Skip to main content

Adolescent bullying, cannabis use and emerging psychotic experiences: a longitudinal general population study

  • C. J. Mackie (a1), M. O'Leary-Barrett (a2), N. Al-Khudhairy (a1), N. Castellanos-Ryan (a3), M. Struve (a1), L. Topper (a1) and P. Conrod (a1) (a3)...

Using longitudinal and prospective measures of psychotic experiences during adolescence, we assessed the risk of developing psychosis in three groups showing low, increasing and elevated psychotic experiences associated with bullying by peers and cannabis use in a UK sample of adolescents.


Data were collected by self-report from 1098 adolescents (mean age 13.6 years; 60.9% boys) at five separate time points, equally separated by 6 months, across a 24-month period. General growth mixture modelling identified three distinct trajectories of adolescents reporting psychotic experiences: elevated, increasing and low.


Controlling for cannabis use, bullying by peers significantly predicted change in psychotic experiences between Time 2 and Time 5 in adolescents belonging to the increasing group. No effect was found for the elevated or low groups. Controlling for bullying, an earlier age of cannabis use and cannabis use more than twice significantly predicted change in psychotic experiences in adolescents belonging to the increasing group. Cannabis use at any age was significantly associated with subsequent change in psychotic experiences in the low group. Reverse causal associations were examined and there was no evidence for psychotic experiences at Time 1 predicting a subsequent change in cannabis use between Times 2 and 5 in any trajectory group.


Bullying by peers and cannabis use are associated with adolescents' reports of increasing psychotic experiences over time. Further research into the longitudinal development of psychosis in adolescence and the associated risk factors would allow for early intervention programmes to be targeted more precisely.

