The moral entrepreneurship of anti‐khat campaigners in Sweden – a critical discourse analysis

Is chewing khat associated with mental health disorders? A scoping review of the content and quality of the current evidence base

BACKGROUND

Khat (Catha edulis) is a plant commonly found in the horn of Africa whose leaves are chewed for their psycho-stimulant effects. Several studies have demonstrated the association between khat use and mental health problems. Nevertheless, evidence is mixed and inconsistent, warranting further review of available studies. This scoping review is aimed at investigating the content and quality of evidence base on the associations between khat use and mental health disorders and suggesting avenues for further research.

METHODS

We used a scoping review methodology to map the existing evidence using PubMed, SCOPUS, Embase, and CINAHL databases. Primary studies focusing on the association between any pattern of khat use and any form of mental health disorders are included. The review focused on all age groups, any study design, all geographical locations, and any publication year. The terms used for searching eligible studies include khat, mental disorders, and various alternative terminologies. Narrative review is employed to present findings.

RESULTS

7,121 articles were found, of which 108 were eligible, conducted across 12 different countries. The majority of the studies was done during the last ten years and the studies mostly employed cross-sectional design. About 10 different categories of mental health disorders have been identified as showing associations with khat use. Despite many contradictory findings between the studies, most of the evidence base suggests that khat use is associated with mental health disorders. Non-specific psychological distress is the most frequently mentioned mental health problem (reported in 26.9% of the studies). Khat use as a predictor variable is mostly assessed using a 'yes/no' category, and as a result, dose-dependent effects of khat use on mental health are not given much consideration.

CONCLUSION

Although most of the studies associate khat use with mental health disorders, the causal relationships are inconclusive given the cross-sectional design of the studies, and the presence of potential confounders and several forms of biases. Available studies also report contradictory findings. Further studies are recommended using prospective designs, standardized and valid measures of khat use, and focusing on specific types of mental health disorders.

Targeting Khat or Targeting Somalis? A Discourse Analysis of Project Evaluations on Khat Abuse among Somali Immigrants in Scandinavia

Background

In Denmark, Norway and Sweden, the use of the psychoactive plant khat is widely seen as a social and health problem exclusively affecting the Somali immigrant population. Several projects by governmental and municipal bodies and agencies have been initiated to reduce khat use and abuse within this target population.

Aim

This article analyses the khat abuse discourse as it is presented in evaluation reports describing projects initiated by the social services to reduce khat abuse.

Methods

Six publicly available and formally evaluated khat projects conducted in the Scandinavian countries were found, and these evaluation reports were subjected to a Foucauldian discourse analysis. The “What's the problem represented to be?” approach was used to generate questions, which were then applied to the material.

Results & CONCLUSIONS

The problem of khat abuse is represented to be that it is the cause of unemployment, lack of integration and relationship issues among Somali immigrants. The analysis shows that the notion of cultural competence is used instrumentally to govern the target population and that the Somali immigrant group is exclusively targeted. This instrumental use of cultural competence partly places the onus on the “Somali community” itself to reduce khat use, which may engender stigmatisation of Somali immigrants in general. The author maintains that an overreliance on cultural explanations overlooks socioeconomic issues and that the focus should be on potentially problematic patterns of khat use rather than Somali immigrants in general.