{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T17:45:48Z","timestamp":1790099148540,"version":"4.0.1"},"reference-count":81,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T00:00:00Z","timestamp":1658707200000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,7,5]]},"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Consumption of the drug khat is high across East Africa and the South-Western Arabian Peninsula despite evidence for its adverse psychiatric effects. This systematic review aims to explore cross-sectional research in the field to determine the strength of the association between khat use and psychiatric symptoms<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Six databases were searched in October 2021\u2014Ovid Medline, Embase, APA PsycINFO, CINAHL, Scopus and Proquest\u2014using the following search terms: \u201ckhat\u201d OR \u201cqat\u201d OR \u201cqaad\u201d OR \u201ccatha\u201d OR \u201cmiraa\u201d OR \u201cmairungi\u201d AND \u201cdepression\u201d OR \u201canxiety\u201d OR \u201cmania\u201d OR \u201cpsych*\u201d OR \u201cschiz*\u201d OR \u201cmental\u201d OR \u201challucinations\u201d OR \u201cdelusions\u201d OR \u201cbipolar\u201d. Eligible studies were cross-sectional studies of any population or setting comparing the prevalence of psychiatric symptoms in long term or dependent khat users with non-users. The quality of each study was appraised by the Newcastle-Ottawa scale. A meta-analysis was planned using a random effects model to produce an OR with 95% CIs\u2014using the Mantel-Haenszel method\u2014alongside an I\n                      <jats:sup>2<\/jats:sup>\n                      statistic to represent heterogeneity. The quality of this meta-analysis was appraised using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) scoring system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>35 studies were eligible for inclusion (total participants=31\u2009893), spanning 5 countries (Ethiopia, Somalia, Kenya, Saudi Arabia, UK). Meta-analysis suggests that khat use is associated with an 122% increased prevalence of psychiatric symptoms (OR 2.22, 95% CIs 1.76 to 2.79, p&lt;0.00001, GRADE score: \u2018very low\u2019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high heterogeneity of the meta-analysis is likely due to the wide variation between the studies within the evidence base. To perform a more accurate systematic review, further primary studies are needed with standardised measurements of variables, particularly khat consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42020224510.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061865","type":"journal-article","created":{"date-parts":[[2022,7,25]],"date-time":"2022-07-25T11:56:37Z","timestamp":1658750197000},"page":"e061865","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Exploring the association between khat use and psychiatric symptoms: a systematic review"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9553-7585","authenticated-orcid":false,"given":"Betsy","family":"Edwards","sequence":"first","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Atkins","sequence":"additional","affiliation":[{"name":"College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,7,25]]},"reference":[{"key":"2025121514052168000_12.7.e061865.1","unstructured":"European Monitoring Centre for Drugs and Drug Addiction . 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