Trotta, Giulia and Spinazzola, Edoardo and Degen, Hannah and Li, Zhikun and Austin-Zimmerman, Isabelle and Leung, Bok Man and Lang, Yifei and Rodriguez, Victoria and Aas, Monica and Sideli, Lucia and Wolff, Kim and Freeman, Tom P and Murray, Robin M and Wong, Chloe C Y and Alameda, Luis and Di Forti, Marta (2025) The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach. Psychological Medicine, 55, e220. 10.1017/S0033291725101190.
External website: https://www.cambridge.org/core/journals/psychologi...
BACKGROUND: Childhood trauma is a well-established risk factor for psychosis, paranoia, and substance use, with cannabis being a modifiable environmental factor that exacerbates these vulnerabilities. This study examines the interplay between childhood trauma, cannabis use, and paranoia using standard tetrahydrocannabinol (THC) units as a comprehensive measure of cannabis exposure.
METHODS: Data were derived from the Cannabis&Me study, an observational, cross-sectional, online survey of 4,736 participants. Childhood trauma was assessed using a modified Childhood Trauma Screen Questionnaire, while paranoia was measured via the Green Paranoid Thoughts Scale. Cannabis use was quantified using weekly standard THC units. Structural equation modeling (SEM) was employed to evaluate direct and indirect pathways between trauma, cannabis use, and paranoia.
RESULTS: Childhood trauma was strongly associated with paranoia, particularly emotional, and physical abuse ( = 16.10, < 0.001; = 16.40, < 0.001). Cannabis use significantly predicted paranoia ( = 0.009, < 0.001). Interactions emerged between standard THC units and both emotional abuse ( = 0.011, < 0.001) and household discord ( = 0.011, < 0.001). SEM revealed a small but significant indirect effect of trauma on paranoia via cannabis use ( = 0.004, = 0.017).
CONCLUSIONS: These findings highlight childhood trauma as a primary driver of paranoia, with cannabis use amplifying its effects. While trauma had a strong direct impact, cannabis played a significant mediating role. Integrating standard THC units into psychiatric research and clinical assessments may enhance risk detection and refine intervention strategies, particularly for childhood trauma-exposed individuals.
A Substance use and dependence > Personal history of substance use (pathway) > Initiation
B Substances > Cannabis / Marijuana
E Concepts in biomedical areas > Medical substance > Medical / medicinal cannabis
F Concepts in psychology > Motivation
F Concepts in psychology > Psychological stress / emotional trauma / adversity
F Concepts in psychology > Psychological stress / emotional trauma / adversity > Adverse childhood experiences (ACE)
G Health and disease > State of health > Mental health
G Health and disease > Substance related disorder > Substance related mental health disorder > Dual diagnosis / comorbidity (mental health)
G Health and disease > Behavioural and mental health disorder (Psychosis / mood)
HA Screening, identification, and diagnostic method > Physical / medical screening, assessment and diagnostic method
T Demographic characteristics > Child / children
VA Geographic area > Europe > United Kingdom
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