Impact of problematic Khat use on mental health in Ethiopia's Somali Regional State: a population study

Tackling the global burden of mental health conditions and substance misuse is an international priority. In recent years, strategic work has begun to develop mental health services in Ethiopia and strengthen human rights protection for people with mental health conditions. To inform mental health service planning in the Somali region of Ethiopia, the extent of mental health conditions and substance misuse requires quantification.

We aimed to investigate associations between problematic khat use and mental health conditions in Ethiopia's Somali Regional State (SRS).

We carried out a quantitative household survey of 844 randomly selected residences in two cities in Ethiopia's SRS: the regional capital, Jigjiga (55.1%, n=465), and third largest city, Kabridahar (44.9%, n=379). We used the culturally validated Problematic Khat Use Screening Test and Mini International Neuropsychiatric Inventory to assess the prevalence and factors associated with mental health conditions and problematic khat use.

Out of 844 participants, 18.6% (n=156) met criteria for major depression, 11.1% (n=92) met criteria for post-traumatic stress disorder (PTSD) and 5.7% (n=48) expressed suicidal ideation. The combined prevalence of these mental health conditions was 21.8% (n=186). Men reported more aggregated mental health conditions than women (30.6%, n=97 vs 16.9%, n=89). Adjusted regression analyses showed that people with problematic khat use had more than twice the prevalence of major depression (prevalence ratio (PR) 2.5, 95% CI 1.7 to 3.5), recurrent depression (PR 2.8, CI 1.8 to 4.4), suicidal ideation (PR 2.4 CI 1.9 to 5.3), PTSD (PR 3.1, CI 1.9 to 5.3) and any mental health condition (PR 2.4, CI 1.7 to 3.4) compared with people without problematic khat use.

This study provides the first data regarding population mental health needs and harms associated with problematic khat use in the SRS, to inform the design, development and prioritisation of mental health services and substance regulation and policy.

Associations between problematic khat use and a range of poor mental health outcomes demonstrate the importance of targeted services for this population. Further research is needed to explore causal pathways underlying these associations.