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Ahmed SH, Zakai A, Zahid M, Jawad MY, Fu R, Chaiton M. Prevalence of post-traumatic stress disorder and depressive symptoms among civilians residing in armed conflict-affected regions: a systematic review and meta-analysis. Gen Psychiatr 2024; 37:e101438. [PMID: 38881616 PMCID: PMC11177673 DOI: 10.1136/gpsych-2023-101438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Background Globally, populations afflicted by armed conflict are known to have high rates of mental health disorders. Aims This meta-analysis aims to estimate the prevalence of post-traumatic stress disorder (PTSD) and depressive symptoms among civilians residing in armed conflict-affected regions. Methods This meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search employing MEDLINE(R), Embase Classic+Embase, APA PsycINFO, Ovid Healthstar, Journal@Ovid Full Text, Cochrane, PTSDpubs and CINAHL was conducted from inception until 19 March 2024 to identify relevant studies. Quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and a Comprehensive Meta-Analysis was used to conduct the statistical analysis. Results The search yielded 38 595 articles, of which 57 were considered eligible for inclusion. The included studies comprised data from 64 596 participants. We estimated a prevalence of 23.70% (95% CI 19.50% to 28.40%) for PTSD symptoms and 25.60% (95% CI 20.70% to 31.10%) for depressive features among war-afflicted civilians. The subgroup analysis based on time since the war and the country's economic status revealed the highest prevalence for both PTSD and depressive symptoms was present during the years of war and in low/middle-income countries. Conclusions The results of this study provide conclusive evidence of the detrimental impacts of armed conflict on mental health outcomes. Hence, it is crucial to emphasise the significance of both physical and mental health in the aftermath of war and take appropriate humanistic measures to overcome challenges in the management of psychiatric illnesses. PROSPERO registration number CRD42023416096.
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Affiliation(s)
| | - Aabia Zakai
- Dow University of Health Sciences, Karachi, Pakistan
| | - Maha Zahid
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Youshay Jawad
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Rui Fu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Chaiton
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Mental Health Policy Research, The Center of Addiction and Mental Health, Toronto, Ontario, Canada
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Ferrajão P, Frias F, Elklit A. Exploring Independent and Cumulative Effects of Adverse Childhood Experiences on PTSD and CPTSD a Study in Ugandan Adolescents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:517. [PMID: 38790512 PMCID: PMC11119836 DOI: 10.3390/children11050517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
Exposure to adverse childhood experiences (ACEs) is related to higher morbidity and mortality among adolescents. The present study analyzed the independent and cumulative effects of ACE exposure on the likelihood of PTSD and a CPSTD diagnosis in Ugandan adolescents. A sample of 401 schoolchildren participated in the study. The primary aim was to collect information on ACEs, PTSD, CPTSD, and attachment styles among adolescents living in different countries. It was found that exposure to 2-3 ACEs and exposure to 4-5 ACEs were significantly associated with PTSD diagnosis, while exposure to sexual abuse, bullying, threats of violence, and near-drowning were significantly related to CPTSD diagnosis. Fearful attachment style was significantly associated with PTSD diagnosis. The results propose that biological, psychological, and social issues interact and contribute to the differential prevalence of ACE, attachment styles, and PTSD/CPTSD. This study underscores the importance of addressing childhood-averse and traumatic experiences as a public health priority in Uganda.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências da Saúde, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, 1500-210 Lisbon, Portugal;
- CIDESD—Research Center in Sports Sciences, Health Sciences and Human Development, Universidade de Trás-os-Montes e Alto Douro, 5000-801 Vila Real, Portugal
| | - Francisco Frias
- Faculdade de Ciências da Saúde, Universidade Europeia, Quinta do Bom Nome, Estrada da Correia 53, 1500-210 Lisbon, Portugal;
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, 5230 Odense, Denmark;
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Niwenahisemo LC, Hong S, Kuang L. Assessing anxiety symptom severity in Rwandese adolescents: cross-gender measurement invariance of GAD-7. Front Psychiatry 2024; 15:1346267. [PMID: 38528981 PMCID: PMC10962260 DOI: 10.3389/fpsyt.2024.1346267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Background Anxiety disorders are among the most common mental health problems experienced by adolescents worldwide because of their evident significant impact on their quality of life and functioning. The generalized anxiety disorder item (GAD-7) was manufactured to identify the severity of self-reported anxiety symptoms. Efforts to address and screen for mental health problems in Rwanda have been limited, and the importance of screening for anxiety disorders is high. The primary aim of this study was to analyze the psychometric properties of the Kinyarwanda version of the Generalized Anxiety Disorder GAD-7, and then test the measurement invariance of the GAD-7 by gender. Methods We used the Rwandese version of GAD-7 among secondary school students in Kigali city (n=1813). Measurement invariance of the GAD-7 across gender and report on anxiety symptom severity prevalence. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to examine measurement invariance. Results Our findings demonstrated that in the sample of 1813 adolescents aged between 12 and 17 years, generalized anxiety symptoms prevalence rates were higher in females (46.4%) than males (n= 29.8%) GAD-7 demonstrated good reliability and validity coefficients with a Cronbach's α of .077 and KMO and Bartlett test of Sphericity = 0.835. In addition to these psychometric properties, the GAD-7 screening scale had equivalence for configural and metric invariance across groups with excellent fit indices, and we confirmed partial scalar invariance across groups. Conclusion The GAD-7 can be used in cross-group comparison of generalized anxiety disorder prevalence, and we acknowledge that full scalar invariance is generally difficult to confirm, especially due to gender differences. We recommend that future studies further investigate populations living in rural areas and conduct trials that will focus on anxiety-specific treatment in Rwandan Clinical health care centers to determine the diagnostic accuracy of this screening tool.
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Affiliation(s)
| | - Su Hong
- *Correspondence: Su Hong, ; Li Kuang,
| | - Li Kuang
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Nyikavaranda P, Pantelic M, Jones CJ, Paudyal P, Tunks A, Llewellyn CD. Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a "feminisms" systematic review. Int J Equity Health 2023; 22:196. [PMID: 37752502 PMCID: PMC10523615 DOI: 10.1186/s12939-023-01990-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Recent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe. METHODS The review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied. RESULTS Eight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access. CONCLUSIONS The design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive. REGISTRATION The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021235571.
