Study register · detailSystematic Review · Psychosis Risk · 2025
Co-occurrence between adverse childhood experiences and cannabis use in psychosis risk and course: A stratified systematic review.
Ricci et al.·Journal of psychiatric researchImpact 3.0
Clear benefitGRADEHigh2 citations
Samplek = 62 Studien
DurationJanuary 2000 to January 2024
EndpointPsychosis risk / disease…
Blindingunklar
DesignSystematic Review
”Key finding
Co-exposure to childhood trauma and cannabis use shows synergistic effects on psychosis risk with odds ratios up to 20,9 and 31,0 respectively; combined exposure associated with earlier manifestation (2,9-3,6 years), more severe symptoms, and reduced treatment response; trauma-informed interventions with substance use components show promising results.
Summary
Stratified systematic review (k=62 studies, 2000–2024) on the co-occurrence of adverse childhood experiences (ACE) and cannabis use in the psychosis spectrum. Significant interactions: OR up to 20,9 in community samples, OR up to 31,0 in first-episode psychosis. Combined exposure associated with earlier disease onset (2,9–3,6 years earlier), more severe positive symptoms, reduced treatment response, poorer functional outcomes. Trauma-informed interventions with an integrated addiction component show promising results.
P
PopulationPersons across the psychosis spectrum (general population, high-risk populations, first-episode psychosis patients, established psychoses, treatment-seeking clinical samples) — pooled 62 primary studies
I
InterventionCo-exposure to adverse childhood experiences (ACE) and cannabis use
O
OutcomeSignificant interaction effects between ACE and cannabis use: odds ratios up to 20,9 in community samples and 31,0 in first-episode psychosis samples; combined exposure associated with earlier disease onset (2,9–3,6 years earlier), more severe positive symptoms, reduced treatment response, and poorer functional outcomes
Confidence in the evidence
Very lowLowModerateHigh
High
The highest of four GRADE levels, the effect estimate is very reliable.
Background: Adverse childhood experiences and cannabis use are robustly associated with psychosis risk, with evidence suggesting their co-occurrence may synergistically amplify risk.
Objective: To synthesize evidence on the co-occurrence between adverse childhood experiences, cannabis use, and psychosis across different populations, examining effects across the psychosis spectrum and providing stage-specific intervention implications.
Methods: Systematic review of literature (January 2000-January 2024) across PubMed/MEDLINE, PsycINFO, Embase, and Web of Science. Studies were categorized into five groups: general population/community, high-risk, first-episode psychosis, established psychosis, and treatment-seeking clinical samples and intervention studies. Quality was assessed using appropriate tools.
Results: Sixty-two studies were included (15 general population, 5 high-risk, 18 first-episode psychosis, 11 established psychosis, 13 treatment-seeking clinical and intervention studies). Epidemiological studies showed significant interactions, with odds ratios up to 20.9 in community samples and 31.0 in first-episode samples. Converging neurobiological mechanisms included HPA axis alterations, inflammatory processes, and endocannabinoid system dysfunction. Patients with combined exposure showed earlier onset (2.9-3.6 years), more severe positive symptoms, reduced treatment response, and poorer functional outcomes. Trauma-informed interventions integrated with substance use components showed promising results.
Conclusions: The co-occurrence between adverse childhood experiences and cannabis use represents a fundamental neurobiological phenomenon manifesting distinctively across the psychosis continuum. Evidence supports a developmental cascade model wherein trauma creates neurobiological vulnerability that subsequent cannabis exposure may exploit. Trauma-informed approaches simultaneously addressing trauma and cannabis use may significantly improve outcomes for this vulnerable population.