Purpose Since 1996, 16 states have legalized marijuana use for medical purposes. The current study provides a scientific assessment of the association of medical marijuana laws (MML) and adolescent marijuana use using national data. Method State representative survey data on approximately 23,000 12–17 year olds was collected by the National Survey on Drug Use and Health annually from 2002–2008. Yearly state-specific estimates of prevalence of past-month marijuana use and perception of its riskiness were statistically tested for differences between states with and without MML by year and across years. Results States with MML had higher average adolescent marijuana use, 8.68% (95% CI: 7.95–9.42) and lower perception of riskiness, during the period 2002–2008 compared to states without MML, 6.94% (95% CI: 6.60–7.28%). In the eight states that passed MML since 2004, in the years prior to MML passage, there was already a higher prevalence of use and lower perceptions of risk in those states compared to states that have not passed MML. Conclusions While the most likely of several possible explanations for higher adolescent marijuana use and lower perceptions of risk in MML states cannot be determined from the current study, results clearly suggest the need for more empirically-based research on this topic.

Objective Observational studies show that when a depressed mother’s symptoms remit, her children’s symptoms decrease. Without random assignment of mother’s treatment, we cannot conclude that the child’s improvement is due to the mother’s treatment. The objective is to determine the differential effects of a depressed mother’s treatment on her child. Methods Randomized double-blind 12-week clinical trial of escitalopram, bupropion, or the combination in depressed mothers (N=76), and independent assessment of their children (N=135) ages 7–17 years. We hypothesized that mothers on combination treatment would have significantly earlier onset and higher rate of remission than on either monotherapy. The mothers’ outcome would be reflected in their children. Results There were no significant treatment differences in mothers’ depressive symptoms or remission. However, children’s depressive symptoms and functioning improved significantly if their mothers received escitalopram (vs. bupropion and combination). Only in the escitalopram group was significant improvement of mother’s depression associated with improvement in the child’s symptoms. Exploratory analyses suggested that this may be due to changes in parental functioning: Mothers on escitalopram (vs. bupropion and combination) reported significantly greater improvement in their ability to listen and talk to their children, who as a group reported that their mothers were more caring over the 12 weeks. Mother’s baseline negative affectivity appeared to moderate the effect of mother’s treatment on children, although the effect was not statistically significant. Children of mothers with low negative affectivity improved on all treatments. Children of mothers with high negative affectivity improved significantly only if the mother was on escitalopram (vs. bupropion and combination). Conclusions The effects of the depressed mother’s improvement on her children may depend on her type of treatment. Depressed mothers with high anxious distress and irritability may require medications that reduce these symptoms in order to show the effect of her remission on her children.

Suicidal behavior is often conceptualized as a response to overwhelming stress. Our model posits that given a propensity for acting on suicidal urges, stressors such as life events or major depressive episodes (MDEs) determine the timing of suicidal acts.Depressed patients (n=415) were assessed prospectively for suicide attempts and suicide, life events and MDE over 2 years. Longitudinal data was divided into 1-month intervals characterized by MDE (yes/no), suicidal behavior (yes/no), and life event scores. Marginal logistic regression models were fit, with suicidal behavior as the response variable and MDE and life event score in either the same or previous month, respectively, as time-varying covariates.Among 7843 person-months, 33% had MDE and 73% had life events. MDE increased risk for suicidal behavior (OR=4.83, p< 0.0001). Life event scores were unrelated to the timing of suicidal behavior (OR=1.06 per 100 point increase, p=0.32), even during an MDE (OR=1.12, p=0.15). However, among those without Borderline Personality Disorders (BPD), both health and work related life events were key precipitants, as was recurrent MDE, with a 13-fold effect. The relationship of life events to suicidal behavior among those with BPD was more complex. Recurrent MDE was a robust precipitant for suicidal behavior, regardless of BPD comorbidity. The specific nature of life events is key to understanding the timing of suicidal behavior. Given unanticipated results regarding the role of BPD and study limitations, these findings require replication. Of note, that MDE, a treatable risk factor, strongly predicts suicidal behaviors is cause for hope.

Objective Recent findings suggest that remissions of maternal depression are associated with decreases in offspring psychopathology. Little is known about the offspring effects of decreases in paternal depression. Method The offspring of married fathers and married mothers were compared. The analysis was restricted to married parents to control for the confounding effect of single parenthood which was more prevalent among depressed mothers. At baseline all parents met criteria for major depressive disorder (MDD), and participated in a 3 month randomized controlled trial to treat depression with a 6 month follow-up. Married parents (N=43) and their children aged 7-17 years (N=78) were assessed independently through direct interviews of children and parents at baseline and followed for 9 months. Child assessors were blind to the clinical status of parents and uninvolved in their treatment. Results At baseline, children of depressed fathers, compared to children of depressed mothers, had significantly fewer psychiatric disorders (11% vs. 37%; p=0.012) and less impairment as measured by the Columbia Impairment Scale (6.5 vs. 11.6; p=0.009). Over time, with treatment of parental depression, the prevalence of most child symptoms decreased among children of depressed mothers, but changed little among children of depressed fathers. Limitations The main limitation of the study is the small number of fathers and their offspring included in the study. Conclusion Maternal as compared to paternal depression had a greater impact on children. With treatment of parental depression the differential prevalence of child symptoms by parental gender narrowed over time. The clinical implication is that children may benefit from treatment of their depressed parents.

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