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

doi:10.1017/S0033291725101190

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

King's College London
Institute of Psychiatry
LUMSA University
King's College London

Research output: Contribution to journal › Article › peer-review

5 Citations (SciVal)

Abstract

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 (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).

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.

Original language	English
Article number	e220
Journal	Psychological Medicine
Volume	55
Early online date	8 Aug 2025
DOIs	https://doi.org/10.1017/S0033291725101190
Publication status	Published - 8 Aug 2025

Funding

This research was supported by the UK Medical Research Council (MRC) under grant reference MR/T007818/1, which funds the salaries of GT, MDF, ZL, and IAZ. LA acknowledges support from the Adrian and Simone Frutiger Fellowship and Carigest SA Foundation. TF is funded by a UKRI Future Leaders Fellowship (MR/Y017560/1). CCYW receives salary support from the National Institute for Health and Care Research (NIHR) Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, and Institute of Psychiatry, Psychology, and Neuroscience, King’s College London. The views expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, NIHR, or the UK Department of Health.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being
SDG 16 Peace, Justice and Strong Institutions

Keywords

cannabis use
childhood trauma
paranoia
standard THC unit
structural equation modeling

ASJC Scopus subject areas

Applied Psychology
Psychiatry and Mental health

Access to Document

10.1017/S0033291725101190Licence: CC BY

Cite this

Trotta, G., Spinazzola, E., Degen, H., Li, Z., Austin-Zimmerman, I., Leung, B. M., Lang, Y., Rodriguez, V., Aas, M., Sideli, L., Wolff, K., Freeman, T. P., Murray, R. M., Wong, C. C. Y., Alameda, L., & Di Forti, M. (2025). The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach. Psychological Medicine, 55, Article e220. https://doi.org/10.1017/S0033291725101190

Trotta, G, Spinazzola, E, Degen, H, Li, Z, Austin-Zimmerman, I, Leung, BM, Lang, Y, Rodriguez, V, Aas, M, Sideli, L, Wolff, K, Freeman, TP, Murray, RM, Wong, CCY, Alameda, L & Di Forti, M 2025, 'The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach', Psychological Medicine, vol. 55, e220. https://doi.org/10.1017/S0033291725101190

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abstract = "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 (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).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.",

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author = "Giulia Trotta and Edoardo Spinazzola and Hannah Degen and Zhikun Li and Isabelle Austin-Zimmerman and Leung, \{Bok Man\} and Yifei Lang and Victoria Rodriguez and Monica Aas and Lucia Sideli and Kim Wolff and Freeman, \{Tom P\} and Murray, \{Robin M\} and Wong, \{Chloe C Y\} and Luis Alameda and \{Di Forti\}, Marta",

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T1 - The impact of childhood trauma and cannabis use on paranoia

T2 - a structural equation model approach

AU - Trotta, Giulia

AU - Spinazzola, Edoardo

AU - Degen, Hannah

AU - Li, Zhikun

AU - Austin-Zimmerman, Isabelle

AU - Leung, Bok Man

AU - Lang, Yifei

AU - Rodriguez, Victoria

AU - Aas, Monica

AU - Sideli, Lucia

AU - Wolff, Kim

AU - Freeman, Tom P

AU - Murray, Robin M

AU - Wong, Chloe C Y

AU - Alameda, Luis

AU - Di Forti, Marta

PY - 2025/8/8

Y1 - 2025/8/8

N2 - 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 (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).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.

AB - 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 (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).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.

KW - cannabis use

KW - childhood trauma

KW - paranoia

KW - standard THC unit

KW - structural equation modeling

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DO - 10.1017/S0033291725101190

M3 - Article

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AN - SCOPUS:105013060892

SN - 0033-2917

VL - 55

JO - Psychological Medicine

JF - Psychological Medicine

M1 - e220

ER -

The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach

Abstract

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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FLF Reducing cannabis harms through evidence-based drug policy

Cite this

The impact of childhood trauma and cannabis use on paranoia: a structural equation model approach

Abstract

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Projects

FLF Reducing cannabis harms through evidence-based drug policy

Cite this