An Examination of Emotion Regulation and Dispositional Mindfulness as Mediators of the Relationship Between Trauma and Cannabis Use Among Young People With HIV

Lauren Nicole Nunez
University of Central Florida

Co-authors: Lauren Nunez¹, Kayla Reyes¹, Hanzhi Gao², Scott Pickett³, Sharon L Nichols⁴, Karina Villalba^1
1University of Central Florida, ²University of South Florida, ³Florida State University, ⁴University of California San Diego

Background: Young people with HIV (YPWH) experience multiple co-occurring stressors that increase risk for cannabis use, including PTSD/trauma symptoms, discrimination, HIV stigma, adverse childhood experiences, racial/ethnic microaggressions, and perceived stress. Emotion dysregulation and low dispositional mindfulness are associated with maladaptive coping behaviors, including substance use, but it is unknown whether they mediate associations between stress/trauma-related factors and cannabis use in YPWH. Identifying these mechanisms may help define modifiable targets for interventions to reduce cannabis use and improve mental health among YPWH. This study examined whether stress/trauma-related factors were associated with greater cannabis use and whether emotion dysregulation and/or dispositional mindfulness mediated these associations.

Methods: DEFINE study participants (YPWH, ages 18–34; at least one episode of alcohol use during the prior month) were assessed at baseline and 9 months. Cannabis use was measured with the ASSIST cannabis-involvement score (use frequency and consequences). Single-mediator models (stress/trauma → difficulties with emotion regulation [DERS] or dispositional mindfulness [FFMQ] → cannabis-involvement) with indirect effects (bootstrapped 5,000 resamples) were tested for each stress/trauma-related factor (PTSD symptoms [PCL-5], perceived stress [PSS], adverse childhood experiences [ACEs], trauma symptoms of discrimination [TSDS], racial and ethnic microaggressions [REMS], everyday discrimination  [EDS], and HIV stigma [BHSS])). Longitudinally, stress/trauma factors and DERS/FFMQ were tested as predictors of residualized change in cannabis use. Analyses were exploratory; no correction for multiple comparisons was applied.

Results: Cross-sectionally (n=46-53 across models), PCL-5 was associated with ASSIST cannabis involvement almost entirely through DERS (indirect=0.18, 95% CI 0.06–0.35, p=.005). DERS also mediated associations of cannabis-involvement with BHSS (0.13, p=.001), ACEs, (0.84, p=.003), REMS (0.15, p=.038), and PSS (0.45, p=.050). FFMQ mediated fewer pathways, with significant indirect effects for BHSS (0.07, p=.033) and PCL-5 (0.08, p=.045); TSDS and REMS showed no significant indirect effect via DERS or FFMQ. Longitudinally (n=29-35 across models), baseline stress predicted DERS, but neither DERS nor FFMQ predicted change in ASSIST cannabis involvement at 9 months, consistent with high stability of use in this cohort.

Conclusions: In this study, emotion dysregulation mediated the cross-sectional associations between PTSD, adverse childhood experiences, discrimination, perceived stress, and cannabis involvement. Neither emotional dysregulation nor mindfulness predicted longitudinal change in cannabis use; however, longitudinal analyses were likely underpowered due to loss to follow-up. These results highlight the need for longitudinal studies to establish causality and identify additional intervention targets.