A Cross-Sectional Study of Khat-Induced Psychotic Disorder Among Chronic Users in Hargeisa, Somaliland: An African Perspective

Khat (Catha edulis) chewing is a common cultural practice in parts of Africa. Chronic use is linked to adverse mental health outcomes, but evidence on khat-induced psychotic disorder (KIPD) from Somaliland is scarce. This study aimed to determine the prevalence of KIPD among chronic khat users in Hargeisa, Somaliland, and to identify associated socio-demographic and use-pattern factors. A community-based cross-sectional study was conducted. Adult chronic khat users were recruited via purposive and snowball sampling. Data were collected through structured interviews, including a socio-demographic questionnaire, the Composite International Diagnostic Interview psychosis module, and a khat use patterns questionnaire. Diagnosis of KIPD was made by trained clinicians according to ICD-10 criteria. Among 422 participants, the prevalence of khat-induced psychotic disorder was 18.7%. The disorder was significantly associated with longer daily chewing sessions and the concurrent use of other psychoactive substances. A substantial proportion of chronic khat users in this setting met criteria for a psychotic disorder induced by khat, indicating a considerable mental health burden associated with this practice. Public health initiatives should incorporate mental health screening and psychoeducation on KIPD risks for khat-using communities. Clinical services need improved capacity to diagnose and manage substance-induced psychoses. Further longitudinal research is required to establish causality and long-term outcomes. Khat, Catha edulis, psychotic disorder, substance-induced psychosis, Somaliland, Africa, cross-sectional study, prevalence This study provides original data on the prevalence and correlates of khat-induced psychotic disorder from an under-researched region, contributing an African perspective to the literature on substance-related mental health morbidity.