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Contributions to the epidemiology and mental health consequences of cannabis smoking.

机译：大麻吸烟对流行病学和心理健康后果的贡献。

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摘要

Cannabis smoking might contribute to the incidence and course of major depression, but it is less clear whether this relationship is particularly pernicious when exposure occurs during adolescence. This hypothesis is guided by prior evidence that adolescence is a particularly vulnerable period of neurodevelopment, and early cannabis exposure may have a lasting toxic effect on normal emotional development. The first study in this dissertation research investigates the degree to which early-onset cannabis smoking (before age 18 years) might predict the later onset of a sustained spell of depressed mood in adulthood (herein, a 'depression spell'), as compared to never and later-onset cannabis users. The second study complements the findings therein and was motivated to inform on the extent to which depression spells were clinically relevant, with relevance operationally measured by functional impairment attributed to depression in an individual's occupational, social, and daily life. Data for these studies came from the U.S. National Surveys on Drug Use and Health (NSDUH), a program of annual cross-sectional surveys of large and nationally representative samples of community-dwelling U.S. residents aged 12 years or older.;The third and fourth studies of this dissertation sought to contribute to our understanding of the epidemiology of cannabis use disorders via two relatively novel and understudied patterns of cannabis smoking. In the first, the tobacco-cannabis combination called 'blunts', which has become an increasingly popular method of cannabis consumption in the U.S., was hypothesized to be associated with more cannabis problems (e.g., when blunt smokers are compared to their non-blunt cannabis smoking peers). Here also, the NSDUH epidemiological surveys made it possible to estimate the degree to which a history of blunt smoking is associated with the level of cannabis problems in a representative sample of recent cannabis users. For the final study in this dissertation research, it was hypothesized that cannabis users who rapidly transitioned from the first drug opportunity to using cannabis might have a greater risk of later cannabis problems. Here, for this study, the data are from the collaborative WHO World Mental Health Surveys (WHO-WMHS), with cross-national data from 14 countries that made it possible to look beyond the boundaries of the U.S. for novel epidemiological evidence on cannabis smoking.;Results from these studies were informative. Early-onset cannabis smoking was associated with a later depression spell in adulthood: cases with an adult-onset depression spell were an estimated 70% more likely to have been exposed to using cannabis in adolescence, as compared to never users. However, the exposure odds ratio with respect to later-onset cannabis exposure was of similar magnitude, suggesting that early-onset cannabis exposure per se is less important than was hypothesized, and that the delay of cannabis onset until adulthood might not greatly affect the risk of a later depression spell. As for the issue of 'clinical relevance,' cases with recent depression spells suffered noteworthy functional impairment attributed to this mood disturbance, with greater impairment seen across at higher levels of cannabis problems. In specific, an estimated 25% (one in four) of the recent depression spell cases experienced severe to very severe functional impairment attributed to their depression. In the study of blunt smoking, as hypothesized, the level of cannabis problems was greater for blunt smokers and when there was more frequent recent blunt smoking, as compared to that experienced by cannabis users with little or no blunt smoking history. Findings from the cross-national epidemiological surveys were generally consistent with expectations---namely, cannabis users who delayed their onset of cannabis smoking for a year or more after initially being offered the chance to try drugs were at a reduced chance of experiencing later cannabis-related problem outcomes.
机译：大麻吸烟可能会导致严重抑郁症的发生和发展，但尚不清楚在青春期发生暴露时这种关系是否特别有害。该假设由先前的证据所指导，该证据表明青春期是神经发育的特别脆弱的时期，而早期接触大麻可能对正常的情绪发展产生持久的毒性作用。本论文研究的第一项研究调查了与18岁以下相比，早发大麻吸烟（18岁之前）可以预测成年后持续的抑郁情绪持续发作（以下称为“抑郁情绪”）的程度。从不和后来发病的大麻使用者。第二项研究对其中的发现进行了补充，其动机是告知抑郁症在临床上的相关程度，并在操作上通过归因于个人的职业，社会和日常生活中的抑郁症的功能障碍来衡量相关性。这些研究的数据来自美国全国药物使用和健康调查（NSDUH），该计划是对12岁以上美国居民的大型，全国代表性样本进行年度横断面调查的计划。本论文的研究旨在通过两种相对新颖且未被充分研究的大麻吸烟模式，为我们对大麻使用障碍流行病学的理解做出贡献。首先，假设烟草-大麻组合被称为“钝器”，它已成为美国越来越流行的大麻消费方法，被认为与更多的大麻问题有关（例如，将钝性吸烟者与非钝性吸烟者相比）。大麻吸烟同行）。同样，在NSDUH流行病学调查中，有可能在最近的大麻使用者代表性样本中估计钝烟史与大麻问题水平相关的程度。对于本论文研究的最终研究，假设从最初的吸毒机会迅速过渡到使用大麻的大麻使用者可能在以后出现大麻问题的风险更大。在此，对于本研究，数据来自世界卫生组织合作的世界心理健康调查（WHO-WMHS），以及来自14个国家的跨国数据，这些数据使人们有可能在美国范围之外寻找有关大麻吸烟的新型流行病学证据。这些研究的结果是有益的。早发大麻吸烟与成年后的抑郁症有关：与从不吸毒者相比，成年抑郁症患者在青春期接触大麻的可能性估计高70％。但是，相对于较晚发作的大麻暴露而言，接触几率比具有相似的幅度，这表明较早于假设的情况，较早假设的大麻暴露本身并不那么重要，并且将大麻发病推迟到成年后可能不会大大影响风险。之后的抑郁症至于“临床相关性”问题，近期情绪低落的患者由于这种情绪障碍而遭受了明显的功能损害，在较高水平的大麻问题中可见更大的损害。具体而言，估计最近的抑郁症病例中有25％（四分之一）经历了由于抑郁症而导致的严重到非常严重的功能障碍。在假设的钝器吸烟研究中，与没有或没有钝器吸烟史的大麻使用者相比，钝器吸烟者的大麻问题水平更高，并且最近的钝器吸烟频率更高。跨国流行病学调查的结果总体上与预期相符-即，在最初被提供尝试毒品的机会后，将大麻发作延迟一年或更长时间吸食大麻的人减少了后来食用大麻的机会相关问题的结果。

著录项

  • 作者

    Fairman, Brian John.;

  • 作者单位

    Michigan State University.;

  • 授予单位 Michigan State University.;
  • 学科 Health Sciences Epidemiology.;Psychology Clinical.;Health Sciences Mental Health.
  • 学位 Ph.D.
  • 年度 2014
  • 页码 211 p.
  • 总页数 211
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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