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. 2023 Nov;53(15):7375-7384.
doi: 10.1017/S0033291723000995. Epub 2023 May 4.

Cannabis use as a potential mediator between childhood adversity and first-episode psychosis: results from the EU-GEI case-control study

Giulia Trotta  1 , Victoria Rodriguez  2 , Diego Quattrone  1 , Edoardo Spinazzola  2 , Giada Tripoli  2 , Charlotte Gayer-Anderson  3 , Tom P Freeman  4 , Hannah E Jongsma  5 , Lucia Sideli  6 , Monica Aas  1 , Simona A Stilo  2 , Caterina La Cascia  7 , Laura Ferraro  7 , Daniele La Barbera  7 , Antonio Lasalvia  8 , Sarah Tosato  8 , Ilaria Tarricone  9 , Giuseppe D'Andrea  2 , Andrea Tortelli  10 , Franck Schürhoff  11 , Andrei Szöke  11 , Baptiste Pignon  11 , Jean-Paul Selten  12 , Eva Velthorst  13 , Lieuwe de Haan  14 , Pierre-Michel Llorca  15 , Paulo Rossi Menezes  16 , Cristina M Del Ben  17 , Jose Luis Santos  18 , Manuel Arrojo  19 , Julio Bobes  20 , Julio Sanjuán  21 , Miquel Bernardo  22 , Celso Arango  23 , James B Kirkbride  5 , Peter B Jones  24 , Alexander Richards  25 , Bart P Rutten  26 , Jim Van Os  2 , Isabelle Austin-Zimmerman  1 , Zhikun Li  1 , Craig Morgan  3 , Pak C Sham  27 , Evangelos Vassos  1 , Chloe Wong  1 , Richard Bentall  28 , Helen L Fisher  1 , Robin M Murray  2 , Luis Alameda  2 , Marta Di Forti  1 ; EU-GEI WP2 Group
Affiliations

Cannabis use as a potential mediator between childhood adversity and first-episode psychosis: results from the EU-GEI case-control study

Giulia Trotta et al. Psychol Med. 2023 Nov.

Abstract

Background: Childhood adversity and cannabis use are considered independent risk factors for psychosis, but whether different patterns of cannabis use may be acting as mediator between adversity and psychotic disorders has not yet been explored. The aim of this study is to examine whether cannabis use mediates the relationship between childhood adversity and psychosis.

Methods: Data were utilised on 881 first-episode psychosis patients and 1231 controls from the European network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study. Detailed history of cannabis use was collected with the Cannabis Experience Questionnaire. The Childhood Experience of Care and Abuse Questionnaire was used to assess exposure to household discord, sexual, physical or emotional abuse and bullying in two periods: early (0-11 years), and late (12-17 years). A path decomposition method was used to analyse whether the association between childhood adversity and psychosis was mediated by (1) lifetime cannabis use, (2) cannabis potency and (3) frequency of use.

Results: The association between household discord and psychosis was partially mediated by lifetime use of cannabis (indirect effect coef. 0.078, s.e. 0.022, 17%), its potency (indirect effect coef. 0.059, s.e. 0.018, 14%) and by frequency (indirect effect coef. 0.117, s.e. 0.038, 29%). Similar findings were obtained when analyses were restricted to early exposure to household discord.

Conclusions: Harmful patterns of cannabis use mediated the association between specific childhood adversities, like household discord, with later psychosis. Children exposed to particularly challenging environments in their household could benefit from psychosocial interventions aimed at preventing cannabis misuse.

Keywords: Cannabis use; childhood experience; mediation; psychotic disorders; trauma.

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Conflict of interest statement

R. M. M. reports personal fees from Janssen, Lundbeck, Sunovion and Otsuka, outside of the submitted work. M. D. F. reports personal fees from Janssen, outside the submitted work. M. B. reports grants and personal fees from Adamed, Janssen-Cilag, Otsuka and Abbiotics; personal fees from Angelini and Casen Recordati; and grants from Lundbeck and Takeda, outside of the submitted work. C. A. has been a consultant to or has received honoraria or grants from Acadia, Angelini, Boehringer, Gedeon Richter, Janssen Cilag, Lundbeck, Minerva, Otsuka, Roche, Sage, Servier, Shire, Schering Plough, Sumitomo Dainippon Pharma, Sunovion and Takeda. M. Q. has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of Adamed, Angelini, Casen Recordati, Janssen-Cilag, Lundbeck, Otsuka, Menarini and Takeda.

Figures

Figure 1.
Figure 1.
Proportion of the total effect of specific types of adversity on psychosis mediated via lifetime cannabis use, cannabis potency, and frequency of using cannabis. The blue portion of each bar indicates the percentage of the effect mediated (indirect effect). Panel A refers to the main analyses on total exposure to childhood adversity (0–17 years), Panel B refers to the sensitivity analyses restricted to early exposure to childhood adversity (0–12 years).
See this image and copyright information in PMC

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