Corresponding author
*Address for correspondence: Dr C. J. Mackie, Institute of Psychiatry, King's College London, 4 Windsor Walk, London SE5 8AF, UK. (Email: [C. J. Mackie]
(Email: [P. Conrod]
Hide All
Akaike H (1979). A new look at the statistical model identification. IEEE Transactions on Automatic Control 19, 616623.
Appels MC, Sitskoorn MM, Vollema MG, Kahn RS (2004). Elevated levels of schizotypal features in parents of patients with a family history of schizophrenia spectrum disorders. Schizophrenia Bulletin 30, 781790.
Arseneault L, Cannon M, Fisher HL, Polancyk G, Moffitt TE, Caspi A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal 325, 12121213.
Barkus E, Murray R (2010). Substance use in adolescence and psychosis: clarifying the relationship. Annual Review of Clinical Psychology 6, 365389.
Bentall RP, Fernyhough C (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin 34, 10121020.
Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, Moore R, Corcoran R (2009). The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry 66, 236247.
Bossong MG, Niesink RJM (2010). Adolescent brain maturation, the endogenous cannabinoid system and the neurobiology of cannabis-induced schizophrenia. Progress in Neurobiology 92, 370385.
Campbell MLC, Morrison AP (2007). The relationship between bullying, psychotic like experiences and appraisals in 14–16 year olds. Behaviour Research and Therapy 45, 15791591.
Cannon TD (2005). Clinical and genetic high-risk strategies in understanding vulnerability to psychosis. Schizophrenia Research 79, 3544.
Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R (2008). Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America. Archives of General Psychiatry 65, 2837.
Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington HL, Taylor A, Arsenault L, Williams B, Braithwaite A, Poulton R, Craig IW (2005). Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene × environment interaction. Biological Psychiatry 57, 11171127.
Collip D, Myin-Germeys I, van Os J (2008). Does the concept of sensitization provide a plausible mechanism for the putative link between the environ?ental and schizophrenia? Schizophrenia Bulletin 34, 220225.
Costello A, Edelbrock C, Kalas R, Kessler M, Klaric S (1982). NIMH Diagnostic Interview Schedule for Children Child Version. National Institute of Mental Health: Rockville, MD.
Cougnard A, Marcelis M, Myin-Germeys I, de Graaf R, Vollebergh W, Krabbendam L, Lieb R, Wittchen H-U, Henquet C, Spauwen J, van Os J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause ?ersistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513527.
Currie CE, Elton RA, Todd J, Platt S (1997). Indicators of socioeconomic status for adolescents: the WHO Health Behaviour in School-aged Children Survey. Health Education Research 12, 385397.
Derogatis LR (1993). BSI Brief Symptom Inventory. Administration, Scoring, and Procedures Manual. National Computer Systems: Minneapolis, MN.
Dhossche D, Ferdinand R, van der Ende J, Hofstra MB, Verhulst F (2002). Diagnostic outcomes of self reported hallucinations in a community sample of adolescents. Psychological Medicine 32, 619627.
Dominguez MDG, Wichers M, Lieb R, Wittchen H-U, van Os J (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin 37, 8493.
Ferdinand RF, Sondeijker F, van der Ende J, Selten JP, Huizink A, Verhulst FC (2005). Cannabis use predicts future psychotic symptoms and vice versa. Addiction 100, 612618.
Ge X, Jin R, Natsuaki MN, Gibbons FX, Brody GH, Cutrona CE (2006). Pubertal maturation and early substance use risks among African American children. Psychology of Addictive Behaviors 20, 404414.
Hanssen M, Bak M, Bijl R, Vollebergh W, van Os J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Harley M, Kelleher I, Clarke M, Lynch F, Arseneault L, Connor D, Fitzpatrick C, Cannon M (2010). Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychological Medicine 40, 16271634.
Hayatbakhsh MR, Najman JM, McGee TR, Bor W, O'Callaghan MJ (2009). Early pubertal maturation in the prediction of early adult substance use: a prospective study. Addiction 104, 5966.
Henquet C, Krabbendam L, Spauwen J, Kaplan C, Lieb R, Wittchen H-U, van Os J (2005). Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people. British Medical Journal 330, 1114.
Henquet C, Rosa A, Krabbendam L, Papiol J, Fananas L, Drukker M, Ramaekers JC, van Os J (2006). An experimental study of catechol-O-methyltransferase Val(158)Met moderation of delta-9-tetrahydrocannabinol-induced effects on psychosis and cognition. Neuropsychopharmacology 31, 27482757.
Houston JE, Murphy J, Adamson G, Stringer M, Shevlin M (2008). Childhood sexual abuse, early cannabis use and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophrenia Bulletin 34, 580585.
Houston JE, Murphy J, Shevlin M, Adamson G (2011). Cannabis use and psychosis: re-visiting the role of childhood trauma. Psychological Medicine 41, 22392348.
Johns LC, van Os J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 11251141.
Kahn RS, Linszen DH, van Os J, Wiersma D, Bruggeman R, Cahn W, de Haan L, Krabbendam L, Myin-Germeys I; Genetic Risk and Outcome of Psychosis (GROUP) Investigators (2010). Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient-sibling and sibling-control pairs. Archives of General Psychiatry 68, 138147.
Kelleher I, Cannon M (2011). Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychological Medicine 41, 16.
Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M (2008). Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. British Journal of Psychiatry 193, 378382.
Kelleher I, Harley M, Murtagh A, Cannon M (2011). Are screening instruments valid for ps?chotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophrenia Bulletin 37, 362369.
