CANNABIS, DEPRESSION AND SUICIDAL THOUGHTS AND BEHAVIORS

 描述(由申请人提供)：最近美国青少年和年轻人大麻使用率的增加，与更多的药物可获得性和社会接受度的提高相形见绌。随着合法化运动的势头增强，一些研究人员和临床医生越来越担心与使用大麻有关的负面身心健康后果，特别是在年轻人中。在最近的一次文献回顾中，Volkow和他的同事确定严重抑郁障碍(MDD)是与大麻使用和滥用有关的关键结果。除了抑郁之外，大麻的使用和滥用还会给自杀想法和行为(STB)带来许多风险。鉴于这些精神后果的相对常见性质，如果大麻使用确实有助于MDD和STB，大麻对公共健康的影响可能是巨大的，特别是如果娱乐使用合法化的话。根据PAS-14-020“鼓励对吸食大麻的社会、行为和健康后果进行基于人群的研究”，这项为期3年的应用利用现有数据(在吸食吸食大麻的鼓励下)，利用州和个人两个层面的纵向分析，全面研究吸食大麻、MDD和性传播疾病之间的关系。目标1将利用具有全国代表性的州一级数据，在考虑到混淆因素后，审查已知影响大麻使用和大麻使用特征的医用大麻政策的关键方面是否与MDD和STB有关，以及州一级关于自杀完成的数据是否相关。利用个人层面的发展视角，AIM 2将利用从青春期早期(12-15岁)到成年初期(17-25岁)的三个不同种族的双胞胎和兄弟姐妹(基线N=8561)的大型数据集的数据，以审查群体间(例如吸食大麻的人与不吸食大麻的人)之间的大麻参与、MDD和性传播疾病之间的纵向关系，以及跨时间的个人内方法。最后，鉴于对参与大麻、MDD和STB的遗传影响的有力支持，AIM 3将使用13,791对成年双胞胎的数据来检查在考虑到参与大麻、MDD和STB之间的遗传重叠(我们已经证明)后，相对于未接触大麻的同卵双胞胎，报告涉及大麻的双胞胎中MDD和STB的可能性是否增加。使用补充的国家和个人一级的分析将使我们能够充分审查涉及大麻的哪些方面具体影响MDD和STB，并提供提供因果关系和反向因果关系检验以及共同责任的纵向数据。 这一综合办法将为有关与大麻使用和滥用有关的发病率和死亡率的主要来源的政策讨论提供信息。

 DESCRIPTION (provided by applicant): A recent increase in the rate of cannabis use by American adolescents and young adults has been compounded by greater drug availability and enhanced societal acceptance. As the movement towards legalization gains momentum, some researchers and clinicians have become increasingly concerned about negative physical and mental health outcomes associated with cannabis use, particularly in young people. In a recent review of the literature, Volkow and colleagues identified major depressive disorder (MDD) as a key outcome associated with cannabis use and misuse. In addition to depression, cannabis use and misuse pose numerous risks for suicidal thoughts and behaviors (STB). Given the relatively common nature of these psychiatric outcomes, if cannabis use truly contributes to MDD and STB, the public health impact of cannabis, particularly if recreational use is legalized, could be substantial. In response to PAS-14-020, "encouraging population-based research on social, behavioral, and health outcomes of marijuana involvement", this 3-year application utilizes existing data (as encouraged by the PAS) and comprehensively examines the relationship between cannabis involvement, MDD and STB using longitudinal analyses at both the state- and person- levels. Using nationally representative state-level data, Aim 1 will examine whether key aspects of medical marijuana policies that are known to influence cannabis use as well as cannabis use characteristics are associated with MDD and STB, as well as state-level data on suicide completion, after accounting for confounding factors. Utilizing an individual-level developmental perspective, Aim 2 will employ data from three large and ethnically diverse datasets of twins and siblings (baseline N=8561) that span early adolescence (age 12-15) to young adulthood (ages 17-25), to examine the longitudinal relationship between cannabis involvement, MDD and STB using between-group (e.g. cannabis users vs. non-users) and within-person across-time approaches. Finally, given robust support for heritable influences on cannabis involvement, MDD and STB, Aim 3 will use data on 13,791 adult twins to examine whether after accounting for the genetic overlap (which we have demonstrated) between cannabis involvement, MDD and STB, there is an elevated likelihood of MDD and STB in twins who report cannabis involvement (ever, early, frequent and problem use) relative to their unexposed co-twin. The use of complementary state- and person-level analyses will allow us to fully examine which aspects of cannabis involvement specifically influence MDD and STB with longitudinal data affording tests of causation and reverse-causation as well as shared liabilities. This integrative approach will inform policy discussion regarding key sources of morbidity and mortality associated with cannabis use and misuse.