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Affiliation(s)
- Patrick Nyikavaranda
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK.
| | - Marija Pantelic
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
| | - Christina J Jones
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, Surrey, UK
| | - Priyamvada Paudyal
- Institute for Global Health and Wellbeing School of Medicine, Keele University, Keele, Staffordshire, ST5 5GB, UK
| | - Alice Tunks
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
| | - Carrie D Llewellyn
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Watson Building, Room 104, Falmer, Brighton, East Sussex, BN1 9PH, UK
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Kagoyire MG, Kangabe J, Ingabire MC. "A calf cannot fail to pick a colour from its mother": intergenerational transmission of trauma and its effect on reconciliation among post-genocide Rwandan youth. BMC Psychol 2023; 11:104. [PMID: 37029441 PMCID: PMC10080878 DOI: 10.1186/s40359-023-01129-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND More than one million Rwandans were killed over a span of one hundred days during the 1994 genocide against the Tutsis. Many adult survivors were severely traumatized by the events, and young people, including those who were born after the genocide, have experienced similar genocide-related trauma. Building on a growing body of research on the generational transmission of trauma, our study addressed the following questions: (1) what are the possible mechanisms of trauma transmission from older generation to post-genocide Rwandan youth, and (2) what are the effects of intergenerational trauma on reconciliation processes in Rwanda. METHODS A qualitative study was conducted in Rwanda among youth born after the genocide, with parents who survived the 1994 genocide against the Tutsis and among mental health and peace-building professionals. Individual interviews (IDIs) included 19 post-genocide descendants of survivors and six focus group discussions (FGDs) were conducted with 36 genocide survivor parents residing in Rwanda's Eastern Province. Ten IDIs were also conducted with mental health and peace-building professionals in the capital city of Kigali. Respondents were recruited through five local organisations that work closely with survivors and their descendants. An inductive thematic analysis approach was used to analyse the data. RESULTS Findings from this study suggest that the trauma experienced by genocide survivor parents is perceived by Rwandan youth, mental health and peace-building professionals, and survivor parents themselves to be transmitted from parent to child through human biology mechanisms, social patterns of silence and disclosure of genocide experiences, and children's and youth's everyday contact with a traumatized parent. Genocide-related trauma among survivor parents is seen as often being triggered by both life at home and the annual genocide commemoration events. Additionally, when transmitted to genocide survivor descendants, such trauma is understood to negatively affect their psychological and social well-being. Intergenerational trauma among youth with genocide survivor parents limits their involvement in post-genocide reconciliation processes. Findings specifically show that some youth avoid reconciliation with a perpetrator's family due to mistrust as well as fear of re-traumatizing their own parents.
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Affiliation(s)
- Marie Grace Kagoyire
- University of Stellenbosch, the Centre for the study of the afterlife of violence, and the reparative Quest (AVReQ), Stellenbosch, South Africa.
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Jansen S, Niyonsenga J, Ingabire CM, Jansen A, Nzabonimpa E, Ingabire N, Kangabe J, Sarabwe E, Richters A, Rutayisire T, Nsabimana E. Evaluating the impact of Community-Based Sociotherapy on social dignity in post-genocide Rwanda: study protocol for a cluster randomized controlled trial. Trials 2022; 23:1035. [PMID: 36539840 PMCID: PMC9768903 DOI: 10.1186/s13063-022-06994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Community-Based Sociotherapy (CBS) is an approach that was introduced in Rwanda in 2005, with the aim of improving psychosocial well-being among its participants and facilitating reconciliation processes. Over the years, CBS has been adapted contextually and the effectiveness of the approach has been measured in different ways, using qualitative and quantitative study designs. This study specifically assesses the effectiveness of CBS in terms of fostering the social dignity of participants as the primary outcome. METHODS/DESIGN A cluster randomized controlled trial design with person-level outcomes whereas the CBS treatment is delivered at the cluster level. A total of 1200 eligible participants will be randomly assigned to two groups in a 1:1 ratio. Participants in the intervention group will receive the CBS intervention, while the control group will be waitlisted. The primary outcome measure is a self-designed and psychometrically validated Social Dignity Scale. The secondary outcome measures will be the WHO (Five) Well-Being Index (WHO-5), the Multidimensional Scale of Perceived Social Support (MSPSS), the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5), the Self-reporting Questionnaire (SRQ-20), and the perceived parental self-efficacy scale. The primary analysis will be performed following an intention to treat analysis, using generalized estimating equation modeling. DISCUSSION We expect this cluster randomized controlled trial to provide insight into the effectiveness of CBS on social dignity and secondary psychosocial outcomes among its group participants, who have different socio-historical backgrounds including genocide survivors, perpetrators, bystanders and their descendants, people in conflicts (family/community), and local leaders. This study will inform CBS implementers, policymakers, practitioners, and other stakeholders on the role of social dignity in interventions that focus on psychosocial healing. TRIAL REGISTRATION ISRCTN ISRCTN11199072. It was registered on 2 April 2022.
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Affiliation(s)
- Stefan Jansen
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Japhet Niyonsenga
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | - Epaphrodite Nsabimana
- grid.10818.300000 0004 0620 2260Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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7
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Ferrajão P, Frias F, Ramos J, Elklit A. A latent class analysis of adverse childhood life events in Ugandan adolescents. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Francisco Frias
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Joana Ramos
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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8
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Kayiteshonga Y, Sezibera V, Mugabo L, Iyamuremye JD. Prevalence of mental disorders, associated co-morbidities, health care knowledge and service utilization in Rwanda - towards a blueprint for promoting mental health care services in low- and middle-income countries? BMC Public Health 2022; 22:1858. [PMID: 36199102 PMCID: PMC9533613 DOI: 10.1186/s12889-022-14165-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda. Methods This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14–65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007–2008 Genocide Survivors Census. Results Of 19,110 general survey participants, most were female (n = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) (p < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% (n = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services. Conclusions Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14165-x.