Kendler KS, Gardner CO, Lichtenstein P (2008). A developmental twin study of symptoms of anxiety and depression: evidence for genetic innovation and attenuation. Psychological Medicine 38, 15671575.
Konings M, Henquet C, Maharajh HD, Hutchinson G, van Os J (2008). Early exposure to cannabis and risk for psychosis in young adolescents in Trinidad. Acta Psychiatrica Scandinavica 118, 209213.
Krabbendam L, van Os J (2005). Schizophrenia and urbanicity: a major environmental influence – conditional on genetic risk. Schizophrenia Bulletin 31, 795799.
Kuepper R, van Os J, Lieb R, Wittchen H-U, Hofler M, Henquet C (2011). Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study. British Medical Journal 342, d738.
Lanza ST, Collins LM (2002). Pubertal timing and the onset of substance use in females during early adolescence. Prevention Science 3, 6982.
Lataster T, van Os J, Drukker M, Henquet C, Feron F, Gunther N, Myin-Germeys I (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423428.
Laurens KR, Hodgins S, Maughan B, Murray RM, Rutter ML, Taylor EA (2007). Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years. Schizophrenia Research 90, 130146.
Lichlyter B, Purdon S, Tibbo P (2011). Predictors of psychosis severity in individuals with primary stimulant addictions. Addictive Behaviors 36, 137139.
Linscott RJ, van Os J (2010). Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI and DSM-VII. Annual Review of Clinical Psychology 6, 391419.
Lo YT, Mendall NR, Rubin DB (2001). Testing the number of components in a normal mixture. Biometrika 88, 767778.
Mackie CJ, Castellanos-Ryan N, Conrod P (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
McGrath J, Welham J, Scott J, Varghese D, Degenhardt L, Hayatbakhsh MR, Alati R, Williams GM, Bor W, Najman JM (2010). Association between cannabis use and psychosis-related outcomes using sibling pair analysis in a cohort of young adults. Archives of General Psychiatry 67, 440447.
Muthén B (2004). Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In Handbook of Quantitative Methodology for the Social Sciences (ed. Kaplan D.), pp. 345368. Sage Publications: Newbury Park, CA.
Muthén LK, Muthén BO (2007). Mplus User's Guide. Muthén & Muthén: Los Angeles, CA.
Myin-Germeys I, Delespaul P, van Os J (2005). Behavioural sensitization to daily life stress in psychosis. Psychological Medicine 35, 733741.
O'Leary-Barrett M, Mackie CJ, Castellanos-Ryan N, Al-Khudhairy N, Conrod PJ (2010). Personality-targeted interventions delay uptake of drinking and decrease risk of alcohol-related problems when delivered by teachers. Journal of the American Academy of Child and Adolescent Psychiatry 49, 954963.
Olweus D (1996). The Revised Olweus Bully/Victim Questionnaire. Research Centre for Health Promotion (HEMIL Centre), University of Bergen: Bergen, Norway.
Plomin R, Emde RN, Braungart JM, Campos J, Corley R, Fulker DW, Kagan J, Reznick JS, Robinson J, Zahn-Wexler C, Defries JC (1993). Genetic change and continuity from fourteen to twenty months: the MacArthur Longitudinal Twin Study. Child Development 64, 13541376.
Read J, van Os J, Morrison AP, Ross CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Sahin HG, Batiguen AD, Ugurtas S (2002). The validity, reliability and factor structure of the Brief Symptom Inventory (BSI) [in Turkish]. Turk Psikiyatri Dergisi 13, 125135.
Schreier A, Wolke D, Thomas K, Horwood J, Hollis C, Gunnell D, Lewis G, Thompson A, Zammit S, Duffy L, Salvi G, Harrison G (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Schwartz G (1978). Estimating the dimension of a model. Annals of Statistics 6, 461464.
Shaw DS, Wagner EF, Arnett J, Aber MS (1992). The factor structure of the Reckless Behavior Questionnaire. Journal of Youth and Adolescence 21, 305323.
StataCorp (2005). Stata Statistical Software: Release 10.1. Stata Corporation: College Station, TX.
Stefanis NC, Delespaul P, Henquet C, Bakoula C, Stefanis CN, van Os J (2004). Early adolescent cannabis exposure and positive and negative dimensions of psychosis. Addiction 99, 13331341.
van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H (2002). Cannabis use and psychosis: a longitudinal population-based study. American Journal of Epidemiology 156, 319327.
van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
Varese F, Udachina A, Myin-Germeys I, Oorschot M, Bentall RP (2011). The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. Psychosis 3, 1828.
Verdoux H, van Os J, Maurice-Tison S, Gay B, Salamon R, Bourgeois M (1998). Is early adulthood a critical developmental stage?for psychosis proneness? A survey of delusional ideation in normal subjects. Schizophrenia Research 29, 247254.
Wigman JTW, van Winkel R, Raaijmakers QAW, Ormel J, Verhulst FC, Reijneveld SA, van Os J, Vollebergh WAM (2011). Evidence for a persistent, environmental-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychological Medicine 41, 23172329.
Yoshizumi T, Murase S, Honjo S, Kaneko H, Murakami T (2004). Hallucinatory experiences in a community sample of Japanese children. Journal of the American Academy of Child and Adolescent Psychiatry 43, 10301036.
Yung AR, Phillips L, Pan Yuen H, Francey SM, McFarlane CA, Hallgreen M, McGorry PD (2003). Psychosis prediction: 12-month follow up of a high-risk (‘prodromal’) group. Schizophrenia Research 60, 2132.
Yung AR, Stanford C, Cosgrave E, Killackey E, Phillips L, Nelson B, McGorry PD (2006). Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophrenia Research 84, 5766.
Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G (2002). Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. British Medical Journal 325, 1199.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 20
Total number of PDF views: 121 *
Loading metrics...

Abstract views

Total abstract views: 390 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th November 2017. This data will be updated every 24 hours.