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<p>The association between khat use and psychosis has long been hypothesised; however, earlier studies were largely exploratory or cross-sectional in nature. This study aimed to examine the association between khat use and psychosis using a community-based longitudinal design in rural Ethiopia. An ambispective longitudinal study was conducted in the East Gurage zone, Central Ethiopia Regional State, using the Addis Ababa University Butajira Health and Demographic Surveillance System (HDSS) methodology for sampling and unique identification. We included adults aged 18&#xa0;years and older who were registered in the HDSS. A total of 923 participants were enrolled on the cohort. Problematic khat use was assessed using the Problematic Khat Use Screening Test (PKUST-17). Both syndromic and symptomatic psychosis were measured using the Operational Criteria Checklist for Psychotic and Affective Disorders. A multivariable Poisson regression model was fitted to examine the association between baseline khat use and incident psychosis at 12&#xa0;months after controlling for confounding variables, such as alcohol use, stressful life events, sleep problems, functional impairment, and other socioeconomic variables. At baseline, 903 participants had unique identification numbers, and 48 individuals (5.3%) were found to be experiencing ‘syndromic’ psychosis. At 12&#xa0;months, 151 participants (16.7%) were lost to follow up. The cumulative incidence of psychosis at 12&#xa0;months was 2.63% (3/114) among never khat users and 5.13% (8/156) among participants who reported khat use in the past five years. In the adjusted Poisson regression model, Khat use in the past five years was significantly associated with a higher risk of psychosis (adjusted IRR 3.82, 95% CI 1.10–13.21). Sleep problems were also significantly associated with psychosis (adjusted IRR 1.63, 95% CI 1.27–2.10). Khat use may increase the risk of psychosis. Disturbed sleep was also consistently associated with psychosis, suggesting the need to further investigate the potential pathway linking khat use, sleep disruption, and psychosis. Early psychosis screening among khat users is recommended. Larger prospective cohort studies are needed to generate more robust evidence on the association between khat use and psychosis.</p>

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The Association Between Khat Use and Psychosis: A Community-based Cohort Study in Ethiopia

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Awoke Mihretu,
  • Wubalem Fekadu,
  • Azeb Asaminew Alemu,
  • Tesfamariam Aklilu,
  • Solomon Teferra,
  • Kassahun Habtamu,
  • Abebaw Fekadu

摘要

The association between khat use and psychosis has long been hypothesised; however, earlier studies were largely exploratory or cross-sectional in nature. This study aimed to examine the association between khat use and psychosis using a community-based longitudinal design in rural Ethiopia. An ambispective longitudinal study was conducted in the East Gurage zone, Central Ethiopia Regional State, using the Addis Ababa University Butajira Health and Demographic Surveillance System (HDSS) methodology for sampling and unique identification. We included adults aged 18 years and older who were registered in the HDSS. A total of 923 participants were enrolled on the cohort. Problematic khat use was assessed using the Problematic Khat Use Screening Test (PKUST-17). Both syndromic and symptomatic psychosis were measured using the Operational Criteria Checklist for Psychotic and Affective Disorders. A multivariable Poisson regression model was fitted to examine the association between baseline khat use and incident psychosis at 12 months after controlling for confounding variables, such as alcohol use, stressful life events, sleep problems, functional impairment, and other socioeconomic variables. At baseline, 903 participants had unique identification numbers, and 48 individuals (5.3%) were found to be experiencing ‘syndromic’ psychosis. At 12 months, 151 participants (16.7%) were lost to follow up. The cumulative incidence of psychosis at 12 months was 2.63% (3/114) among never khat users and 5.13% (8/156) among participants who reported khat use in the past five years. In the adjusted Poisson regression model, Khat use in the past five years was significantly associated with a higher risk of psychosis (adjusted IRR 3.82, 95% CI 1.10–13.21). Sleep problems were also significantly associated with psychosis (adjusted IRR 1.63, 95% CI 1.27–2.10). Khat use may increase the risk of psychosis. Disturbed sleep was also consistently associated with psychosis, suggesting the need to further investigate the potential pathway linking khat use, sleep disruption, and psychosis. Early psychosis screening among khat users is recommended. Larger prospective cohort studies are needed to generate more robust evidence on the association between khat use and psychosis.