Exploring Attachment, Trauma, and Cannabis Use in Psychotic Disorders: A Qualitative Study of Patient and Family Perspectives

Background Psychotic disorders are debilitating mental illnesses that affect individuals psychologically, occupationally, and socially. Several modifiable risk factors were shown to increase the risk for psychosis and associated consequences (i.e., severity, chronicity, and suicide). Research suggests that insecure attachment styles, history of psychological trauma, and substance use disorders (of which cannabis is the most frequent) can increase the risk for and severity of psychotic illness. However, it remains unclear how these known risk factors interact with each other and create different pathways of vulnerability. Most importantly, while clinicians are becoming more aware of these interactions, little is known whether these risk factors are recognized and addressed by patients and their families to prevent illness or support recovery. In fact, many clinicians report that patients and their main supports (family and friends) are often unaware of these risks or unable to address them. This study aims to fill this gap by qualitatively examining the understanding that patients and family members have regarding their illness and these risks for their illness, in order to better inform the interventions needed for optimal recovery. Method Patients and family members were recruited from the Early Psychosis Intervention Program in Saskatoon and the Schizophrenia Society of Saskatchewan. Semi-structured interviews were conducted with 17 patients experiencing first-episode psychosis and 9 family members. Interviews were coded and analyzed using thematic analysis based on Braun and Clarke’s 6-phase framework. Results Five major themes were generated: 1) Confusion: the mark of illness onset, and a shared experience; 2) Cannabis: the snake in the grass; 3) Shifts in relationships mirror shifts in recovery, and vice versa; 4) Trauma at the centre: significant impact and insignificant recognition; and 5) Looking forward: healing while belonging: the role of family and specialized programs. Conclusion Our findings reveal that patients and their families often have varying and inadequate understanding of the common risk factors affecting early psychosis. While the psychoeducation offered in the specialized clinic is highly valued, it is not always accessible or sufficient to alleviate these risks. The results highlight the necessity for targeted interventions aimed at increasing knowledge translation and treatment engagement.