Social Psychiatry and Psychiatric Epidemiology

, Volume 52, Issue 11, pp 1425–1434 | Cite as

Comorbid psychopathology and everyday functioning in a brief intervention study to reduce khat use among Somalis living in Kenya: description of baseline multimorbidity, its effects of intervention and its moderation effects on substance use

  • Marina Widmann
  • Bernice Apondi
  • Abednego Musau
  • Abdulkadir Hussein Warsame
  • Maimuna Isse
  • Victoria Mutiso
  • Clemens Veltrup
  • David Ndetei
  • Michael Odenwald
Original Paper

Abstract

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.

Keywords

Khat use Somali refugees Brief Intervention Depression Posttraumatic stress disorder 

References

  1. 1.
    Krikorian AD (1984) Kat and its use: an historical perspective. J Ethnopharmacol 12:115–178CrossRefPubMedGoogle Scholar
  2. 2.
    Kalix P (1990) Pharmacological properties of the stimulant khat. Pharmacol Ther 48(3):397–416CrossRefPubMedGoogle Scholar
  3. 3.
    Toennes SW et al (2003) Pharmacokinetics of cathinone, cathine and norephedrine after the chewing of khat leaves. Br J Clin Pharmacol 56(1):125–130CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kelly JP (2011) Cathinone derivatives: a review of their chemistry, pharmacology and toxicology. Drug Test Anal 3(7-8):439–453CrossRefPubMedGoogle Scholar
  5. 5.
    Pennings EJ, Opperhuizen A, van Amsterdam JG (2008) Risk assessment of khat use in the Netherlands: a review based on adverse health effects, prevalence, criminal involvement and public order. Regul Toxicol Pharmacol 52(3):199–207CrossRefPubMedGoogle Scholar
  6. 6.
    Warfa N et al (2007) Khat use and mental illness: a critical review. Soc Sci Med 65:309–318CrossRefPubMedGoogle Scholar
  7. 7.
    Al-Habori M (2005) The potential adverse effects of habitual use of Catha edulis (khat). Expert Opin Drug Saf 4(6):1145–1154CrossRefPubMedGoogle Scholar
  8. 8.
    Al-Hebshi NN et al (2010) Effect of khat chewing on periodontal pathogens in subgingival biofilm from chronic periodontitis patients. J Ethnopharmacol 132(3):564–569Google Scholar
  9. 9.
    Al-Motarreb A, Al-Habori M, Broadley KJ (2010) Khat chewing, cardiovascular diseases and other internal medical problems: The current situation and directions for future research. J Ethnopharmacol 132(3):540–548CrossRefPubMedGoogle Scholar
  10. 10.
    Beckerleg S (2010) East African discourses on khat and sex. J Ethnopharmacol 132(3):600–606. doi:10.1016/j.jep.2010.08.057
  11. 11.
    Odenwald M et al (2009) Use of khat and posttraumatic stress disorder as risk factors for psychotic symptoms: a study of Somali combatants. Soc Sci Med 69(7):1040–1048CrossRefPubMedGoogle Scholar
  12. 12.
    Foreign Policy. Fragile States 2014. 2014 [cited 2015 Aug, 20.]; webpage]. http://foreignpolicy.com/fragile-states-2014/-rankings. Accessed 3 Oct 2016
  13. 13.
    UNHCR (2016) Refugees in the Horn of Africa: Somali displacement crisis. http://data.unhcr.org/horn-of-africa/country.php?id=197. Accessed 3 Oct 2016
  14. 14.
    Klein A (2007) Khat and the creation of tradition in the Somali diaspora. In: Fountain J, Korf DJ (eds) Drugs in society: a European perspective. Radcliffe Publishing: OxfordGoogle Scholar
  15. 15.
    Zein A (1988) Polydrug abuse among Ethiopian university students with particular reference to khat (Catha edulis). J Trop Med Hyg 91:71–75PubMedGoogle Scholar
  16. 16.
    Omolo OE, Dhadphale M (1987) Alcohol use among khat (Catha) chewers in Kenya. Br J Addict 82(1):97–99CrossRefPubMedGoogle Scholar
  17. 17.