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Affiliation(s)
| | - Vincent Sezibera
- Department of Clinical Psychology, Center for Mental Health, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Lambert Mugabo
- Center for Mental Health, University of Rwanda, Kigali, Rwanda
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Seidi PA, Abas NQ, Jaff D, Dunstan R, Soltan L, Brumwell A, Wilson M, Nicholson T, Palmquist AEL. Assessment of Perinatal Depression Risk among internally displaced Yazidi Women in Iraq: a descriptive cross-sectional study. BMC Pregnancy Childbirth 2022; 22:359. [PMID: 35468737 PMCID: PMC9040272 DOI: 10.1186/s12884-022-04658-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 03/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background Yazidi survivors of a 2014 genocidal attack by the self-proclaimed Islamic State of Iraq and Syria (ISIS) have complex medical and mental health needs in the perinatal and postpartum period. Few studies have assessed perinatal mental health needs for this population of women who are living in camps for Internally Displaced Persons (IDP) in the Kurdistan Region of Iraq (KRI). Methods The specific aim of this formative cross-sectional study was to assess the prevalence of perinatal depressive symptoms, specifically the risk of perinatal depression symptoms, among a purposive sample of Yazidi women living in camps for internally displaced persons in the Kurdistan region of Iraq. One hundred twenty-two pregnant and recently postpartum (<1 year) Yazidi women completed a Kurdish-language version of the Edinburgh Postnatal Depression Scale (EPDS) questionnaire. Pregnant and postpartum participants’ responses were analyzed together, in order to assess an overall combined risk of perinatal mental health issues for the study population. Logistic regression analyses were used to measure the association of participant characteristics with an elevated risk of perinatal depressive symptoms. Results Participants were 17-45 years of age (mean 32 years, SD 7.63) Among the 122 women, 67.2% (n=82) were pregnant and 32.8% (n=40) were <1 year postpartum. Overall, 78% (n=95) of participants were at an elevated risk of depression (EPDS >10), and 53% (n=65) of all participants were at risk of moderate to severe depression (EPDS >12). Thoughts of self-harm (EPDS item 10) were reported among 97% (n=118) of participants. Logistic regression analysis indicated that increased risk of perinatal depressive symptoms was significantly associated with reports of health problems during pregnancy (OR=3.22, 95% [CI]:1.08-9.61) and marital status (OR=16.00; 95% [CI]: 0.42-0.50). Age (OR= 0.84; 95% [CI]: 0.75–0.94) and level of education (OR=0.15; 95% [CI]: 0.42-0.50) had protective effects. Conclusions Rates of perinatal depressive symptoms risk among internally displaced Yazid pregnant and postpartum women are higher than the general Kurdish-speaking population in Iraq (28.4%). Culturally responsive trauma informed perinatal and postpartum care services, which include both community-based and clinical strategies for perinatal depressive symptoms and suicide prevention for this population, are critically needed.
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Affiliation(s)
- Pegah Am Seidi
- Research Center, University of Garmian, Kurdistan, Iraq. .,Research Center, University of Garmian Kalar, Kurdistand, Sulaimania, Iraq.
| | | | - Dilshad Jaff
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Raven Dunstan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lein Soltan
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Aunchalee E L Palmquist
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bahati C, Rukundo G, Nyirahabimana N, Izabayo J, Niyonsenga J, Sezibera V. The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey. Psychiatry Res 2022; 310:114465. [PMID: 35219265 DOI: 10.1016/j.psychres.2022.114465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Abstract
Despite mounting evidence indicating an increased risk of long-term mental disorders in Rwanda's general population, little is still known about the national prevalence of mental disorders among victims of intimate partner violence (IPV) in a post-conflict setting. The aim of this study was to compare the prevalence of mental disorders among IPV exposed and non-exposed individuals in Rwanda. This was a cross-sectional study based on secondary data from the 2018 Rwanda Mental Health Survey. The sample consisted 20,381 participants selected nationwide, from 7,124 households (age range: 14-65 years), of which 3,759 Rwandans were exposed to IPV (18.4%) and 16,622 were non-exposed to IPV (81.6%). Participants were screened for IPV exposure and common mental disorders, and data was analyzed using the SPSS version 25 software. The results showed that the rate of any mental disorder was substantially higher in the group exposed to IPV than the non-exposed, at 32.4% and 11.7% respectively. These results highlight that among Rwandans diagnosed with severe mental disorders, participants with a history of IPV exposure present with increased odds of mental disorders prevalence and severity. Therefore, people seeking mental health care should also be screened for their IPV exposure and offered appropriate interventions.
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Affiliation(s)
- Claire Bahati
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda.
| | - Gilbert Rukundo
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Swiss Tropical and Public Health Institute
| | | | - Josias Izabayo
- Centre for Mental Health, College of Medicine and Health Sciences
| | - Japhet Niyonsenga
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Mental Health & Behaviour Research Group, College of Medicine and Health Sciences, University of Rwanda
| | - Vincent Sezibera
- Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda; Centre for Mental Health, College of Medicine and Health Sciences
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González-Castro JL, Ubillos-Landa S, Puente-Martínez A, Gracia-Leiva M, Arias-Rodriguez GM, Páez-Rovira D. Posttraumatic Stress Symptoms Among Polyvictimized Women in the Colombian Armed Conflict: The Mediating Role of Social Acknowledgment. Front Psychol 2021; 12:741917. [PMID: 34675848 PMCID: PMC8525420 DOI: 10.3389/fpsyg.2021.741917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022] Open
Abstract
For decades, in a situation of armed conflict in Colombia, women have suffered polyvictimization and discrimination with severe consequences that last even during the post-war peace process. This study analyzes the impact on posttraumatic stress and recovery of war-related violence against women, discrimination, and social acknowledgment. A cross-sectional study was conducted in 2019–2020. Participants were 148 women with a mean age of 47.66years (range 18–83), contacted through the NGO Ruta Pacifica de las Mujeres who had experienced significant personal violence. Results show that levels of perceived discrimination and lack of social acknowledgment are mediators in the relationship between polyvictimization and posttraumatic stress symptoms. Recognition by significant others, disapproval by family and the larger social milieu affects different posttraumatic stress disorder (PTSD) dimensions and therefore how these women adapt to the effects of trauma. Findings provide strong evidence that the way society and family treats women after a traumatic event affects how the victim recovers from this event. Recognition as a victim and disapproval can coexist and be a burden for women if not adequately addressed. Results stress the importance of understanding and intervening in PTSD recovery through the analysis of social processes, and not only through and individual focus.
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Affiliation(s)
| | | | | | | | | | - Darío Páez-Rovira
- Social Psychology Department, University of the Basque Country, Gipuzkoa, Spain
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12
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Hoppen TH, Priebe S, Vetter I, Morina N. Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:bmjgh-2021-006303. [PMID: 34321235 PMCID: PMC8319986 DOI: 10.1136/bmjgh-2021-006303] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/20/2021] [Indexed: 11/06/2022] Open
Abstract
Objective Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989–2019) affected by PTSD and/or MD. Methods We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989–2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs. Results Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively. Conclusions Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.
