64 J Gandhara Med Dent Sci
October - December 2025
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PREVALENCE OF CANNABIS USE AMONG PATIENTS WITH PSYCHOSIS REPORTING TO THE
PSYCHIATRY WARD, SAIDU GROUP OF TEACHING HOSPITAL
Hussain Ali1, Ashfaq Hussain2, Abrar Khan3, Haidar Ali4, Sumera Attaullah5, Afroz Ahmad6,
Liaqat Ali Khan7
ABSTRACT
OBJECTIVES
To assess the prevalence and pattern of cannabis use among psychosis
patients and its association with age group, gender, and socioeconomic
status.
METHODOLOGY
This cross-sectional study was conducted at the Psychiatry Ward of Saidu
Group of Teaching Hospital, Swat, using a consecutive sampling method on
183 patients. Pakistani male and female psychotic patients aged 18 and
above with a history of cannabis use were included, while those with other
psychiatric disorders, intellectual disabilities, neurodevelopmental disorders,
incomplete records, or unwillingness to participate were excluded. Data on
age, gender, and socioeconomic status were collected. Cannabis use
frequency and duration were self-reported.
RESULTS
The mean age was 35.49 ± 9.14 years. There were 46 (25.14%) females and
137 (74.86%) males. Cannabis use was reported in 56 (30.6%) patients, with
daily use by 48 (26.23%) and twice-daily use by 8 (4.37%) patients. Cannabis
use was significantly associated with age group (p<0.001) and gender
(p<0.001), but not with socioeconomic status (p=0.7). Daily or twice-daily
use was more common among adolescents (50%) than adults (22%), with no
females reporting daily or twice-daily use.
CONCLUSION
Cannabis use was prevalent among psychosis patients, with higher frequency
observed in adolescents and males. Adolescents were more likely to report
daily or twice-daily use of the substance. Frequent use was more common
among individuals from low- and medium-socioeconomic backgrounds.
KEYWORDS: Cannabis Use, Psychosis, Adolescents, Socioeconomic Status
How to cite this article
Ali H, Hussain A, Khan A, Ali H,
Attaullah S, Ahmad A, et al.
Prevalence of Cannabis Use among
Patients with Psychosis Reporting to
the Psychiatry Ward, Saidu Group of
Teaching Hospital. J Gandhara Med
Dent Sci. 2025;12(4):64-68.https://doi.
Date of Submission: 16-03-2025
Date Revised: 08-09-2025
Date Acceptance: 17-09-2025
2Assistant Professor, Department of
Psychiatry, Saidu Group of Teaching
Hospital, Swat
3Senior Registrar, Department of
Hospital, Swat
4Medical Officer, Psychiatry Ward, Saidu
Group of Teaching Hospital, Swat
5Clinical Psychologist, Saidu Group of
Teaching Hospital, Swat
6Clinical Psychologist, Saidu Group of
Teaching Hospital, Swat
7Medical Officer, Psychiatry Ward, Saidu
Group of Teaching Hospital, Swat
Correspondence
1Hussain Ali, Senior Registrar,
Department of Psychiatry, Saidu
Group of Teaching Hospital, Swat
+92-344-8306070
drhusainjan@gmail.com
Psychiatry, Saidu Group of Teaching
INTRODUCTION
In Pakistan, the prevalence of psychosis, particularly
schizophrenia, is estimated to affect approximately 1–
2% of the population. Regional variations exist, with
urban areas in Punjab reporting rates around 2.5% and
rural areas about 2%. In Sindh, the prevalence is
estimated at 2% among urban populations and 1.5% in
rural areas. Khyber Pakhtunkhwa shows a prevalence of
2% in urban areas and 2.5% in rural regions.
