteria:

Inclusion Criteria Exclusion Criteria
When deciding on what articles that I will be reviewing I looked out for key words and the medical subject headings.

• I checked if the title answered my question. If not, I briefly read the abstracts to review the article.
• What type of studies were carried out? Are the results and conclusion easy to understand?
• Age was a huge criterion for me also, as I wanted my results specific to young adults.
• I also checked if the articles were peer-reviewed. When deciding on what articles to review to excluded articles that did not provide any form of answer to my research questions.

• I excluded articles that had were hard comprehend
• I excluded articles that weren’t the age limit I wanted or articles that didn’t involve young adults at all.
• I excluded articles that didn’t share the aim of my research question; basically, any articles investigating cannabis use with other heath conditions.
Table 1: Initial Search Summary

Question:
P:
Young adults of all agender between the ages of 18-30 I:
Cannabis use C:
none O:
Depression and anxiety

Database Search History Yield Hits Duplicates
Medline 1 Cannabis.mp. or exp Cannabis/ (24300)
2 depression.mp. or exp Depression/ (419478)
3 exp Anxiety/ or anxiety.mp. (250887) 4 stress.mp. (964420)
5 1 and 2 and 3 and 4 (103) 102 61 0
PsycInfo 1 exp Cannabis/ or Cannabis.mp. (15141)
2 depression.mp. (340094)
3 exp Anxiety/ or anxiety.mp. (243220)
4 Stress.mp. or exp Stress/ (265048) 5 1 and 2 and 3 and 4 (140) 140 86 10
Adapted from Lou and Durando (2008)

Types of Studies Found:

Search Strategy Revisions:

Table 2: Second search summary

Database Search History Yield Hits Duplicates
MEDLINE 6 Cannabis.mp. or exp Cannabis/ (24309) 77 57 4
7 limit 6 to (english language and humans
and “young adult (19 to 24 years)”) (3325)
8 marijuana.mp. or exp Cannabis/ (27165)
9 limit 8 to (english language and humans
and “young adult (19 to 24 years)”) (4195)
10 7 or 9 (5210)
11 Depression.mp. or exp Depression,
Chemical/ or exp Depression/ or exp Cortical
Spreading Depression/ or exp Inbreeding
Depression/ (419654)
12 limit 11 to “young adult and adult (19-
24 and 19-44)” (147733)
13 exp Performance Anxiety/ or exp
Anxiety/ or exp Anxiety, Separation/ or exp
Test Anxiety Scale/ or anxiety.mp. or exp
Anxiety Disorders/ (285661)
14 limit 13 to (English language and
humans and “young adult and adult (19-24
and 19-44)” and English) (104765)
15 exp Stress, Physiological/ or
stress.mp. or exp Humans/ or exp Stress,
Mechanical/ or exp Stress, Psychological/ or
exp Depression/ (19520137)
16 limit 15 to (English language and
humans and “young adult and adult (19-24
and 19-44)”) (4359277)
17 10 and 12 and 14 and 16 (221)
18 limit 17 to (English language and full
text and humans and “young adult and adult
(19-24 and 19-44)” and English and adverse
effects) (89)
19 limit 18 to (English language and full
text and humans and “young adult (19 to 24
years)” and english and adverse effects –
focussed) (77)
20 18 and 19 (77)

6   exp "Cannabis Use Disorder"/ or exp Cannabis/ or cannabis.mp. (15141)

