The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach.
Giulia Trotta, Edoardo Spinazzola, Hannah Degen, Zhikun Li, Isabelle Austin-zimmerman, Bok Man Leung, Yifei Lang, Victoria Rodriguez, Monica Aas, Lucia Sideli, Kim Wolff, Tom P Freeman, Robin M Murray, Chloe C Y Wong, Luis Alameda, Marta Di Forti
Psychological medicine August 8, 2025 Peer reviewed DOI: 10.1017/s0033291725101190 via PubMed
Summary
Childhood trauma, especially emotional and physical abuse, is strongly linked to paranoia. Cannabis use also predicts paranoia, and it amplifies the effect of trauma, particularly emotional abuse and household discord. A small indirect pathway from trauma to paranoia through cannabis use was found. Using standard THC units to measure cannabis exposure may improve risk assessment and interventions for trauma-exposed individuals.
Study at a glance
| Design | observational cross-sectional survey |
|---|---|
| Sample size | 4,736 |
| Population | participants from the Cannabis&Me study |
| Key finding | Childhood trauma is a primary driver of paranoia, with cannabis use amplifying its effects. |
Abstract
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. 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. Childhood trauma was strongly associated with paranoia, particularly emotional, and physical abuse (β = 16.10, q < 0.001; β = 16.40, q < 0.001). Cannabis use significantly predicted paranoia (β = 0.009, q < 0.001). Interactions emerged between standard THC units and both emotional abuse (β = 0.011, q < 0.001) and household discord (β = 0.011, q < 0.001). SEM revealed a small but significant indirect effect of trauma on paranoia via cannabis use (β = 0.004, p = 0.017). 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.