Clinical Complexity of Youths With Major Depression and Cannabis Use Disorder: Evidence From a National Medicaid Cohort

OBJECTIVE: Cannabis use disorder is rising among youths with major depressive disorder, yet little is known about how youths with both disorders differ from those with major depressive disorder alone. METHODS: Using 2016-2021 national Medicaid data, the authors identified youths ages 9-24 years with newly diagnosed major depressive disorder and used multivariable logistic regression to compare individuals with or without cannabis use disorder diagnoses. RESULTS: Among 1,898,383 youths with major depressive disorder, 76,289 (4.0%) had co-occurring cannabis use disorder. Youths with comorbid cannabis use disorder were significantly more likely to be male, Black, Hispanic, or multiracial and to have severe depression (adjusted OR [AOR]=1.97) and multiple comorbid conditions, particularly other substance use disorders (AOR=7.47) and histories of self-harm (AOR=1.84), and were less likely to receive psychotherapy (AOR=0.76) (all p<0.01), compared with youths without cannabis use disorder. CONCLUSIONS: Youths with major depression and cannabis use disorder represent a clinically complex subgroup requiring evidence-based treatment addressing the co-occurrence of both disorders.