Young Adult Depression and Cannabis Use: Associations Before and After Recreational Legalization

Introduction: The co -occurrence of depression with cannabis use worsens both mood and substance use disorder outcomes, with young adults particularly at risk of co -occurrence. This research investigates whether the association of state -level prevalence rates of young adult (age 18-25) depression and cannabis use in the U.S. changed following enactment of recreational (adult use) cannabis legalization between 2008 and 2019. Methods: Annual, state prevalence data on past -year major depressive episode (hereafter, depression) and past -month cannabis use were extracted from the National Survey on Drug Use and Health (N=600 state -year observations). Moderated regression models tested whether the association of depression with cannabis use differed before versus after recreational legalization by comparing prevalence rates of depression and cannabis use in states that enacted recreational legalization to those that did not, while fixing state, year, and medical legalization effects. Data were accessed and analyzed in 2023. Results: Prevalence rates of both depression and cannabis use increased throughout the study period. The positive statistical effect of depression on cannabis use more than doubled in magnitude after legalization (b=0.564, 95% CI=0.291, 0.838) as compared to before (b=0.229, 95% CI=0.049, 0.409), representing a significant change (b=0.335, 95% CI=0.093, 0.577). Conclusions: These results suggest that the association between prevalence rates of young adult depression and cannabis use strengthened following recreational legalization in the U.S. This is potentially due to increases in cannabis accessibility and the acceptance of the health benefits of cannabis, which may enhance the use of cannabis as a coping mechanism among young adults with depression. Am J Prev Med 2024;66(2):333-341. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.