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Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, University of Münster, Münster, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Inja Vetter
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Platt JM, Pozen J, Ntaganira J, Sezibera V, Neugebauer R. Gender Differences in Traumatic Experiences and Posttraumatic Stress Symptoms After the Rwandan Genocide Against the Tutsi. J Trauma Stress 2021; 34:799-807. [PMID: 34118164 PMCID: PMC9059246 DOI: 10.1002/jts.22693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
The effects of the 1994 Rwandan Genocide against the Tutsi are widespread and long-lasting, but little is known about how posttraumatic consequences differ regarding gender. In the present study, we estimated the associations between trauma exposure and posttraumatic stress symptoms (PTSS) in a Rwandan community sample and examined whether the associations differed by gender. The sample comprised 498 adults (75.2% women) living in Rwanda's Huye District in 2011. We used a validated self-report checklist to assess the eight most frequent traumatic experiences during the Genocide. The PTSD Checklist-Civilian version (PCL-C) was used to assess PTSS. Associations between trauma exposure and PTSS were estimated using structural equation modeling (SEM), with additional SEMs stratified by gender. The prevalence of exposure to each traumatic event ranged from 15.1% to 64.5%, with more severe PTSS among individuals who reported personal physical injury, β = .76, 95% CI [0.54, 0.98]; witnessing sexual/physical violence against a loved one, β = .51, 95% CI [0.20, 0.81]; a close relative/friend's death, β = .54, 95% CI [0.24, 0.83]; property destruction, β = .35, 95% CI [0.048, 0.51]; or a family member's death due to illness, β = .21, 95% CI [0.00, 0.41]. Men who saw people killed and women who witnessed sexual/physical violence against a close family member reported elevated PTSS. The psychiatric impact of the Rwandan Genocide continues into the 21st century. Increased attention should be paid to the long-term and demographic patterns of distress and disorder, especially in the absence of widespread clinical mental health services.
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Affiliation(s)
- Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA
| | - Joanna Pozen
- New York University College of Global Public Health, New York, New York, USA
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Rwanda School of Public Health, Kigali, Rwanda
| | - Vincent Sezibera
- Department of Clinical Psychology, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Richard Neugebauer
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA,Division of Epidemiology, Department of Child & Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA,Departement of Psychiatry, Faculty of Medicine, Columbia University
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14
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Obaje HI, Okengwu GC, Kenan JJ, Uwimana A, Ndayambaje A, Carey TA, Wong R. Assessing the knowledge, perceptions, and mental health impact of COVID-19 among students in Rwanda. JOURNAL OF PUBLIC MENTAL HEALTH 2021. [DOI: 10.1108/jpmh-10-2020-0125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose
This paper aims to assess the knowledge, perceptions and mental health impact of COVID-19 among students in Rwanda.
Design/methodology/approach
This paper is a cross-sectional online survey questionnaire.
Findings
The mean knowledge score among the 375 respondents was 75.14% (SD ± 19.1), with 195 (55.1%) of the respondents scoring below 80%. Students who believed that COVID-19 education was sufficient were more likely to have lower knowledge levels (OR = 1.84, 95% CI = 1.15; 2.94). While most respondents were aware of their vulnerability to the virus, they did not see themselves at risk of becoming infected. The percentage of respondents reported to have some form of mental health issues was 49.7%. The three most important factors in influencing mental health were age, history of mental health issues, and the way news was reported. Education quality was less affected for those who received online schooling (OR = 0.55, 95% CI = 0.33, 0.94).
Practical implications
Education about COVID-19 should be strengthened by capitalizing on existing online and offline learning platforms to frequently update new or changing information.
Originality/value
This paper was the first study assessing the knowledge, perception and mental health impact of COVID-19 among Rwanda students.
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Denkinger JK, Rometsch C, Engelhardt M, Windthorst P, Graf J, Pham P, Gibbons N, Zipfel S, Junne F. Longitudinal Changes in Posttraumatic Stress Disorder After Resettlement Among Yazidi Female Refugees Exposed to Violence. JAMA Netw Open 2021; 4:e2111120. [PMID: 34047793 PMCID: PMC8164098 DOI: 10.1001/jamanetworkopen.2021.11120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Posttraumatic stress disorder (PTSD) is highly prevalent among refugees surviving mass atrocities, especially among women. Longitudinal studies investigating factors associated with PTSD course are essential to enable adequate treatment yet widely lacking. OBJECTIVE To identify longitudinal changes in PTSD severity and posttraumatic coping among severely traumatized female refugees as well as risk and protective factors for PTSD course. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study took place in 14 German cities in the context of a humanitarian admission program that resettled 1000 especially vulnerable women and children from northern Iraq to Germany. Approximately 400 adult beneficiaries of the humanitarian admission program were eligible for the study. At baseline, a total of 116 of the 400 beneficiaries (29.0%) participated, with 96 (82.8%) of these women participating in the follow-up assessment. The study included a baseline assessment conducted 2 years after resettlement (September 1, 2017, to January 12, 2018) and a 1-year follow-up (August 29, 2018, to January 15, 2019). EXPOSURES Violence and/or captivity during the 2014 genocide in northern Iraq by the so-called Islamic State. MAIN OUTCOMES AND MEASURES Posttraumatic stress disorder severity and coping strategies were assessed in interpreter-aided interviews using the Impact of Event Scale-Revised. RESULTS A total of 116 women (mean [SD] age, 32.2 [8.2] years; 115 [99.1%] Yazidi; 1 [0.9%] Christian) participated at baseline. According to the Impact of Event Scale-Revised, a high PTSD severity was found (mean [SD] raw sum score, 60.88 [15.75] of 88, with higher scores indicating greater distress), with no significant change over time. Helpful coping strategies included prayer, belief in collective strength, and belief in personal strength. Earlier symptoms of intrusions (β = 0.389, P = .007) and longer captivity (β = 0.218, P = .02) were identified as being associated with PTSD severity 1 year later. Longer captivity was associated with PTSD aggravation over time (β = 0.227, P = .04). Posttraumatic strengthening in faith (β = -0.206, P = .05) and in social relationships (β = -0.221, P = .03) were associated with a reduction in PTSD symptoms. CONCLUSIONS AND RELEVANCE These findings suggest that female refugee survivors of genocide are at high risk for severe and chronic PTSD beyond the initial years of resettlement. The findings provide suggestions for mental health care specialized for particularly vulnerable populations.