Baluchistan has the lowest estimates, with 1% for both
rural and urban populations.1 The causes of psychosis in
Pakistan are multifaceted, encompassing genetic,
biological, and environmental factors. Genetic
predisposition plays a significant role, especially in
individuals with a family history of psychiatric
disorders. Environmental stressors such as traumatic
events, substance abuse, and socioeconomic challenges
also contribute to the onset of psychosis. Cultural
beliefs and stigma surrounding mental health often lead
individuals to attribute psychotic symptoms to
supernatural causes, delaying appropriate medical
intervention.2 Cannabis is one of the most commonly
used psychoactive substances worldwide, with
increasing prevalence due to its perceived medicinal
and recreational benefits.3 However, accumulating
evidence suggests a strong association between
cannabis use and various psychiatric disorders,
particularly psychosis.4 Psychotic disorders,
characterized by hallucinations, delusions, and Impaired
cognitive function has been widely studied in relation to
cannabis consumption.5 Numerous studies indicate that
frequent use of cannabis can increase the risk of
psychosis, especially in young populations.6,7 A meta-
analysis encompassing 66,816 individuals found that
heavy cannabis users had an approximately 3.9 times
greater risk of developing schizophrenia and other
psychosis-related outcomes compared to non-users.
This analysis confirmed a dose-response relationship,
indicating that higher levels of cannabis use correlate
ORIGINAL ARTICLE
org/10.37762/jgmds.12-4.704
65J Gandhara Med Dent Sci
October - December 2025
many other developing countries, there has been an
increase in cannabis use among young adults.9 Despite
its illegal status, cannabis is accessible, often without
awareness of its potential psychiatric consequences.
The impact of cannabis on mental health is of particular
concern in clinical settings, where psychiatric wards
frequently admit patients presenting with psychotic
symptoms linked to substance use.10 Cannabis use is a
modifiable risk factor, and its cessation could
potentially prevent or alleviate psychotic symptoms in
specific individuals. Assessing the prevalence of
cannabis use among psychosis patients admitted to the
Psychiatry Ward at Saidu Group of Teaching Hospitals
will provide valuable information on its role as a
contributing factor. Identifying this association may aid
in implementing targeted preventive interventions and
psycho-educational programs, ultimately reducing the
burden of psychotic disorders in the community.
METHODOLOGY
This cross-sectional study was conducted at the
Psychiatry Ward of Saidu Group of Teaching Hospital,
Swat, from March 20, 2024, to February 10, 2025,
using a consecutive sampling method. Written informed
consent was taken, and they were assured of
confidentiality. Psychosis was defined according to the
DSM-5 as a condition a person experiences when he or
she is experiencing severe disconnection from reality. It
included people with symptoms such as delusions,
hallucinations, disorganized speech, grossly
disorganized behavior, and negative symptoms. In order
to include the cases of people diagnosed with
schizophrenia, schizoaffective disorder, or acute
psychotic disorder. The sample was 183, calculated
through OpenEPI with a 95% confidence level and a
5% margin of error using 37% cannabis use among
psychosis patients from a previous study.11 Both male
and female psychotic patients aged 18 and above at
Saidu Group of Teaching Hospital with a history of
cannabis use were included. Those with other
psychiatric disorders, intellectual disability,
neurodevelopmental disorders, incomplete records, or
unwillingness to participate were excluded. Age,
gender, and socioeconomic status were recorded for all
participants. Socioeconomic status (SES) was
operationally defined based on monthly household
income in Pakistani Rupees (PKR), with low SES
classified as less than PKR 30,000 per month, medium
SES as PKR 30,000 to 100,000 per month, and high
SES as greater than PKR 100,000 per month. To
understand their background and substance use habits,
we spoke with patients and their attendants in a
respectful and socially acceptable manner. Cannabis
use was assessed through self-reported history, where
patients shared details about their usage, frequency, and
duration. We also reviewed clinical records and
psychiatric evaluations, seeking input from caregivers
when needed. Our approach ensured accurate reporting
while prioritizing the patients’ comfort and
confidentiality. Data were analyzed using R software
version 4.3.2. Descriptive statistics were applied to
present continuous variables as mean ± standard
deviation (SD) and categorical variables as frequency
and percentage (n, %). The association between
cannabis use and categorical variables (age group,
gender, and socioeconomic status) was assessed using
the Pearson’s chi-squared test or Fisher's exact test, as
appropriate. A p-value < 0.05 was considered
statistically significant. Figures were generated using
the ggplot2 package.
