Metacognition Mediates the Association Between Drug Dependence and Sleep Disturbances: Cross-Sectional Findings among Khat-Chewing Polysubstance Users

Maladaptive metacognitive thoughts about sleep often precede incidences of sleep disturbances. While the relationship between sleep disturbances and khat dependence is known, no research has examined the function of metacognition as a potential mediator between khat dependency and sleep problems in polysubstance users. This study used a brief structured questionnaire to measure the sleep problems, the severity of khat dependence (SDS-khat), and a metacognition score on khat-chewing polysubstance users ( n = 374, age = 26.95 ± 3.80 years). The association was determined using Baron and Kenny’s mediation effect model. The average SDS-khat score was 6.66 ± 1.41, and the metacognition score was 26.40 ± 4.09. Severity of khat dependence showed significant negative correlation with metacognition ( b = − .53, standard error ( SE ) = .15, p < .001), and metacognition showed significant negative correlation with complaints of sleep disturbances, sleep deficit-related daytime problems, and sleep deficit-related socio-occupational disturbances ( b = − .17, SE = .03, p < .001), ( b = − .19, SE = .03, p < .001), ( b = − .12, SE = .05, p < .05) respectively. Polysubstance users with khat dependence and comorbid sleep disturbances were more likely to have poor metacognition.