State- and Trait-Level Depressive Symptoms and Marijuana Use Among Urban Youth

Marijuana is the most used illicit substance among youth, yet whether risk reflects stable or fluctuating depressive symptoms is unclear.

This study examined whether state-level and trait-level depressive symptoms affect marijuana use, informing nurse-led screening and prevention.

Guided by ecological systems theory, this secondary analysis of the Adolescent Health and Development in Context study used an ordered logistic regression model. Trait-level symptoms were each youth's average over time; state-level symptoms, deviations from the average. The model adjusted for caregiver education, sex, race, and age across 3 levels: observations within youth within families.

We analyzed 2807 observations from 1516 youth, from 1456 households trait-level depressive symptoms (adjusted odds ratio [aOR] = 5.31; 95% confidence interval [CI], 2.82-10.00) and state-level symptoms (aOR = 2.70; 95% CI, 1.44-5.04) predicted higher frequency use. Male sex (aOR = 2.04; 95% CI, 1.16-3.60) and age (aOR = 1.79; 95% CI, 1.48-2.16) were significant. At age 12, any use was negligible; by age 18, up-to-twice-weekly use reached 13.3% for males and 7.3% for females at high trait-level symptoms.

Trait-level symptoms carry the larger, chronic risk, while state-level elevations trigger additional short-term increase in use; interventions during acute distress may prevent escalation. Nurses can use depression screening to prevent use and flag underlying depression.