Peer-reviewed article

Adolescent Withdrawn/Depressed Symptoms: A Pathway From Early Adversity to Later Marijuana Use.

Yousefkhani MP, Vasilenko SA, Razza RA · 31 Aug 2026

Abstract

Introduction Adverse childhood experiences (ACEs) are robust predictors of marijuana use, yet the developmental mechanisms remain unclear. Building on prior cross-sectional studies using broad internalizing composites, this study prospectively distinguishes withdrawn/depressed from anxious/depressed symptoms as candidate mediators across nearly two decades. Methods This prospective, longitudinal study used data from the Future of Families and Child Wellbeing Study (FFCWS), a US cohort of children born between 1998 and 2000. The final analytic sample included 2 865 participants (52.1% female; 46.6% Black, 27.3% Hispanic, 18.5% White). A parallel mediation model was tested using parent-reported cumulative and specific ACEs (age 3) as predictors, parent-reported withdrawn/depressed and anxious/depressed symptoms (CBCL; age 15) as mediators, and youth self-reported monthly marijuana use (age 22) as the outcome. Results Cumulative ACEs at age 3 significantly predicted more frequent marijuana use at age 22. This association was partially mediated by adolescent withdrawn/depressed symptoms, which accounted for approximately 16% of the total effect, whereas anxious/depressed symptoms were not a significant mediator. The strength of this mediating pathway varied across specific ACE types, consistent with a dimensional model of adversity. Conclusions These findings provide prospective longitudinal evidence for a specific internalizing pathway linking early adversity to young adult marijuana use. Although a minority of the overall association, this indirect pathway is notable given the nearly two-decade span and points to adolescent depressive symptoms as a meaningful, modifiable intervention target. The differential mediation patterns suggest that interventions should be tailored to specific ACE profiles, with depression-focused approaches being particularly relevant for deprivation-based adversities.