7 limit 6 to 320 young adulthood (4388)
8 Marijuana.mp. or exp Marijuana/ or exp Marijuana Usage/ (12202)
9 limit 8 to 320 young adulthood (3449)
10 exp “Long-term Depression (Neuronal)”/ or exp “Depression (Emotion)”/ or exp Major Depression/ or exp Reactive Depression/ or exp Recurrent Depression/ or Depression.mp. (340399)
11 limit 10 to (320 young adulthood and human) (69121)
12 exp Separation Anxiety Disorder/ or exp Anxiety Sensitivity/ or exp Health Anxiety/ or exp Performance Anxiety/ or exp Anxiety Management/ or exp Social Anxiety/ or exp Test Anxiety/ or exp Mathematics Anxiety/ or exp Anxiety Disorders/ or exp Computer Anxiety/ or exp Anxiety/ or Anxiety.mp. or exp Separation Anxiety/ or exp Speech Anxiety/ (262143)
13 limit 12 to (320 young adulthood and human) (50561)
14 exp Psychological Stress/ or exp Diathesis Stress Model/ or exp Chronic Stress/ or exp Social Stress/ or exp Stress Reactions/ or exp “Stress and Coping Measures”/ or exp “Stress and Trauma Related Disorders”/ or exp Physiological Stress/ or exp Acute Stress Disorder/ or stress.mp. or exp Academic Stress/ or exp Stress/ or exp Stress Management/ (266292)
15 limit 14 to (320 young adulthood and human) (42826)
16 7 and 9 and 11 and 13 and 15 (17) 17 10 12

Adapted from Lou and Durando (2008)

Articles to Review (List 10):

1. Hengartner MP, Angst J, Ajdacic-Gross V, Rossler W. Cannabis use during adolescence and the occurrence of depression, suicidality and anxiety disorder across adulthood: Findings from a longitudinal cohort study over 30 years. Journal of Affective Disorders. 2020;1:98–103.
2. Glodosky NC, Cuttler C. Motives Matter: Cannabis use motives moderate the associations between stress and negative affect. Addictive Behaviors. 2020;1:106188.
3. Tomko RL, Baker NL, Hood CO, Gilmore AK, McClure EA, Squeglia LM, et al. Depressive symptoms and cannabis use in a placebo-controlled trial of N- Acetylcysteine for adult cannabis use disorder. Psychopharmacology. 2020 Feb;237(2):479–90.
4. Coulston CM, Perdices M, Tennant CC. The neuropsychological correlates of cannabis use in schizophrenia: Lifetime abuse/dependence, frequency of use, and recency of use. Schizophrenia Research. 2007;96(1–3):169–84.
5. Yurasek AM, Miller MB, Pritschmann RK, Curtis AF, McCrae CS. Negative mood as a mediator of the association between insomnia severity and marijuana problems in college students. Journal of Sleep Research. 2020;29(4).
6. Spradlin A, Marcus DK, Cuttler C. The latent structure of cannabis misuse: A taxometric analysis. Psychological Assessment. 2020;32(8):803–8.
7. Albertella L, Le Pelley ME, Copeland J. Cannabis use in early adolescence is associated with higher negative schizotypy in females. European Psychiatry. 2017;235–41.
8. Ketcherside A, Filbey FM. Mediating processes between stress and problematic marijuana use. Addictive Behaviors. 2015;113–8.
9. Bottorff JL, Johnson JL, Moffat BM, Mulvogue T. Relief-oriented use of marijuana by teens. Substance Abuse Treatment, Prevention, and Policy. 2009;
10. Buckner JD, Ecker AH, Vinci C. Cannabis use vulnerability among socially anxious users: Cannabis craving during a social interaction. Psychology of Addictive Behaviors. 2013;27(1):236–42.

References:

1. Gobbi G, Atkin T, Zytynski T, Wang S, Askari S, Boruff J, et al. Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019 Apr 1;76(4):426–34.
2. Khadrawy YA, Sawie HG, Abdel-Salam OME, Hosny EN. Cannabis exacerbates depressive symptoms in rat model induced by reserpine. Behavioural Brain Research. 2017 May 1;324:41–50.

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3. Hengartner MP, Angst J, Ajdacic-Gross V, Rossler W. Cannabis use during adolescence and the occurrence of depression, suicidality and anxiety disorder across adulthood: Findings from a longitudinal cohort study over 30 years. Journal of Affective Disorders. 2020;1:98–103.
4. Danielsson A-K, Lundin A, Agardh E, Allebeck P, Forsell Y. Cannabis use, depression and anxiety: A 3-year prospective population-based study. Journal of Affective Disorders. 2016 Mar 15;193:103–8.

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