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Affiliation(s)
- Jana Katharina Denkinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Caroline Rometsch
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martha Engelhardt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Alice Salomon University Berlin, University of Applied Science, Berlin, Germany
| | - Petra Windthorst
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Hospital Havelhöhe, Berlin, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Phuong Pham
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Niamh Gibbons
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Magdeburg, Otto von Guericke University, Magdeburg, Germany
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Bendavid E, Boerma T, Akseer N, Langer A, Malembaka EB, Okiro EA, Wise PH, Heft-Neal S, Black RE, Bhutta ZA. The effects of armed conflict on the health of women and children. Lancet 2021; 397:522-532. [PMID: 33503456 PMCID: PMC7612212 DOI: 10.1016/s0140-6736(21)00131-8] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/16/2023]
Abstract
Women and children bear substantial morbidity and mortality as a result of armed conflicts. This Series paper focuses on the direct (due to violence) and indirect health effects of armed conflict on women and children (including adolescents) worldwide. We estimate that nearly 36 million children and 16 million women were displaced in 2017, on the basis of international databases of refugees and internally displaced populations. From geospatial analyses we estimate that the number of non-displaced women and children living dangerously close to armed conflict (within 50 km) increased from 185 million women and 250 million children in 2000, to 265 million women and 368 million children in 2017. Women's and children's mortality risk from non-violent causes increases substantially in response to nearby conflict, with more intense and more chronic conflicts leading to greater mortality increases. More than 10 million deaths in children younger than 5 years can be attributed to conflict between 1995 and 2015 globally. Women of reproductive ages living near high intensity conflicts have three times higher mortality than do women in peaceful settings. Current research provides fragmentary evidence about how armed conflict indirectly affects the survival chances of women and children through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health, but major systematic evidence is sparse, hampering the design and implementation of essential interventions for mitigating the harms of armed conflicts.
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Affiliation(s)
- Eran Bendavid
- Center for Population Health Sciences, Division of Primary Care and Population Health, Department of Medicine, Stanford University, CA, USA.
| | - Ties Boerma
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ana Langer
- Women and Health Initiative, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique, Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR Congo
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Paul H Wise
- Department of Pediatrics, Stanford University, CA, USA
| | - Sam Heft-Neal
- Center on Food Security and the Environment, Stanford University, CA, USA
| | - Robert E Black
- The Institute for International Programs, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children (SickKids), Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan
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17
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Ishimwe AB, Kaufman J, Uwamahoro D, Wall JT, Herth K, Chang E, Ngirabega JDD, Leonard W. Cross-cultural adaptation and psychometric properties of the Herth Hope Index in Kinyarwanda: adapting a positive psychosocial tool for healthcare recipients and providers in the Rwandan setting. Health Qual Life Outcomes 2020; 18:286. [PMID: 32831084 PMCID: PMC7444040 DOI: 10.1186/s12955-020-01537-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/11/2020] [Indexed: 11/23/2022] Open
Abstract
Background The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. Methods A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n = 43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n = 206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach’s alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. Results The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (α = 0.85) and test-retest reliability (r = 0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square = 1.53; root mean square error of approximation = 0.05; standardized root mean square residual = 0.05; comparative fit index = 0.96; Tucker-Lewis Index = 0.95). Conclusion This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.
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Affiliation(s)
| | - Julia Kaufman
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
| | | | - Jonathan Taylor Wall
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA
| | - Kaye Herth
- Minnesota State University, Mankato, 228 Wiecking Center, Mankato, MN, 56001, USA
| | - Emery Chang
- UCLA Health, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Jean de Dieu Ngirabega
- East African Health Research Commission, Quartier Kigobe, Avenue des Etats Unis, no. 71, B.P, 350, Bujumbura, Burundi
| | - Wendy Leonard
- TIP Global Health, PO Box 1285, KN 4 St, Kigali, Rwanda
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18
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Dedeken P, Nickenig Vissoci JR, Sebera F, Boon PAJM, Rutembesa E, Teuwen DE. Validity, Reliability, and Diagnostic Cut-off of the Kinyarwandan Version of the Hamilton Depression Rating Scale in Rwanda. Front Psychol 2020; 11:1343. [PMID: 32719632 PMCID: PMC7350898 DOI: 10.3389/fpsyg.2020.01343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/20/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods: The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden’s index was used for determining diagnostic cut-off. Results: The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32–0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion: The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap.
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Affiliation(s)
- Peter Dedeken
- Department of Neurology, Heilig Hart Hospital, Lier, Belgium.,Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium.,Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Fidele Sebera
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.,Department of Neurology, Neuropsychiatric Hospital, CARAES Ndera, Kigali, Rwanda.,Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Paul A J M Boon
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Eugene Rutembesa
- Department of Neurology and Psychiatry, University of Rwanda, Kigali, Rwanda
| | - Dirk E Teuwen
- Corporate Societal Responsibility, UCB Pharma, Brussels, Belgium
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19
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Uwayezu MG, Nikuze B, Fitch MI. A focus on cancer care and the nursing role in Rwanda. Can Oncol Nurs J 2020; 30:223-226. [PMID: 33118964 PMCID: PMC7583575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- Marie Goretti Uwayezu
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Bellancille Nikuze
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
| | - Margaret I Fitch
- School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda; Bloomberg Faculty of Nursing, University of Toronto, Toronto; Honorary Lecturer, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda
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20
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Ng LC, Stevenson A, Kalapurakkel SS, Hanlon C, Seedat S, Harerimana B, Chiliza B, Koenen KC. National and regional prevalence of posttraumatic stress disorder in sub-Saharan Africa: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003090. [PMID: 32413027 PMCID: PMC7228043 DOI: 10.1371/journal.pmed.1003090] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 04/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND People living in sub-Saharan Africa (SSA) are disproportionately exposed to trauma and may be at increased risk for posttraumatic stress disorder (PTSD). However, a dearth of population-level representative data from SSA is a barrier to assessing PTSD. This manuscript sought to calculate pooled PTSD prevalence estimates from nationally and regionally representative surveys in SSA. METHODS AND FINDINGS The search was conducted in PubMed, Embase, PsycINFO, and PTSDpubs and was last run between October 18, 2019, and November 11, 2019. We included studies that were published in peer-reviewed journals; used probabilistic sampling methods and systematic PTSD assessments; and included ≥ 450 participants who were current residents of an SSA country, at least 50% of whom were aged between 15 and 65 years. The primary outcomes were point prevalence estimates of PTSD across all studies, and then within subgroups. