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Abstract
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BACKGROUND:Emerging epidemiological evidence suggests an association between cannabis use and bipolar disorder (BD). To date, the prevalence of comorbid cannabis use disorder (CUD) has not been well described, nor has the association between CUD and the clinical course of BD.
AIM:To estimate the prevalence of CUD comorbidity among individuals with BD and identify clinical features associated with CUD.
METHODS:We searched PubMed from inception to December 2020, supplemented by manual searches of reference lists of included articles and prior review for eligible records. We included articles if they (1) were in English, (2) reported on individuals with a diagnosis of BD as a primary study group, (3) reported on the prevalence of CUD, and (4) used an observational study design (eg, cohort or cross-sectional). All abstracts, full-Text articles, and other sources were reviewed, and data were extracted for quantitative analyses. We estimated CUD prevalence using a random-effects meta-Analysis model, alongside stratification, to characterize heterogeneity. We reported CUD prevalence as a percentage with 95% CIs. We assessed the study-level risk of bias using the Joanna Briggs Institute checklist for observational studies. We estimated heterogeneity using the I2statistic.
FINDINGS:48 studies, representing 86,833 participants, met all inclusion criteria. Most participants had Bipolar I Disorder (92%), were Caucasian (74%), female (55%), and the median (SD) age was 37.4 (6.8) years. The overall pooled prevalence of CUD was 17% (95% CI: 13%-20%), with significant heterogeneity between estimates (I2=99%). When stratified by source, the prevalence of CUD was 6% (95% CI: 4%-8%) in population-based samples, 16% in community samples (95% CI: 14%-18%), and 39% in inpatient samples (95% CI: 33%-46%), which were significantly different (P<0.01). CUD comorbidity was higher in males (odds ratio [OR]=2.05, 95% CI: 1.69-2.47). The age at BD onset was approximately 3 years earlier in those with CUD (mean difference [MD]=-3.04yrs, 95% CI:-5.36,-0.73). The lifetime prevalence of psychosis symptoms (OR=1.94, 95% CI: 1.63-2.31), mixed episodes (OR=1.50, 95% CI: 1.25-1.80), rapid cycling (OR=2.06, 95% CI: 1.41-3.01), and suicide attempts (OR=2.74, 95% CI: 1.39-5.39) was higher among BD patients with comorbid CUD.
CONCLUSIONS:These findings suggest that CUD appears to be prevalent among individuals with BD cannabis, with the highest prevalence in in-patient populations. Clinicians should be aware of the increased prevalence of CUD in BD populations and its association with more deleterious outcomes and prognosis. © 2021 Lippincott Williams and Wilkins. All rights reserved.
Language: en |