RESULTS
The mean age of participants was 35.49 ± 9.14 years.
Among the patients, 37 (20.22%) were adolescents, and
146 (79.78%) were adults. There were 46(25.14%)
females and 137 (74.86%) males. Based on
socioeconomic status, 11 (6.01%) patients belonged to
the high socioeconomic group, 84 (45.90%) to the
medium socioeconomic group, and 88 (48.09%) to the
low socioeconomic group. (Table 1) The frequency of
Cannabis use among psychosis patients was 56(30.6%).
(Fig 1) Cannabis use was reported once a day by 48
(26.23%) patients and twice a day by 8 (4.37%)
patients. (Fig 2) Table 2 shows the association of
cannabis use with age group, gender, and
socioeconomic status among psychosis patients.
Cannabis use was significantly higher among
adolescents (41.07%) compared to adults (58.93%) (p <
0.001). All cannabis users were male (100%) (p <
0.001). No significant association was found between
cannabis use and socioeconomic status (p = 0.7).
Cannabis use frequency was significantly associated
with age group (p<0.001), gender (p<0.001), and
socioeconomic status (p=0.02). Daily or twice-daily
cannabis use was more common among adolescents
(n=23, 50%) than adults (n=33, 22%). Males exhibited
higher cannabis use at all frequencies, with no females
reporting daily or twice-daily use. Individuals from
medium socioeconomic backgrounds were more likely
to use cannabis twice daily (n=7, 88%), whereas daily
use was more prevalent in those from low
socioeconomic backgrounds (n=27, 56%). (Table 3)
Prevalence of Cannabis Use among Patients with Psychosis
66 J Gandhara Med Dent Sci
October - December 2025
Table 1: Distribution of Age, Gender, and Socioeconomic Status
of the Psychosis Patients
Characteristic N = 183
Age(years) 35.49 ± 9.14
Age group
Adolescent 37 (20.22%)
Adult 146 (79.78%)
Gender
Female 46 (25.14%)
Male 137 (74.86%)
Socioeconomic Status
High 11 (6.01%)
Low 88 (48.09%)
Medium 84 (45.90%)
Figure 1: Frequency of Cannabis Use among Psychosis Patients
Figure 2: Frequency of Cannabis Use among Psychosis Patients
Table 2: Frequency of Cannabis Use by Age Group, Gender, and
Socioeconomic Status
Characteristic Cannabis use P-value
No, N = 127 No, N = 127
Age Group
Adolescent 14 (11.02%) 23 (41.07%) <0.001
Adult 113 (88.98%) 33 (58.93%)
Gender
Female 46 (36.22%) 00 (0.00%) <0.001
Male 81 (63.78%) 56(100.00%)
Socioeconomic Status
High 09 (7.09%) 02 (3.57%) 0.7
Low 61 (48.03%) 27 (48.21%)
Medium 57 (44.88%) 27 (48.21%)
Pearson’s Chi-squared test; Fisher’s exact test
Pearson’s Chi-squared test; Fisher’s exact test
DISCUSSION
The present study investigated the prevalence and
association of cannabis use among individuals with
psychosis, stratified by age group, gender, and
socioeconomic status. The findings demonstrated that
cannabis use was observed in 30.6% of the study
population, aligning with previous reports showing a
higher prevalence of substance use in psychosis patients
compared to the general population. These results are
consistent with the findings of Gage et al.12, who found
that cannabis use is a significant risk factor for the onset
and exacerbation of psychotic disorders, particularly
among susceptible individuals. Other studies have
found a positive association between cannabis use and
psychosis.13 Patel et al. reported that socioeconomic
disadvantage and male gender were additional
predictors of cannabis use in psychosis patients,
supporting the multifactorial nature of this association.
