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
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.
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.
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).
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.
KeywordsKhat use Somali refugees Brief Intervention Depression Posttraumatic stress disorder
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 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
- 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
- 12.Foreign Policy. Fragile States 2014. 2014 [cited 2015 Aug, 20.]; webpage]. http://foreignpolicy.com/fragile-states-2014/-rankings. Accessed 3 Oct 2016
- 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.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
- 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
- 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.Widmann M et al The modified assist-linked brief intervention for khat users: a randomized controlled effectiveness study (submitted) Google Scholar
- 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.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
- 34.Saß H et al (2003) Diagnostische Kriterien des Diagnostischen und Statistischen Manuals Psychischer Störungen–Textrevision–DSM-IV-TR. Göttingen: Hogrefe.Google Scholar
- 38.WHO (1997) Composite International Diagnostic Interview (CIDI): Core version 2.1. World Health Organization, GenevaGoogle Scholar
- 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.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
- 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.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
- 52.Raudenbush SW, Bryk AS (2002) Hierarchical linear models: Applications and data analysis methods, vol 1. Sage, London, UK Google Scholar