    Widmann M et al (2014) Khat use, PTSD and psychotic symptoms among Somali refugees in Nairobi—a pilot study. front. Public Health 2:71Google Scholar
  18. 18.
    Patel SL (2008) Attitudes to khat use within the Somali community in England. Drugs Educ Prev Policy 15(1):37–53CrossRefGoogle Scholar
  19. 19.
    Griffiths P et al (1997) A transcultural pattern of drug use: qat (khat) in the UK. Br J Psychiatry 170:281–284CrossRefPubMedGoogle Scholar
  20. 20.
    Bhui K et al (2003) Traumatic events, migration characteristics and psychiatric symptoms among Somali refugees–preliminary communication. Soc Psychiatry Psychiatr Epidemiol 38(1):35–43CrossRefPubMedGoogle Scholar
  21. 21.
    Lindert J et al (2009) Depression and anxiety in labor migrants and refugees—a systematic review and meta-analysis. Soc Sci Med 69(2):246–257CrossRefPubMedGoogle Scholar
  22. 22.
    Fazel M, Wheeler J, Danesh J (2005) Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet 365(9467):1309–1314CrossRefPubMedGoogle Scholar
  23. 23.
    Bhui K et al (2006) Mental disorders among Somali refugees. Soc Psychiatry Psychiatr Epidemiol 41(5):400–408CrossRefPubMedGoogle Scholar
  24. 24.
    Bhui K, Warfa N (2010) Trauma, khat and common psychotic symptoms among Somali immigrants: A quantitative study. J Ethnopharmacol 132(3):549–553CrossRefPubMedGoogle Scholar
  25. 25.
    Vasilaki EI, Hosier SG, Cox WM (2006) The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol alcoholism 41(3):328–335CrossRefPubMedGoogle Scholar
  26. 26.
    O’Donnell A et al (2014) The impact of brief alcohol interventions in primary healthcare: a systematic review of reviews. Alcohol Alcohol 49(1):66–78CrossRefPubMedGoogle Scholar
  27. 27.
    Young MM et al (2014) Effectiveness of brief interventions as part of the Screening, Brief Intervention and Referral to Treatment (SBIRT) model for reducing the nonmedical use of psychoactive substances: a systematic review. Syst Rev 3(1):1CrossRefGoogle Scholar
  28. 28.
    Saitz R (2014) Screening and brief intervention for unhealthy drug use: little or no efficacy. Front Psychiatry 5:121CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Odenwald M, Al’Absi M (2016) Khat use and related addictive, mental health and physical disorders. The need to address a growing risk. Eastern Mediterranean Health J (in press) Google Scholar
  30. 30.
    Widmann M et al The modified assist-linked brief intervention for khat users: a randomized controlled effectiveness study (submitted) Google Scholar
  31. 31.
    Lindley A (2007) Protracted displacement and remittances: the view from Eastleigh, Nairobi. Research Paper No. 143. Series: New Issues in Refugee Research. UNHCR, Geneva, Switzerland. http://eprints.soas.ac.uk/7464/1/Lindley_-_2007_-_Protracted_displacement_and_remittances.pdf. Accessed 3 Oct 2016
  32. 32.
    Micheni MW (2010) The making of a Somali capital base at the heart of Nairobi. Daily Nation (newspaper), Sept 25, 2010. http://www.nation.co.ke/news/The-making-of-a-Somali-capital-base-at-the-heart-of-Nairobi-/1056-1018208-tfmt47z/index.html. Accessed 3 Oct 2016
  33. 33.
    Kroenke K, Spitzer RL, J.B.W. Williams (2001) The PHQ-9—validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Saß H et al (2003) Diagnostische Kriterien des Diagnostischen und Statistischen Manuals Psychischer Störungen–Textrevision–DSM-IV-TR. Göttingen: Hogrefe.Google Scholar
  35. 35.
    Adewuya A, Ola B, Afolabi O (2006) Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. J Affect Disord 96(1–2):89–93CrossRefPubMedGoogle Scholar
  36. 36.
