Association of anxiety and depression with cannabis usage disorder among thalassemia patients: A national inpatient sample analysis

Abstract Introduction: With increasing cannabis usage in the United States, a mounting association with mental health disorders is observed. This study aims to evaluate the prevalence of Cannabis Use Disorder (CUD) and its association with depression and anxiety among inpatient thalassemia patients. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) from 2018 to 2022. Adult hospitalizations with thalassemia were identified using ICD-10 codes along with Cannabis usage disorder, depression and anxiety. We used logistic regression to analyze various socio-demographic factors along with cannabis usage disorder that are associated with depression and anxiety individually. We also performed a sub-group analysis comparing the same among cannabis users and non-users. Results: Among 49,874 patients with thalassemia, 37,615 (75%) were identified as female. CUD was significantly associated with depression (OR 2.40; p <0.001) and anxiety (OR 2.44; p<0.001). Female gender was associated with higher odds of both depression (OR 1.55; p <0.001) and GAD (OR 1.49; p< 0.001). Patients aged 40–64 years had significantly higher odds of both depression (OR 2.01) and GAD (OR 1.86) vs those <40 years; those ≥65 had decreased odds of GAD (OR= 0.89, p = 0.049). Black, Hispanic, and Asian/Pacific Islander patients had lower odds of both depression and GAD compared to White patients. While elective admissions were associated with reduced odds of both depression (aOR = 0.79) and GAD (aOR = 0.80), disposition to skilled nursing facilities was strongly associated with increased odds of both conditions (OR13.4 for depression, OR7.01 for anxiety). Notably, anxiety rates increased significantly over time, with highest odds in 2021 (OR = 1.19, p < 0.001) and 2022 (OR 1.14, p = 0.002). When stratified by cannabis use, predictors of both anxiety and depression showed significant heterogeneity. Among non-users, traditional demographic predictors such as female sex, middle age, and race remained robust predictors of depression and anxiety. In contrast, among cannabis users, these associations were attenuated and often non-significant, suggesting a distinct risk profile. Notably, higher income quartile was associated with higher depression odds in cannabis users (OR = 1.79, p= 0.012), contrasting with non-users where income was not a risk factor. Conclusion: There is a strong association between CUD and mental health disorders including anxiety and depression among thalassemia patietns. Among cannabis users, traditional risk factors that helped assess and screen for depression and anxiety no longer are significant, impressing the possible alteration of neurobiological pathways. This signified the necessity to focus on appropriate identification and management of depression and anxiety in vulnerable populations like thalassemia patients.