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42016029441). Out of 2,825 unique articles reviewed, 25 studies including a total of 58,887 eligible participants (54% female) in 10 out of the 48 countries in SSA were identified. Most studies enrolled any adult aged 18 years or older. However, some studies only enrolled specific age brackets or persons as young as 15 years old. Six studies were national surveys, and 19 were regional. There were 4 key findings in the meta-analysis: (1) the overall pooled prevalence of probable PTSD was 22% (95% CI 13%-32%), while the current prevalence-defined as 1 week to 1 month-was 25% (95% CI 16%-36%); (2) prevalence estimates were highly variable, ranging from 0% (95% CI 0%-0%) to 74% (95% CI 72%-76%); (3) conflict-unexposed regions had a pooled prevalence of probable PTSD of 8% (95% CI 3%-15%), while conflict-exposed regions had a pooled prevalence of probable PTSD of 30% (95% CI 21%-40%; p < 0.001); and (4) there was no significant difference in the pooled prevalence of PTSD for men and women. The primary limitations of our methodology are our exclusion of the following study types: those published in languages other than English, French, and Portuguese; smaller studies; those that focused on key populations; those that reported only on continuous measures of PTSD symptoms; and unpublished or non-peer-reviewed studies. CONCLUSIONS In this study, PTSD symptoms consistent with a probable diagnosis were found to be common in SSA, especially in regions exposed to armed conflict. However, these studies only represent data from 10 of the 48 SSA countries, and only 6 studies provided national-level data. Given the enormous heterogeneity expected across the continent, and also within countries and regions, this review cannot speak to rates of PTSD in any regions not included in this review. Thus, substantial gaps in our knowledge of PTSD prevalence in SSA remain. More research on population-level prevalence is needed to determine the burden of trauma symptoms and PTSD in SSA and to identify acceptable and feasible approaches to address this burden given limited mental healthcare resources.
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Affiliation(s)
- Lauren C. Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
| | - Anne Stevenson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Sreeja S. Kalapurakkel
- Duke University Global Health Institute, Durham, North Carolina, United States of America
- Centre for Global Mental Health, Health Service and Population Research, Department Institute of Psychiatry, Psychology and Neuroscience King’s College, London, United Kingdom
| | - Charlotte Hanlon
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Boniface Harerimana
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bonginkosi Chiliza
- Department of Psychiatry, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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Rugema L, Persson M, Mogren I, Ntaganira J, Krantz G. A qualitative study of healthcare professionals' perceptions of men and women's mental healthcare seeking in Rwanda. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:891-903. [PMID: 31944336 DOI: 10.1002/jcop.22308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
This study aimed to explore health care professionals (HCP') perceptions about mental-health-seeking behaviours in men and women and its social and gender implications in Rwanda. Six focus group discussions including 43 HCPs working at mental health facilities and district hospitals in Rwanda were conducted. Data were analysed using qualitative content analysis. The emerging theme "Traditional gender role patterns and stigma are displayed in mental health care seeking, adherence to treatment and family effects" illustrated how HCPs perceived gender differences and outcomes in mental healthcare seeking. The theme was based on three categories: "Gender differences in health care seeking patterns," "Gender roles and stigma affect adherence to counselling and treatment," and "Gender roles exert an influence on family support" and related subcategories, with which each described various aspects contributing to the result. According to HCPs who regularly encountered people with mental health problems, neither men nor women with mental health problems could adequately benefit from the available mental health services because of the strong influence stigma and prevailing traditional gender roles had on men's and women's mental-healthcare-seeking behaviour. There is an urgent need for comprehensive societal interventions involving policy makers, HCPs, and the general population to diminish the stigma tied to mental illness and the traditional gender norms that negatively influence healthcare-seeking patterns; such actions can improve the health of many citizens.
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Affiliation(s)
- Lawrence Rugema
- Department of Community Health, School of Public health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
| | - Joseph Ntaganira
- Department of Community Health, School of Public health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Gunilla Krantz
- Department of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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22
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Muwonge J, Umubyeyi A, Rugema L, Krantz G. Suicidal behaviour and clinical correlates in young adults in Rwanda: a population-based, cross-sectional study. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Barnes-Ceeney K, Gideon L, Leitch L, Yasuhara K. Recovery After Genocide: Understanding the Dimensions of Recovery Capital Among Incarcerated Genocide Perpetrators in Rwanda. Front Psychol 2019; 10:637. [PMID: 31040801 PMCID: PMC6476899 DOI: 10.3389/fpsyg.2019.00637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Utilizing survey data from 302 men and women incarcerated in the Rwandan correctional system for the crime of genocide, and structured interviews with 75 prisoners, this mixed methods study draws on the concept of recovery capital to understand how individuals convicted of genocide navigate post-genocide healing. Genocide smashes physical and human capital and perverts social and cultural capital. Experiencing high levels of posttraumatic stress symptoms with more than two-thirds of the sample scoring above typical civilian cut-off levels, raised levels of depression, and high levels of anxiety, and failing physical health, the genocide perpetrators require multiple sources of recovery capital to foster internal resilience as they look forward to rebuilding their own lives.
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Affiliation(s)
- Kevin Barnes-Ceeney
- Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States
| | - Lior Gideon
- John Jay College of Criminal Justice, New York, NY, United States
| | - Laurie Leitch
- Threshold GlobalWorks, LLC, New York, NY, United States
| | - Kento Yasuhara
- Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States
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Hoppen TH, Morina N. The prevalence of PTSD and major depression in the global population of adult war survivors: a meta-analytically informed estimate in absolute numbers. Eur J Psychotraumatol 2019; 10:1578637. [PMID: 30834069 PMCID: PMC6394282 DOI: 10.1080/20008198.2019.1578637] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background: Elevated prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) have been reported in populations exposed to war. However, no global estimates of war survivors suffering from PTSD and/or MD in absolute numbers have been reported. Objective: We made the first attempt to estimate in absolute numbers how many adult war survivors globally may suffer PTSD and/or MD, which should inform local and global mental health programmes. Method: Drawing on the Uppsala Conflict Database, we reviewed all countries that suffered at least one war within their own territory between 1989 and 2015 (time span chosen on availability of geo-referenced data and population estimates). We then conducted a meta-analysis of current randomized epidemiological surveys on prevalence of PTSD and/or MD among war survivors. Finally, we extrapolated our results from the meta-analysis on the global population of adult war survivors by means of using general population data from the United Nations. Results: We estimate that about 1.45 billion individuals worldwide have experienced war between 1989 and 2015 and were still alive in 2015, including one billion adults. On the basis of our meta-analysis, we estimate that about 354 million adult war survivors suffer from PTSD and/or MD. Of these, about 117 million suffer from comorbid PTSD and MD. Conclusions: Based on the slim available evidence base, the global number of adult war survivors suffering PTSD and/or MD is vast. Most war survivors live in low-to-middle income countries with limited means to handle the enormous mental health burden. Since representative high quality data is lacking from most of these countries, our results contain a large margin of uncertainty and should be interpreted with caution.