    Wulsin L, Somoza E, Heck J (2002) The feasibility of using the Spanish PHQ-9 to screen for depression in primary care in Honduras. Prim Care Compan J Clin Psychiatry 4(5):191–195CrossRefGoogle Scholar
  37. 37.
    Manea L, Gilbody S, McMillan D (2012) Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis. CMAJ 184(3):E191–E196CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    WHO (1997) Composite International Diagnostic Interview (CIDI): Core version 2.1. World Health Organization, GenevaGoogle Scholar
  39. 39.
    Odenwald M et al (2005) Khat use as risk factor for psychotic disorders: a cross-sectional and case-control study in Somalia. BMC Med 3(1):5CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Ndetei DM (1988) Psychiatric phenomenology across countries: constitutional, cultural, or environmental? Acta Psychiatr Scand Suppl 344:33–44CrossRefPubMedGoogle Scholar
  41. 41.
    Foa, E.C., L.; Jaycox L, Perry K (1997) The validation of a self-report measure of PTSD: the posttraumatic diagnostic scale. Psychol Assess 9:445–451CrossRefGoogle Scholar
  42. 42.
    Odenwald M et al (2007) Screening for posttraumatic stress disorder among Somali ex-combatants: a validation study. Conflict Health. doi:10.1186/1752-1505-1-10 PubMedPubMedCentralGoogle Scholar
  43. 43.
    World Health Organization (2006) WHO Expert Committee on Drug Dependence, Thirty-fourth report, in WHO Technical Report Series No. 942. WHO, Washington, p 36Google Scholar
  44. 44.
    Odenwald M, Klein A, Warfa N (2006) Khat addiction. In: El-Guebaly N, Carra G, Galanter M (eds) Textbook of addiction treatment: international perspectives. Springer, New York, pp 455–466Google Scholar
  45. 45.
    Dhadphale M, Omolo OE (1988) Psychiatric morbidity among khat chewers. East Afr Med J 65(6):355–359PubMedGoogle Scholar
  46. 46.
    Odenwald M et al (2007) The consumption of khat and other drugs in Somali combatants: a cross-sectional study. PLOS Med (Baltimore) 4(12):e341CrossRefGoogle Scholar
  47. 47.
    WHO (2002) The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction 97(9):1183–1194CrossRefGoogle Scholar
  48. 48.
    Humeniuk RE et al (2010) The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. World Health Organization, GenevaGoogle Scholar
  49. 49.
    Humeniuk R et al (2012) A randomized controlled trial of a brief intervention for illicit drugs linked to the alcohol, smoking and substance involvement screening Test (ASSIST) in clients recruited from primary health-care settings in four countries. Addiction 107(5):957–966CrossRefPubMedGoogle Scholar
  50. 50.
    Jacobsen NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19CrossRefGoogle Scholar
  51. 51.
    Siddiqui O, Hung HM, O’Neill R (2009) MMRM vs. LOCF: a comprehensive comparison based on simulation study and 25 NDA datasets. J Biopharm Stat 19(2):227–246CrossRefPubMedGoogle Scholar
  52. 52.
    Raudenbush SW, Bryk AS (2002) Hierarchical linear models: Applications and data analysis methods, vol 1. Sage, London, UK Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Marina Widmann
    • 1
    • 2
  • Bernice Apondi
    • 3
  • Abednego Musau
    • 3
  • Abdulkadir Hussein Warsame
    • 4
  • Maimuna Isse
    • 4
  • Victoria Mutiso
    • 3
  • Clemens Veltrup
    • 5
  • David Ndetei
    • 3
    • 6
  • Michael Odenwald
    • 1
    • 2
  1. 1.University of KonstanzKonstanzGermany
  2. 2.vivo international e.V.KonstanzGermany
  3. 3.Africa Mental Health FoundationUpperhill NairobiKenya
  4. 4.Tawakal Medical ClinicNairobiKenya
  5. 5.Fachklinik Freudenholm-RuhlebenPlönGermany
  6. 6.University of NairobiNairobiKenya

Personalised recommendations