Khat Use, PTSD and Psychotic Symptoms among Somali Refugees in Nairobi – A Pilot Study

Abstract

In East-African and Arab countries, khat leaves are traditionally chewed in social settings. They contain the amphetamine-like alkaloid cathinone. Especially among Somali refugees, khat use has been associated with psychiatric symptoms. We assessed khat-use patterns and psychiatric symptoms among male Somali refugees living in a disadvantaged urban settlement area in Kenya, a large group that has not yet received scientific attention. We wanted to explore consume patterns and study the associations between khat use, traumatic experiences, and psychotic symptoms. Using privileged access sampling, we recruited 33 healthy male khat chewers and 15 comparable non-chewers. Based on extensive preparatory work, we assessed khat use, khat dependence according to DSM-IV, traumatic experiences, posttraumatic stress disorder (PTSD), and psychotic symptoms using standardized diagnostic instruments that had been adapted to the Somali language and culture. Hazardous use patterns like chewing for more than 24 h without interruption were frequently reported. All khat users fulfilled the DSM-IV-criteria for dependence and 85% reported functional khat use, i.e., that khat helps them to forget painful experiences. We found that the studied group was heavily burdened by traumatic events and posttraumatic symptoms. Khat users had experienced more traumatic events and had more often PTSD than non-users. Most khat users experience khat-related psychotic symptoms and in a quarter of them we found true psychotic symptoms. In contrast, among control group members no psychotic symptoms could be detected. We found first evidence for the existence and high prevalence of severely hazardous use patterns, comorbid psychiatric symptoms, and khat use as a self-medication of trauma-consequences among male Somali refugees in urban Kenyan refugee settlements. There is a high burden by psychopathology and adequate community-based interventions urgently need to be developed.

Level of khat dependence, use patterns, and psychological correlates in Yemen: a cross-sectional investigation

“…It has been reported that khat users, typically men, get together with their peers in the afternoon and chew khat for several hours, leading to financial and familial problems (35). Khat use has been linked to altered neurobiological mechanisms related to stress and emotion regulation (36), and there is evidence to suggest that khat is associated with worsening of ongoing psychopathology (4,5,13,37,38). Although concurrent and khat-only users in this study showed comparable levels of khat dependence, it is possible that variants of tobacco use (duration of use, exposure, and types of tobacco products such as cigarettes and shisha) could affect khat use patterns.…”

“…Functional mood disturbances (anxiety and depression) have also been reported during khat sessions, but these are temporary and may disappear the next day (11). Evidence indicates that long-term or excessive khat use is a risk factor for progression of ongoing mental health problems (4,12,13).…”

Khat use and related addiction, mental health an physical disorders: the need to address a growing risk

“…Khat use is higher among individuals suffering from traumatic and stressful events (9,32), those with pre-existing mental disorders (33) in an attempt to "self-medicate" pre-existing symptoms such as depression, anxiety and trauma (34,35), and those experiencing medication side-effects (36). Khat helps individuals with mental disorders to feel better but increases the risk of additional psychotic symptoms (34).…”

“…An initiative funded by the German government, which currently involves the University of Konstanz (Germany), the University of Nairobi (Kenya), the University of Munich (LMU, Germany), the University of Jimma (Ethiopia) and several NGOs, aims i) to develop and evaluate sustainable interventions for community-based mental health care that include khat (30,69,70), ii) to develop and evaluate currently not available research and clinical methods (30,71) and iii) to study the effects of khat use on psychotic developments in crosssectional and longitudinal studies in order to identify noxious khat use patterns and mediating and moderating variables (9).…”

“…Today, soon after harvesting, the twigs and shoots are rolled into bundles and wrapped in banana leaves in order to retain moisture (8). In most instances, bundles are the traded units, but lower qualities might also be marketed in standard plastic bags (9). The leaves and tender stems are usually chewed and kept in a tight wad in the cheek.…”