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Affiliation(s)
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Morina N, Stam K, Pollet TV, Priebe S. Prevalence of depression and posttraumatic stress disorder in adult civilian survivors of war who stay in war-afflicted regions. A systematic review and meta-analysis of epidemiological studies. J Affect Disord 2018; 239:328-338. [PMID: 30031252 DOI: 10.1016/j.jad.2018.07.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/21/2018] [Accepted: 07/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Epidemiological surveys on depression and posttraumatic stress disorder (PTSD) among civilian war survivors in war-afflicted regions have produced heterogeneous prevalence estimates of these conditions. METHODS To determine the prevalence of both depression and PTSD in civilian war survivors in the area of conflict, we conducted a systematic search of Medline, PsycInfo, and Pilots databases. We included epidemiological studies that had used structured clinical interviews. We conducted random effects meta-analyses on prevalence proportions as well as univariate mixed model meta-regressions. RESULTS We included 33 studies that assessed prevalences of depression (k = 18) and/or PTSD (k = 30). Across all studies, pooled point prevalences of 0.27 and 0.26 were found for depression and PTSD, respectively. Ten percent of participants fulfilled criteria for both disorders. Surveys with a higher mean age of participants reported higher prevalence of depression. Furthermore, samples with higher rates of unemployment and higher percentages of women reported higher prevalence of PTSD, whereas samples with a higher number of participants living with a partner reported lower prevalence of PTSD. LIMITATIONS The findings are limited by poor psychometric reporting practices. CONCLUSIONS Our findings suggest that both depression and PTSD are highly prevalent in war survivors who stayed in the area of conflict. Yet, future research on this topic need to focus on psychometric properties of instruments used to assess psychopathology among war survivors. Notwithstanding this limitation, there is an urgent need for large-scale mental health programs that are appropriate for war-affected countries with limited resources and address depression as much as PTSD.
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Affiliation(s)
- Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany; Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Kimberly Stam
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas V Pollet
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK
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26
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Ibrahim H, Ertl V, Catani C, Ismail AA, Neuner F. Trauma and perceived social rejection among Yazidi women and girls who survived enslavement and genocide. BMC Med 2018; 16:154. [PMID: 30208905 PMCID: PMC6136186 DOI: 10.1186/s12916-018-1140-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In August 2014, the Islamic State of Iraq and Syria (ISIS), a terrorist organization, attacked the Yazidi's ancestral homeland in northwestern Iraq. Among other atrocities, they abducted thousands of women and girls and traded many of them into sexual slavery. The aim of this study is to determine the mental health of women and girl survivors of these events in relation to enslavement and experiences with genocide-related events, as well as perceived social rejection in their community. METHODS Between February and July 2017, trained local assessors interviewed a sample of 416 Yazidi women and girls (65 of whom had survived sexual enslavement), aged between 17 and 75 years, and living in internally displaced person camps in the Kurdistan Region of Iraq. Post-traumatic stress disorder (PTSD) and depression symptoms were assessed using validated Kurdish versions of standard instruments. Scales for trauma exposure and perceived rejection were developed for the purpose of this study. RESULTS Participants reported a high number of traumatic events. More than 80% of girls and women, and almost all participants who were formerly enslaved, met criteria for a probable DSM-5 PTSD diagnosis. Trauma exposure and enslavement predicted poor mental health. In addition, among formerly enslaved girls and women, perceived social rejection in their community mediated the relationship between traumatic enslavement events and depression symptoms. CONCLUSIONS In a context of maximum adversity, enslavement and war-related events contribute to high levels of PTSD and depression. Perceived social rejection seems to play a role in the relationship between trauma exposure and mental health among abducted genocide survivors. Providing psychosocial support and treatment for Yazidi people is essential and urgently required.
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Affiliation(s)
- Hawkar Ibrahim
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany. .,Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq. .,vivo International, Konstanz, Germany.
| | - Verena Ertl
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Claudia Catani
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
| | - Azad Ali Ismail
- Department of Clinical Psychology, Koya University, Koya, Kurdistan Region, Iraq
| | - Frank Neuner
- Department of Psychology, Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany.,vivo International, Konstanz, Germany
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Rurangirwa AA, Mogren I, Ntaganira J, Govender K, Krantz G. Intimate partner violence during pregnancy in relation to non-psychotic mental health disorders in Rwanda: a cross-sectional population-based study. BMJ Open 2018; 8:e021807. [PMID: 29997142 PMCID: PMC6082444 DOI: 10.1136/bmjopen-2018-021807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of non-psychotic mental health disorders (MHDs) and the association between exposure to all forms of intimate partner violence (IPV) during pregnancy and MHDs. DESIGN Cross-sectional population-based study conducted in the Northern Province of Rwanda and Kigali city. PARTICIPANTS AND SETTINGS Totally, 921 women who gave birth ≤13 months before being interviewed were included. Simple random sampling was done to select villages, households and participants. Community health workers helped to identify eligible participants and clinical psychologists, nurses or midwives conducted face-to-face interviews. The collected data were analysed using descriptive statistics and bivariable and multivariable logistic regression modelling RESULTS: The prevalence rates of generalised anxiety disorder, suicide ideation and post-traumatic stress disorder (PTSD) were 19.7%, 10.8% and 8.0%, respectively. Exposure to the four forms of IPV during pregnancy was highly associated with the likelihood of meeting diagnostic criteria for each of the non-psychotic MHDs investigated. Physical, psychological and sexual violence, showed the strongest association with PTSD, with adjusted ORs (aORs) of 4.5, 6.2 and 6.3, respectively. Controlling behaviour had the strongest association with major depressive episode in earlier periods with an aOR of 9.2. CONCLUSION IPV and MHDs should be integrated into guidelines for perinatal care. Moreover, community-based services aimed at increasing awareness and early identification of violence and MHDs should be instituted in all villages and health centres in Rwanda. Finally, healthcare providers need to be educated and trained in a consistent manner to manage the most challenging cases quickly, discreetly and efficiently.
