{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:43:16Z","timestamp":1787013796031,"version":"build-2736575974"},"reference-count":71,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009776","name":"McMaster University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009776","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Epidemiologic research suggests that adolescent cannabis use is associated with psychological distress (i.e. depression and anxiety symptoms); however, most studies have relied on 20th\u2010century data, when cannabis was significantly less potent than today. This study aimed to estimate the association between adolescent cannabis use and psychological distress using contemporary population\u2010based data and examine the roles of time [as a proxy for increasing \u03949\u2010tetrahydrocannabinol (THC) potency], sex and age of initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Representative cross\u2010sectional survey conducted biennially from 2013 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>35\u2009007 adolescents in grades 7 to 12.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Past\u2010year cannabis use was categorized as Never, 1\u20132 times, 3\u20139 times, 10\u201339 times or 40+\u2009times. Psychological distress was measured with the Kessler\u20106 scale using a cut\u2010off score of 13+\u2009indicating anxiety\/depression symptoms. Multivariable modified Poisson and least\u2010squares models were used to estimate the association between past\u2010year cannabis use and psychological distress. Survey year and sex were tested as effect modifiers on the multiplicative and additive scales. The association between school grade of cannabis use initiation and psychological distress was also estimated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      From 2013 to 2023, the prevalence of psychological distress increased from 10.7% to 27.4%, whereas cannabis use decreased from 23.1% to 17.6%. Survey year and sex were statistically significant effect modifiers for the association between cannabis use and psychological distress with associations consistent with a super\u2010additive effect but not multiplicative synergy (additive interactions:\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05; multiplicative interactions:\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). The association between cannabis use and psychological distress strengthened over time, particularly for those using 40+\u2009times compared with abstinence (from 0% [95% confidence interval (CI) = \u22126% to 6%] adjusted prevalence difference in 2013 to 18% (95% CI = 11%\u201325%] adjusted prevalence difference in 2023). Independent of time, there was evidence of dose\u2013response among females, but not males. A 5% (95% CI = 1%\u201310%) lower prevalence of psychological distress was observed per later school grade of cannabis use initiation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychological distress increased markedly among adolescents in Ontario, Canada, from 2013 to 2023. In that setting, adolescent cannabis use was statistically significantly associated with psychological distress, especially among females, and this association increased in magnitude over time, especially for those using most frequently. It is possible that adolescents are increasingly self\u2010medicating psychological distress with cannabis and\/or that rising cannabis potency is increasingly contributing to psychological distress. While causality cannot be established, based on the precautionary principle, policymakers should prioritize cannabis prevention strategies that aim to reduce frequency of use, limit potency and delay age of initiation, particularly among females.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70333","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T14:00:52Z","timestamp":1769608852000},"page":"1495-1507","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Adolescent cannabis use and psychological distress from 2013 to 2023: A population\u2010based study in Ontario, Canada"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1734-5067","authenticated-orcid":false,"given":"Andr\u00e9 J.","family":"McDonald","sequence":"first","affiliation":[{"name":"Peter Boris Centre for Addictions Research St. Joseph's Healthcare Hamilton  Hamilton Canada"},{"name":"Department of Psychiatry and Behavioural Neurosciences McMaster University  Hamilton Canada"},{"name":"Michael G. 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