Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine Addis Ababa, Addis Ababa, Ethiopia,
Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia,
Eur Addict Res. 2019;25(4):161-172. doi: 10.1159/000499970. Epub 2019 Apr 16.
Problematic khat use, not khat use per se, is a public health and social concern for the public, researchers, and policy makers. However, the construct problematic khat use is not well-established and not fully recognized in the modern definition of substance use disorders including Diagnostic Statistic Manual (DSM-5) and international classification of diseases (ICD-10), although DSM-5 included it in the "stimulant use disorder" category. Existing scoping reviews have focused on khat use, which could not allow the differentiation of khat use from problematic khat use. Thus, the aim of this systematic review was to define and validate the construct problematic khat use.
This systematic review was reported following the PRISMA guidelines. We searched all English language studies without publication date restriction from 5 databases; PubMed, EMBASE, psychINFO, SocINDEX, and Google scholar. All studies that defined, explored, evaluated, or measured the construct problematic khat use were included. Adapted data extraction tool and criteria for quality evaluation were employed. We presented the results in tables and thematic synthesis of the major findings.
Overall, 30 qualitative and cross-sectional design studies were included. Associated harms with khat use, an increased amount used, increased frequency of use, and withdrawal experiences were indicators of problematic khat use. Using khat on an average of 3 or more times per week and using other psychoactive substances during and after khat use were frequently used to define problematic khat use. The most frequently reported withdrawal symptoms were depressed mood, irritability, fatigue, lack of motivation, increased sleep, and appetite. The existing measures (severity of dependence scale and DSM-5) of problematic khat use had psychometrically acceptable properties in terms of construct, criterion, and convergent validity, but they are poor in terms of other domains of validity including content, conceptual, and semantic validity.
Problematic khat use constitutes, but is not limited to, harms, increased use over time, and frequent engagement in other psychoactive substances misuse. Khat use is different from problematic khat use since it is occasional and used for prayer, social, and functional reasons. Strong empirical studies that could establish thresholds for patterns of problematic khat use and a culturally suitable problematic khat use measures that follows a bottom-up approach of scale development are warranted.
有问题的阿拉伯茶使用，而不是阿拉伯茶本身的使用，是公众、研究人员和政策制定者关注的公共卫生和社会问题。然而，在包括《精神障碍诊断与统计手册》（DSM-5）和《国际疾病分类》（ICD-10）在内的物质使用障碍的现代定义中，有问题的阿拉伯茶使用这一概念尚未得到很好的确立，也未得到充分认可，尽管 DSM-5 将其纳入了“兴奋剂使用障碍”类别。现有的范围综述侧重于阿拉伯茶的使用，这使得无法区分阿拉伯茶的使用和有问题的阿拉伯茶的使用。因此，本系统评价的目的是定义和验证有问题的阿拉伯茶使用这一概念。
本系统评价按照 PRISMA 指南进行报告。我们从 5 个数据库（PubMed、EMBASE、心理信息、社会索引和 Google Scholar）中搜索了所有没有出版日期限制的英文研究。纳入了定义、探索、评估或测量有问题的阿拉伯茶使用这一概念的所有研究。采用了经过修改的数据提取工具和质量评估标准。我们将结果以表格和主要发现的主题综合形式呈现。
总体而言，纳入了 30 项定性和横断面设计的研究。与阿拉伯茶使用相关的危害、使用量增加、使用频率增加和戒断体验是有问题的阿拉伯茶使用的指标。每周使用阿拉伯茶 3 次或以上，以及在使用阿拉伯茶期间和之后使用其他精神活性物质，常被用来定义有问题的阿拉伯茶使用。最常报告的戒断症状包括情绪低落、易怒、疲劳、缺乏动力、睡眠和食欲增加。现有的有问题的阿拉伯茶使用测量工具（依赖严重程度量表和 DSM-5）在构念、标准和收敛效度方面具有可接受的心理测量学特性，但在其他效度领域（内容、概念和语义效度）表现较差。
有问题的阿拉伯茶使用包括但不限于危害、随时间推移使用量增加和频繁使用其他精神活性物质滥用。阿拉伯茶的使用与有问题的阿拉伯茶使用不同，因为它是偶尔使用的，用于祈祷、社交和功能目的。有必要进行强有力的实证研究，以确定有问题的阿拉伯茶使用模式的阈值，并制定一种文化上适宜的、遵循自下而上的量表开发方法的有问题的阿拉伯茶使用测量工具。
