Mapping the Interplay Between Childhood Trauma, Substance Use, and Psychopathology in Early Psychosis: A Network...

Evidence suggests a complex interplay among childhood trauma (CT), substance use, and psychopathology in psychosis, yet the precise nature of these relationships remains unclear. Network analysis offers distinct advantages for examining these factors simultaneously, as it can capture multidirectional associations across multiple trauma subtypes, substances, and symptoms that conventional methods may overlook.

In this study, data from 317 patients with early psychosis were used. CT was assessed across 5 subtypes (sexual, physical, and emotional abuse; physical and emotional neglect) using a tailored questionnaire completed by case managers. Current use of alcohol, opioids, cocaine, cannabis, and amphetamines was evaluated with the Case Manager Rating Scale for Substance Abuse. Symptoms were measured with the Positive and Negative Syndrome Scale. A mixed graphical model was fitted to estimate conditional associations among CT, substance use, and psychopathology. Further analyses on the network's connectivity were conducted.

Three distinct patterns of connection emerged, respectively associated with cannabis use, depressive symptoms, and attentional difficulties, linking trauma to psychopathology. Cannabis emerged as a central bridge, linking trauma to both symptom severity and broader substance use.

These findings highlight the nuanced relationships between CT, substance use, and psychopathology. They further suggest that cannabis may serve both as a catalyst for psychopathology and as a gateway to broader substance use among trauma-exposed individuals. Together, these findings may support more comprehensive clinical formulation and informed treatment planning in early intervention settings.