title: 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.
authors: Department of Clinical Psychology, University of Konstanz , Konstanz , Germany.
authors: Marina
authors: M
authors: Widmann
authors: Africa Mental Health Foundation , Nairobi , Kenya.
authors: Abdulkadir Hussein
authors: AH
authors: Warsame
authors: Department of Clinical Psychology, University of Konstanz , Konstanz , Germany.
authors: Jan
authors: J
authors: Mikulica
authors: Department of Clinical Psychology, University of Konstanz , Konstanz , Germany.
authors: Johannes
authors: J
authors: von Beust
authors: Africa Mental Health Foundation , Nairobi , Kenya.
authors: Maimuna Mohamud
authors: MM
authors: Isse
authors: Africa Mental Health Foundation , Nairobi , Kenya ; Department of Psychiatry, University of Nairobi , Nairobi , Kenya.
authors: David
authors: D
authors: Ndetei
authors: Department of Family Medicine, University of Minnesota Medical School , Duluth, MN , USA ; Department of Physiology and Pharmacology, University of Minnesota Medical School , Duluth, MN , USA.
authors: Mustafa
authors: M
authors: al'Absi
authors: Department of Clinical Psychology, University of Konstanz , Konstanz , Germany ; Vivo International , Allensbach , Germany.
authors: Michael G
authors: MG
authors: Odenwald
keywords: PTSD; Somali refugees in Kenya; khat; khat-related psychosis; psychotic symptoms