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.
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.
University of Konstanz, Box 23, 78457, Konstanz, Germany.|vivo international e.V., PO Box 5108, 78430, Konstanz, Germany.
Marina
0000-0002-5589-9346
M
Widmann
Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.
Bernice
B
Apondi
Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.
Abednego
A
Musau
Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya.
Abdulkadir Hussein
AH
Warsame
Tawakal Medical Clinic, 5th street, Eastleigh, Nairobi, Kenya.
Maimuna
M
Isse
Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.
Victoria
V
Mutiso
Fachklinik Freudenholm-Ruhleben, Postfach 5, 24301, Plön, Germany.
Clemens
C
Veltrup
Africa Mental Health Foundation, Mawensi Gardens, Upperhill Nairobi, Kenya.|University of Nairobi, Nairobi, Kenya.
David
D
Ndetei
University of Konstanz, Box 23, 78457, Konstanz, Germany. Michael.odenwald@uni-konstanz.de.|vivo international e.V., PO Box 5108, 78430, Konstanz, Germany. Michael.odenwald@uni-konstanz.de.
Michael
M
Odenwald
D000328:Adult; D029754:Catha; D003863:Depression / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D000076322:Multimorbidity; D011614:Psychotherapy, Brief; D011618:Psychotic Disorders / Q000453:epidemiology; D012036:Refugees / Q000523:psychology / Q000706:statistics & numerical data; D012998:Somalia / Q000208:ethnology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D055815:Young Adult
Brief Intervention; Depression; Khat use; Posttraumatic stress disorder; Somali refugees