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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 Murray, Chloe C Y Wong, Luis Alameda, Marta Di Forti

Psychological Medicine August 8, 2025 DOI: 10.1017/s0033291725101190 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Observational cross-sectional study Peer reviewed
Sample size 4,736
Population Adults who participated in the Cannabis&Me online survey
Topics Cannabis
Keywords Cannabis use Childhood trauma Paranoia Standard THC Unit Structural equation modeling
Citations 4
Key findings Childhood trauma is a primary driver of paranoia, and cannabis use amplifies this effect, with a small but significant indirect pathway from trauma to paranoia via cannabis use.

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.

Comparable studies

Other cross-sectional and survey studies on cannabis, most cited first.

Study Year Design Participants
Cannabis use before age 15 and subsequent executive functioning 104 chronic cannabis users (49 early-onset before age 15, 55 late-onset after age 15)... 2011 Observational cross-sectional study n = 148
Patterns of simultaneous polysubstance use in drug using university students Drug-using university students 2006 Cross-sectional survey n = 149
Persisting Reductions in Cannabis, Opioid, and Stimulant Misuse After Naturalistic Psychedelic Use: An Online Survey Online survey respondents 2020 Cross-sectional survey
User perceptions of the benefits and harms of hallucinogenic drug use: A web-based questionnaire study Users of hallucinogenic drugs who completed a web-based questionnaire 2010 Cross-sectional survey n = 600
Illicit Use of LSD or Psilocybin, but not MDMA or Nonpsychedelic Drugs, is Associated with Mystical Experiences in a Dose-Dependent Manner Adults recruited from the MAPS website and newsletter, most reporting use of various... 2012 Cross-sectional survey n = 337

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