Search

Background: During recent decades, the consumption of the stimulant khat (catha edulis) has profoundly changed in countries around the Horn of Africa, and excessive use patterns have emerged-especially evident among displaced Somalis. This is related to the development of severe somatic and psychiatric disorders. There are currently no preventive or interventional studies targeting khat use. This study's aim was to test screening and brief intervention (SBI) to reduce khat use among urban Somali refugees living in Kenya with limited access to public healthcare., Methods: In this controlled study, 330 male Somali khat users from the community were either assigned to SBI (161) or an assessment-only control condition (AC; 169); due to field conditions a rigorous experimental design could not be implemented. The World Health Organization's (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)-linked brief intervention was adapted to khat and Somali culture. Trained local counselors administered the intervention. The amount and frequency of khat use was assessed using the time-line-follow-back method. We compared the month before the intervention (t1) to the two months after it (t2, t3). Baseline differences in khat use frequency were corrected by partial matching and mixed effect models used to evaluate intervention effects., Results: SBI was well accepted and feasible for khat users. Over the complete observation period and from t1 to t2, khat use amount and frequency decreased (p < .001) and the intervention group showed a greater reduction (group x time effects with p ≤ .030). From t2 to t3, no further reduction and no group differences emerged., Conclusion: The results provide preliminary evidence that khat use amount and frequency can be reduced in community settings by SBI, requiring little resources. Thorough assessment alone might have intervention-like effects. The non-treatment-seeking community sample and the non-professional counselors are distinct from SBI studies with other substances in other countries, but support the feasibility of this approach in khat use countries and especially in Somali populations with limited access to healthcare. Future studies that employ rigorous experimental design are needed., Trial Registration: ClinicalTrials.gov identifier: NCT02253589. Date of first registration 01/10/2014, retrospectively registered https://clinicaltrials.gov/ct2/show/NCT02253589 . First participant 16/09/2014., (© 2022. The Author(s).)

Background: Khat ( Catha edulis ) is a traditionally used substance in African and Arab countries that contains the amphetamine-like alkaloid cathinone. Khat use among Ethiopian students is a growing concern. This study aims to describe khat use, psychological problems, and motivation to change and to determine associated factors of khat use among students from Jimma University seeking psychological assistance. Methods: In a cross-sectional study, a sample of 717 students from Jimma University, southwestern Ethiopia, who seek assistance to reduce khat use were recruited. The study used Amharic and Afaan Oromoo language versions of common psychological instruments and employed them as part of a comprehensive tablet computer-delivered self-report assessment battery, comprising the SRQ-20, the PCL-5, the LEC-5, the AUDIT, and the SOCRATES-khat. In addition, socio-demographic, economic variables, and functioning problems due to severe mental disorders were assessed. The analysis relied on the data of the 575 included participants and used clinical cut-off values to describe this treatment-seeking sample and hierarchical regression models to determine variables associated with khat use. Results: The sample showed high khat use in the past month ( M = 31.55 bundles, SD = 28.53, on M = 15.11 days, SD = 8.54); 17.0% showed highly problematic use. The sample was extremely burdened with comorbid psychiatric problems: 21.6% reported functioning problems due to past mental disorders, 60.2% scored above the cut-off for current common mental disorders, 37.9% screened positive for PTSD, and 47.1% reported hazardous alcohol use. Small to medium intercorrelations between variables were detected, and in hierarchical regression models, higher motivation to change khat use was associated with higher use of the substance. Conclusions: This study clearly shows the need to develop research instruments, screening methods, and assistance services for khat-using students at Jimma University. Study participants' high mental health burden shows the need for targeted intervention programs that go beyond brief interventions for khat use. Furthermore, the study highlights challenges for implementing such services: the barriers to utilization for females and khat users without comorbid mental health problems., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer AA declared a shared affiliation, with one of the authors with two of the authors to the handling editor at the time of the review., (Copyright © 2021 Hassen, Soboka, Widmann, Keller, Zeller, Büchele, Barnewitz, Yitayih, Schiller, Senger, Adorjan and Odenwald.)

Studying the relationship between mental illnesses and their environmental and genetic risk factors in low-income countries holds excellent promises. These studies will improve our understanding of how risk factors identified predominantly in high-income countries also apply to other settings and will identify new, sometimes population-specific risk factors. Here we report the successful completion of two intertwined pilot studies on khat abuse, trauma, and psychosis at the Gilgel Gibe Field Research Center in Ethiopia. We found that the Gilgel Gibe Field Research Center offers a unique opportunity to collect well-characterized samples for mental health research and to perform genetic studies that, at this scale, have not been undertaken in Ethiopia yet. We also supported service development, education, and research for strengthening the professional profile of psychiatry at the site.

Background and Aims: Migration and khat use were found to correlate with high rates of psychopathology. In this paper we aimed for assessing baseline multimorbidity and its interactions with a Brief Intervention., Methods: In the RCT, 330 male Somali khat users were assigned to treatment conditions (khat use is a predominantly male habit). The ASSIST-linked BI for khat users was administered. Using the TLFB Calendar, the PHQ-9, a Somali short version of the PDS and parts from the CIDI, khat use and comorbidity was assessed. With a regression analysis we tested for the influence of comorbidity and with mixed effect models group differences over time in sleep duration, khat use-time and everyday functioning., Results: We found high rates of baseline multimorbidity: 51% (N = 168) for depression, 22% (N = 74) for PTSD and 23% (N = 73) for khat-psychotic symptoms. Depression and khat-psychotic symptoms, but not PTSD symptoms decreased without group differences. Khat use-time decreased and functional time increased with significant time × group interactions (p ≤ 0.046). Depression and PTSD did not influence therapy success but in participants without comorbid psychopathology, more khat use reduction after the intervention was found (p = 0.024)., Conclusion: Somali khat users in Kenya are highly burdened by multimorbidity of depression, PTSD and khat-psychotic symptoms. The main effects for time and differences in healthy vs. mentally ill khat users indicate potential of unspecific support and the specific need for mental health care in combination with substance abuse treatment. The increase of everyday functioning promises more options for alternative activities, preventing excessive use and addiction.