The significant association between cannabis use and
age group observed in this study aligns with existing
evidence suggesting that younger individuals are more
prone to substance use. The higher frequency of
cannabis use among adolescents (41.07%) compared to
adults (58.93%) could be attributed to several factors,
including peer influence, impulsivity, and
experimentation during adolescence. Adolescence is a
critical period of brain development, marked by
neuronal maturation processes, including myelination
and synaptic pruning.14 The endocannabinoid system
plays a pivotal role in these developmental processes;
thus, exogenous cannabinoids like tetrahydrocannabinol
(THC) may disrupt typical neurodevelopment,
potentially leading to cognitive impairments and
increased susceptibility to psychosis.15 Recent studies
have reinforced these concerns, indicating that heavy
Table 3: Pattern of Cannabis Use by Age Group, Gender, and
Socioeconomic Status
Characterist
ic
Not at all,
N = 127
Once a
day, N = 48
Twice a
day, N = 8
P-
Value
Age group
Adolescent 14(11.02%) 21 (43.75%) 02(25.00%) <0.001
Adult 113
(88.98%)
27(56.25%) 06(75.00%)
Gender
Female 46(36.22%) 00(0.00%) 00(0.00%) <0.001
Male 81(63.78%) 48(100.00%) 08(100.00%)
Socioeconomic Status
High 09(7.09%) 01(2.08%) 01(12.50%) 0.02
Low 61(48.03%) 27(56.25%) 00(0.00%)
Medium 57(44.88%) 20(41.67%) 07(87.50%)
cannabis use can have lasting effects on working
memory.16 Additionally, the influence of peers remains
a significant factor in adolescent cannabis use, with
literature suggesting that adolescents are more likely to
use cannabis if their parents do.17 The exclusive
Prevalence of Cannabis Use among Patients with Psychosis
67J Gandhara Med Dent Sci
October - December 2025
cannabis use among males in this study shows a
significant association between male gender and
cannabis consumption. This finding is consistent with
global patterns, where males are more likely to engage
in substance use than females.18 Biological factors, such
as higher testosterone levels, may contribute to this
difference, as testosterone is linked to risk-taking
behaviors.19 Sociocultural norms that normalize
substance use among males may further explain this
trend. Moreover, males with psychotic disorders may
demonstrate greater impulsivity and risk-taking
tendencies, making them more prone to substance use.20
LIMITATIONS
This study has certain limitations that need to be
considered when interpreting the findings. Information
on cannabis use and other variables was obtained
through self-report, which is prone to recall bias and
potential underreporting, especially among females due
to social stigma. Because the study was hospital-based,
the results may not be fully representative of the
general population, and the cross-sectional design
prevents any conclusions about causal relationships.
Cannabis use was not confirmed with biochemical tests
such as urine drug screening, which limits diagnostic
accuracy. The classification of socioeconomic status
may also not fully reflect the complexity of social and
economic determinants. Lastly, regression analysis was
not carried out, so odds ratios and stronger measures of
association could not be provided.
CONCLUSIONS
Approximately one-third of patients with psychosis
reported cannabis use, with adolescents and males
showing a higher frequency of use. Adolescents were
more likely to consume cannabis daily or twice daily,
increasing their susceptibility to its psychiatric and
health consequences. Although all reported users were
male, this should be interpreted cautiously, as
underreporting among females may occur due to
sociocultural stigma. Socioeconomic status was not
significantly associated with overall use; however,
more frequent consumption was observed among low-
and middle-income groups. Further community-based
studies with biochemical validation are needed to
clarify these associations.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
Hussain Ali - Concept & Design; Data Analysis/Interpretation;
Drafting Manuscript; Critical Revision; Supervision; Final
Approval
Ashfaq Hussain - Concept & Design; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Supervision; Final Approval
Abrar Khan - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Supervision;
Final Approval
Haidar Ali – Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical
Revision; Final Approval
Sumera Attaullah - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Supervision;
Final Approval
Afroz Ahmad - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Liaqat Ali Khan - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Prevalence of Cannabis Use among Patients with Psychosis