Government of Saskatchewan, Ministry of Health, 3475 Albert Street, Regina, Canada, S4S 6X6; School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada.
Government of Nunavut, Department of Health, Iqaluit, Nunavut. X0A 0H0, Nunavut, Canada.
J Affect Disord. 2021 Feb 15;281:467-475. doi: 10.1016/j.jad.2020.12.043. Epub 2020 Dec 16.
Studies have shown a high degree of comorbidity between cannabis use disorder (CUD) and other mental illnesses. However, there is a paucity of research on the comorbidity between CUD with major depression (MD) and generalized anxiety disorder (GAD). This systematic review with meta-analysis aimed to assess the prevalence and strength of association between co-morbid CUD with MD and GAD.
An extensive search of Medline, CINAHL, PsycINFO, EMBASE, and grey literature were conducted to cover articles published between January 1, 1980, and July 31, 2020. Inclusion criteria were publications in English Language, original research, nationally representative samples, and non-clinical randomly selected adult populations. A systematic review and meta-analysis for the prevalence and ORs for comorbid CUD with MD or GAD were done.
A total of 67 articles were identified by the electronic searches. A full-text review yielded 8 publications on nationally representative epidemiological surveys. 12-month and lifetime comorbidity estimates were extracted and used for the meta-analysis. CUD was strongly associated with MDE (OR 3.22; 2.31 - 4.49) and with GAD (OR 2.99; 2.14 - 4.16).
Limitations of this study include the heterogeneity observed due to the combination of studies from different geographic regions with different modifications of diagnostic criteria and varied response rates. This was addressed with a random-effects model.
This review confirms the evidence of high prevalence and a 3-fold comorbid association between CUD with MD and CUD with GAD. Implementation of evidence-based policy interventions with effective, integrated management of comorbid CUDs with psychiatric disorders may contribute to positive patient outcomes.
研究表明，大麻使用障碍（CUD）与其他精神疾病之间存在高度共病性。然而，关于 CUD 与重度抑郁症（MD）和广泛性焦虑症（GAD）共病的研究很少。本系统评价和荟萃分析旨在评估 CUD 与 MD 和 GAD 共病的患病率和关联强度。
对 Medline、CINAHL、PsycINFO、EMBASE 和灰色文献进行广泛搜索，以涵盖 1980 年 1 月 1 日至 2020 年 7 月 31 日期间发表的文章。纳入标准为使用英语语言的出版物、原始研究、全国代表性样本和非临床随机选择的成人人群。对 CUD 与 MD 或 GAD 共病的患病率和 OR 进行系统评价和荟萃分析。
通过电子搜索共确定了 67 篇文章。对全文进行审查后，确定了 8 篇关于全国代表性流行病学调查的出版物。提取了 12 个月和终生共病估计值，并用于荟萃分析。CUD 与 MDE（OR 3.22；2.31-4.49）和 GAD（OR 2.99；2.14-4.16）密切相关。
本研究的局限性包括由于来自不同地理区域的研究组合、不同诊断标准的修改以及不同的反应率而观察到的异质性。这是通过随机效应模型来解决的。
本综述证实了 CUD 与 MD 和 CUD 与 GAD 之间存在高患病率和 3 倍共病关联的证据。实施基于证据的政策干预措施，对 CUD 与精神障碍进行有效、综合的管理，可能有助于改善患者的预后。
