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Replication in two independent population-based samples that childhood maltreatment and cannabis use synergistically impact on psychosis risk

Published online by Cambridge University Press:  16 June 2011

M. Konings
Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, The Netherlands Department of Psychiatry, GGZ Eindhoven, The Netherlands
N. Stefanis
University of Mental Health Research Institute (UMHRI) and Department of Psychiatry, National and Kapodistrian University of Athens, Greece
R. Kuepper
Department of Psychiatry, GGZ Eindhoven, The Netherlands
R. de Graaf
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
M. ten Have
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
J. van Os
Department of Psychiatry, GGZ Eindhoven, The Netherlands Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK
C. Bakoula
First Department of Pediatrics, Athens University Medical School, ‘Aghia Sophia’ Children's Hospital, Athens, Greece
C. Henquet*
Department of Psychiatry, GGZ Eindhoven, The Netherlands PsyQ Heerlen, Mondriaan, Zuid-Limburg, The Netherlands
*Address for correspondence: Dr C. Henquet, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, PO Box 616 (Vijverdal), 6200 MD Maastricht, The Netherlands. (Email:



There may be biological plausibility to the notion that cannabis use and childhood trauma or maltreatment synergistically increase the risk for later development of psychotic symptoms. To replicate and further investigate this issue, prospective data from two independent population-based studies, the Greek National Perinatal Study (n=1636) and The Netherlands Mental Health Survey and Incidence Study (NEMESIS) (n=4842), were analyzed.


Two different data sets on cannabis use and childhood maltreatment were used. In a large Greek population-based cohort study, data on cannabis use at age 19 years and childhood maltreatment at 7 years were assessed. In addition, psychotic symptoms were assessed using the Community Assessment of Psychic Experiences (CAPE). In NEMESIS, the Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms at three different time points along with childhood maltreatment and lifetime cannabis use.


A significant adjusted interaction between childhood maltreatment and later cannabis use was evident in both samples, indicating that the psychosis-inducing effects of cannabis were stronger in individuals exposed to earlier sexual or physical mistreatment [Greek National Perinatal Study: test for interaction F(2, 1627)=4.18, p=0.02; NEMESIS: test for interaction χ2(3)=8.08, p=0.04].


Cross-sensitivity between childhood maltreatment and cannabis use may exist in pathways that shape the risk for expression of positive psychotic symptoms.

Original Articles
Copyright © Cambridge University Press 2011

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