King's College London

The study, published in BMJ Mental Health and led by researchers from King’s College London, Jigjiga University in Ethiopia and the University of Edinburgh, surveyed 844 adults in the cities of Jigjiga and Kabridahar to investigate patterns of khat use and their relationship with mental health.

Khat is a stimulant plant traditionally used for recreational and cultural purposes across parts of East Africa and the Middle East, including Ethiopia, Somalia, Yemen, Djibouti and Kenya. Its active compounds, cathinone and cathine, have stimulant effects and can produce feelings of increased energy, alertness and euphoria.

While khat use is an established part of social and cultural life in many communities, concerns have been raised about the potential health effects of problematic use (where people experience dependence, poor mental health, physical harm or disruption of their social or work life). In some settings, including areas affected by conflict and limited access to mental health services, khat may also be used as a way of coping with psychological distress or traumatic experiences.

Despite longstanding concern about the potential mental health effects of khat, evidence from representative populations remains limited, particularly in communities where access to mental health and addiction services is restricted.

The researchers used two established questionnaires to assess participants’ khat use and mental health. The Problematic Khat Use Screening Test (PKUST-17), developed in Ethiopia, was used to assess harms associated with khat use, while the Mini-International Neuropsychiatric Interview (MINI) was used to assess a range of mental health conditions and symptoms.

Among the 844 participants, 18.6% met the criteria for current major depressive disorder, while 12.3% had recurrent major depressive disorder, 10.9% had PTSD and 5.7% reported suicidal ideation. Just over 21.8% of participants had at least one of these mental health conditions or symptoms. Problematic khat use was identified in 113 participants (13.9%), including 106 men (36.1%) and seven women (1.4%).

The researchers found that people with problematic khat use were more likely to have mental health conditions than those without problematic use, after taking into account confounding factors including age, gender, education and marital status. The prevalence of major depressive disorder, recurrent depressive disorder, suicidal ideation or PTSD was 2.5-3.1 times higher in people reporting problematic khat use. Almost half (49.5%) of participants with problematic khat use had at least one of the mental health conditions or symptoms assessed in the study, compared to 16.4% who did not have problematic khat use.

The researchers say the findings highlight the need for greater awareness of the potential health harms associated with problematic khat use, alongside improved access to mental health and addiction services.

They also recommend further research into culturally appropriate approaches to supporting people experiencing both mental health conditions and problematic substance use, particularly in communities where khat use is more common than alcohol use.

The work was supported, in part, by funding from Wellcome.