Importance Cannabis use is increasing worldwide and is suspected to be associated with increased risk of psychiatric disorders; however, the association with affective disorders has been insufficiently studied. Objective To examine whether cannabis use disorder (CUD) is associated with an increased risk of psychotic and nonpsychotic unipolar depression and bipolar disorder and to compare associations of CUD with psychotic and nonpsychotic subtypes of these diagnoses. Design, Setting, and Participants This prospective, population-based cohort study using Danish nationwide registers included all individuals born in Denmark before December 31, 2005, who were alive, aged at least 16 years, and living in Denmark between January 1, 1995, and December 31, 2021. Exposure Register-based diagnosis of CUD. Main Outcome and Measures The main outcome was register-based diagnosis of psychotic or nonpsychotic unipolar depression or bipolar disorder. Associations between CUD and subsequent affective disorders were estimated as hazard ratios (HRs) using Cox proportional hazards regression with time-varying information on CUD, adjusting for sex; alcohol use disorder; substance use disorder; having been born in Denmark; calendar year; parental educational level (highest attained); parental cannabis, alcohol, or substance use disorders; and parental affective disorders. Results A total of 6 651 765 individuals (50.3% female) were followed up for 119 526 786 person-years. Cannabis use disorder was associated with an increased risk of unipolar depression (HR, 1.84; 95% CI, 1.78-1.90), psychotic unipolar depression (HR, 1.97; 95% CI, 1.73-2.25), and nonpsychotic unipolar depression (HR, 1.83; 95% CI, 1.77-1.89). Cannabis use was associated with an increased risk of bipolar disorder in men (HR, 2.96; 95% CI, 2.73-3.21) and women (HR, 2.54; 95% CI, 2.31-2.80), psychotic bipolar disorder (HR, 4.05; 95% CI, 3.52-4.65), and nonpsychotic bipolar disorder in men (HR, 2.96; 95% CI, 2.73-3.21) and women (HR, 2.60; 95% CI, 2.36-2.85). Cannabis use disorder was associated with higher risk for psychotic than nonpsychotic subtypes of bipolar disorder (relative HR, 1.48; 95% CI, 1.21-1.81) but not unipolar depression (relative HR, 1.08; 95% CI, 0.92-1.27). Conclusions and Relevance This population-based cohort study found that CUD was associated with an increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression. These findings may inform policies regarding the legal status and control of cannabis use.

中文翻译：

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大麻使用障碍以及随后的精神病性和非精神病性单相抑郁症和双相情感障碍的风险。

重要性 大麻的使用在全世界范围内不断增加，并且被怀疑与精神疾病风险增加有关；然而，与情感障碍的关联尚未得到充分研究。目的 检查大麻使用障碍 (CUD) 是否与精神病性和非精神病性单相抑郁症和双相情感障碍的风险增加相关，并比较 CUD 与这些诊断的精神病性和非精神病性亚型的关联。设计、背景和参与者 这项前瞻性、基于人口的队列研究使用丹麦全国登记册，包括 2005 年 12 月 31 日之前在丹麦出生、1995 年 1 月 1 日期间在丹麦活着、年龄至少 16 岁的所有个人。 2021 年 12 月 31 日。基于暴露登记的 CUD 诊断。主要结果和措施 主要结果是基于登记的精神病性或非精神病性单相抑郁症或双相情感障碍的诊断。CUD 和随后的情感障碍之间的关联被估计为风险比 (HR)，使用 Cox 比例风险回归和 CUD 的时变信息，并根据性别进行调整；酒精使用障碍；物质使用障碍；出生于丹麦；公历年; 父母的教育水平（最高）；父母吸食大麻、酗酒或药物滥用；和父母情感障碍。结果 共有 6 651 765 人（50.3% 女性）接受随访，随访时间为 119 526 786 人年。大麻使用障碍与单相抑郁症（HR，1.84；95% CI，1.78-1.90）、精神病性单相抑郁症（HR，1.97；95% CI，1.73-2.25）和非精神病性单相抑郁症（HR，1.73-2.25）的风险增加相关。 1.83；95% CI，1.77-1.89）。使用大麻与男性（HR，2.96；95% CI，2.73-3.21）和女性（HR，2.54；95% CI，2.31-2.80）以及精神病性双相情感障碍（HR，4.05；95% CI，2.31-2.80）的双相情感障碍风险增加相关。 95% CI，3.52-4.65），以及男性非精神病性双相情感障碍（HR，2.96；95% CI，2.73-3.21）和女性（HR，2.60；95% CI，2.36-2.85）。与双相情感障碍的非精神病亚型相比，大麻使用障碍与更高的精神病风险相关（相对 HR，1.48；95% CI，1.21-1.81），但与单相抑郁无关（相对 HR，1.08；95% CI，0.92-1.27）。结论和相关性 这项基于人群的队列研究发现，CUD 与精神病性和非精神病性双相情感障碍以及单相抑郁症的风险增加相关。这些发现可能会为有关大麻使用的法律地位和控制的政策提供信息。