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Affiliation(s)
- Akashi Andrew Rurangirwa
- Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Goteborg, Sweden
| | - Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, School of Public Health, University of Rwanda, Kigali, Rwanda
| | - Kaymarlin Govender
- Health Economics and HIV/AIDS Research Division (HEARD), Universityof KwaZulu-Natal, Durban, South Africa
| | - Gunilla Krantz
- Section of Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, The Sahlgrenska Academy at University of Gothenburg, Goteborg, Sweden
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28
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Mukamana D, Collins A, Rosa WE. Genocide Rape Trauma: A Conceptual Framework for Understanding the Psychological Suffering of Rwandan Survivors. Res Theory Nurs Pract 2018; 32:125-143. [PMID: 29792253 DOI: 10.1891/1541-6577.32.2.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In 1994, the Rwandan genocide claimed the lives of approximately 1 million Tutsi and moderate Hutu citizens. Systematic rape was a strategic component of the Hutu extremist plan to eradicate the Tutsi minority population. This involved collective and repeated sexual assaults with brutal violence, public humiliation, and torture. This article maps the ongoing psychological impact on Rwandan genocide rape survivors and identifies implications for international nursing practice. The research formalizes their narratives, identifying a number of interconnected elements that combine to produce myriad forms of chronic psychological suffering in the Rwandan context. This work in turn reveals the specific needs of these survivors that may be addressed by nursing. It allows nurses, as experts in managing the human responses to health and illness, to develop a more complete understanding of psychological suffering as it pertains to vulnerable populations during and in the wake of extreme social conflict. This clarifies the roles of nurse educators, clinicians, and policy advocates as key agents in providing genocide rape survivors with the resources and expertise needed to effectively manage their ongoing trauma.
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Jalloh MF, Li W, Bunnell RE, Ethier KA, O'Leary A, Hageman KM, Sengeh P, Jalloh MB, Morgan O, Hersey S, Marston BJ, Dafae F, Redd JT. Impact of Ebola experiences and risk perceptions on mental health in Sierra Leone, July 2015. BMJ Glob Health 2018; 3:e000471. [PMID: 29607096 PMCID: PMC5873549 DOI: 10.1136/bmjgh-2017-000471] [Citation(s) in RCA: 230] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/17/2017] [Accepted: 11/08/2017] [Indexed: 12/13/2022] Open
Abstract
Background The mental health impact of the 2014-2016 Ebola epidemic has been described among survivors, family members and healthcare workers, but little is known about its impact on the general population of affected countries. We assessed symptoms of anxiety, depression and post-traumatic stress disorder (PTSD) in the general population in Sierra Leone after over a year of outbreak response. Methods We administered a cross-sectional survey in July 2015 to a national sample of 3564 consenting participants selected through multistaged cluster sampling. Symptoms of anxiety and depression were measured by Patient Health Questionnaire-4. PTSD symptoms were measured by six items from the Impact of Events Scale-revised. Relationships among Ebola experience, perceived Ebola threat and mental health symptoms were examined through binary logistic regression. Results Prevalence of any anxiety-depression symptom was 48% (95% CI 46.8% to 50.0%), and of any PTSD symptom 76% (95% CI 75.0% to 77.8%). In addition, 6% (95% CI 5.4% to 7.0%) met the clinical cut-off for anxiety-depression, 27% (95% CI 25.8% to 28.8%) met levels of clinical concern for PTSD and 16% (95% CI 14.7% to 17.1%) met levels of probable PTSD diagnosis. Factors associated with higher reporting of any symptoms in bivariate analysis included region of residence, experiences with Ebola and perceived Ebola threat. Knowing someone quarantined for Ebola was independently associated with anxiety-depression (adjusted OR (AOR) 2.3, 95% CI 1.7 to 2.9) and PTSD (AOR 2.095% CI 1.5 to 2.8) symptoms. Perceiving Ebola as a threat was independently associated with anxiety-depression (AOR 1.69 95% CI 1.44 to 1.98) and PTSD (AOR 1.86 95% CI 1.56 to 2.21) symptoms. Conclusion Symptoms of PTSD and anxiety-depression were common after one year of Ebola response; psychosocial support may be needed for people with Ebola-related experiences. Preventing, detecting, and responding to mental health conditions should be an important component of global health security efforts.
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Affiliation(s)
- Mohamed F Jalloh
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wenshu Li
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Rebecca E Bunnell
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Kathleen A Ethier
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Kathy M Hageman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Paul Sengeh
- Office of the Chief Executive Officer, FOCUS 1000, Freetown, Sierra Leone
| | - Mohammad B Jalloh
- Office of the Chief Executive Officer, FOCUS 1000, Freetown, Sierra Leone
| | - Oliver Morgan
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sara Hersey
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Barbara J Marston
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Foday Dafae
- Ministry of Health and Sanitation (MoHS), Freetown, Sierra Leone
| | - John T Redd
- Division of Global Health Protection, Centers for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Krakauer EL, Muhimpundu MA, Mukasahaha D, Tayari JC, Ntizimira C, Uhagaze B, Mugwaneza T, Ruzima A, Mpanumusingo E, Gasana M, Karamuka V, Nkurikiyimfura JL, Park P, Barebwanuwe P, Tapela N, Elmore SN, Bukhman G, Leng M, Grant L, Binagwaho A, Sezibera R. Palliative Care in Rwanda: Aiming for Universal Access. J Pain Symptom Manage 2018; 55:S77-S80. [PMID: 28803090 DOI: 10.1016/j.jpainsymman.2017.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022]
Abstract
In 2011, Rwanda's Ministry of Health set a goal of universal access to palliative care by 2020. Toward this audacious egalitarian and humanitarian goal, the Ministry of Health worked with partners to develop palliative care policies and a strategic plan, secure adequate supplies of opioid for the country, initiate palliative care training programs, and begin studying a model for integrating coordinated palliative care into the public health care system at all levels. It also initiated training of a new cadre of home-based care practitioners to provide palliative care in the home. Based on these developments, the goal appears within reach.
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