Cannabis vaping and mental health: The association of Δ‐9‐tetrahydrocannabinol and cannabidiol with anxiety and depressive symptoms—Findings from the United States National Youth Tobacco Survey (2021–2023)

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Abstract
Background and aim: Cannabis use is associated with psychiatric comorbidities, and the use of elta‐9‐tetrahydrocannabinol (THC) and cannabidiol (CBD) produces different neurophysiological and pharmacological effects. This study estimated the strength of associations between vaping of THC and CBD with depressive and anxiety symptoms in adolescents. Design: Observational data were drawn from three years of the nationally representative US National Youth Tobacco Survey (2021–2023). The survey adopted a probabilistic stratified, three‐stage cluster design. Setting: The United States. Participants: A total of 69 899 adolescents aged 11 to 18, with 51.3% males. Measurements: CBD and THC cannabis vaping behaviours; Patient Health Questionnaire 2‐item and Generalised Anxiety Disorder 2‐item, which respectively assess depressive and anxiety symptoms. Logistics regression analyses were conducted after multiple imputation and adjusting for covariates. Findings: Relative to those who did not vape, adolescents who vaped THC only [adjusted odds ratio (aOR) = 1.40, 95% confidence interval (CI) = 1.20–1.64] or dual CBD/THC (aOR = 1.51, 95% CI = 1.22–1.86) were more likely to experience depressive symptoms; whereas those who vaped CBD only (aOR = 1.74, 95% CI = 1.24–2.46) or THC only (aOR = 1.18, 95% CI = 1.01–1.38) were more likely to experience anxiety symptoms. When the sample was restricted to adolescents who had vaped cannabis products, those who only vaped CBD had a higher likelihood of experiencing anxiety symptoms (aOR = 1.51, 95% CI = 1.05–2.17), relative to those who exclusively vaped THC. Conclusions: Among adolescents, Δ‐9‐tetrahydrocannabinol (THC) vaping and dual THC/cannabidiol vaping might be associated with an increased risk of experiencing depressive symptoms. In contrast, adolescents who vape cannabidiol may have a higher likelihood of experiencing anxiety symptoms.

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