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Erschienen in: Social Psychiatry and Psychiatric Epidemiology 11/2012

01.11.2012 | Original Paper

Mental and physical health in Rwanda 14 years after the genocide

verfasst von: Naasson Munyandamutsa, Paul Mahoro Nkubamugisha, Marianne Gex-Fabry, Ariel Eytan

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 11/2012

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Abstract

Purpose

To examine the socio-demographic determinants of post-traumatic stress disorder (PTSD) and its association with major depressive episode and self-perceived physical and mental health in a large random sample of the Rwandan population 14 years after the 1994 genocide.

Methods

Using the Mini International Neuropsychiatric Interview and Medical Outcomes Study 36-Item Short-Form (SF-36) translated in Kinyarwanda, we interviewed 1,000 adult residents from the five provinces of Rwanda. Socio-demographic data and specific somatic symptoms were also recorded. Data analysis included 962 questionnaires.

Results

Participants were predominantly female (58.9%), aged between 16 and 34 years (53.2%), with a low level of education (79.7% below secondary school). Prevalence of PTSD was estimated to be 26.1%. In multivariable analysis, factors associated with PTSD were being aged between 25 and 34 years, living in extreme poverty, having endured the murder of a close relative in 1994, being widowed or remarried, having lost both parents and living in the South Province. Participants who fulfilled diagnostic criteria for PTSD were significantly more often affected with major depression (68.4 vs. 6.6%, P < 0.001) and substance dependence (7.6 vs. 3.5%, P = 0.013) than respondents without PTSD. They scored significantly lower on all SF-36 subscales. Somatic symptoms such as hiccups, fainting and loss of speech or hearing delineated a specific pattern of post-traumatic stress syndrome.

Conclusions

PTSD remains a significant public health problem in Rwanda 14 years after the genocide. Facilitating access to appropriate care for all those who need it should be a national priority.
Literatur
1.
Zurück zum Zitat Moore J (2009) Rwanda’s genocide—15 years later (globalpost online) Moore J (2009) Rwanda’s genocide—15 years later (globalpost online)
2.
Zurück zum Zitat Hagengimana A et al (2003) Somatic panic-attack equivalents in a community sample of Rwandan widows who survived the 1994 genocide. Psychiatry Res 117(1):1–9PubMedCrossRef Hagengimana A et al (2003) Somatic panic-attack equivalents in a community sample of Rwandan widows who survived the 1994 genocide. Psychiatry Res 117(1):1–9PubMedCrossRef
3.
Zurück zum Zitat Pham PN, Weinstein HM, Longman T (2004) Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation. JAMA 292(5):602–612PubMedCrossRef Pham PN, Weinstein HM, Longman T (2004) Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation. JAMA 292(5):602–612PubMedCrossRef
4.
Zurück zum Zitat Bolton P, Neugebauer R, Ndogoni L (2002) Prevalence of depression in rural Rwanda based on symptom and functional criteria. J Nerv Ment Dis 190(9):631–637PubMedCrossRef Bolton P, Neugebauer R, Ndogoni L (2002) Prevalence of depression in rural Rwanda based on symptom and functional criteria. J Nerv Ment Dis 190(9):631–637PubMedCrossRef
5.
Zurück zum Zitat de Jong JP et al (2000) The prevalence of mental health problems in Rwandan and Burundese refugee camps. Acta Psychiatr Scand 102(3):171–177PubMedCrossRef de Jong JP et al (2000) The prevalence of mental health problems in Rwandan and Burundese refugee camps. Acta Psychiatr Scand 102(3):171–177PubMedCrossRef
6.
Zurück zum Zitat Dyregrov A et al (2000) Trauma exposure and psychological reactions to genocide among Rwandan children. J Trauma Stress 13(1):3–21PubMedCrossRef Dyregrov A et al (2000) Trauma exposure and psychological reactions to genocide among Rwandan children. J Trauma Stress 13(1):3–21PubMedCrossRef
7.
Zurück zum Zitat Neugebauer R et al (2009) Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide. Int J Epidemiol 38(4):1033–1045PubMedCrossRef Neugebauer R et al (2009) Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide. Int J Epidemiol 38(4):1033–1045PubMedCrossRef
8.
Zurück zum Zitat Schaal S et al (2010) Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry 10:55PubMedCrossRef Schaal S et al (2010) Rates and risks for prolonged grief disorder in a sample of orphaned and widowed genocide survivors. BMC Psychiatry 10:55PubMedCrossRef
9.
Zurück zum Zitat Bolton P (2001) Local perceptions of the mental health effects of the Rwandan genocide. J Nerv Ment Dis 189(4):243–248PubMedCrossRef Bolton P (2001) Local perceptions of the mental health effects of the Rwandan genocide. J Nerv Ment Dis 189(4):243–248PubMedCrossRef
10.
Zurück zum Zitat Zraly M, Nyirazinyoye L (2010) Don’t let the suffering make you fade away: an ethnographic study of resilience among survivors of genocide-rape in southern Rwanda. Soc Sci Med 70(10):1656–1664PubMedCrossRef Zraly M, Nyirazinyoye L (2010) Don’t let the suffering make you fade away: an ethnographic study of resilience among survivors of genocide-rape in southern Rwanda. Soc Sci Med 70(10):1656–1664PubMedCrossRef
11.
Zurück zum Zitat Daniel WW (1987) Biostatistics: a foundation for analysis in the health sciences, 5th edn. John Wiley & Sons, New York Daniel WW (1987) Biostatistics: a foundation for analysis in the health sciences, 5th edn. John Wiley & Sons, New York
12.
Zurück zum Zitat Bostoen K, Chalabi Z (2006) Optimization of household survey sampling without sample frames. Int J Epidemiol 35(3):751–755PubMedCrossRef Bostoen K, Chalabi Z (2006) Optimization of household survey sampling without sample frames. Int J Epidemiol 35(3):751–755PubMedCrossRef
13.
Zurück zum Zitat Sheehan DV et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(20):22–33 (quiz 34–57)PubMed Sheehan DV et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(20):22–33 (quiz 34–57)PubMed
14.
Zurück zum Zitat Onyeama M, Agomoh A, Jombo E (2010) Bipolar disorder in Enugu, South East Nigeria: demographic and diagnostic characteristics of patients. Psychiatr Danub 22(Suppl 1):S152–S157PubMed Onyeama M, Agomoh A, Jombo E (2010) Bipolar disorder in Enugu, South East Nigeria: demographic and diagnostic characteristics of patients. Psychiatr Danub 22(Suppl 1):S152–S157PubMed
15.
Zurück zum Zitat Ertl V et al (2011) Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial. JAMA 306(5):503–512PubMedCrossRef Ertl V et al (2011) Community-implemented trauma therapy for former child soldiers in Northern Uganda: a randomized controlled trial. JAMA 306(5):503–512PubMedCrossRef
16.
Zurück zum Zitat Schaal S, Elbert T, Neuner F (2009) Prolonged grief disorder and depression in widows due to the Rwandan genocide. Omega (Westport) 59(3):203–219 Schaal S, Elbert T, Neuner F (2009) Prolonged grief disorder and depression in widows due to the Rwandan genocide. Omega (Westport) 59(3):203–219
17.
Zurück zum Zitat Spies G et al (2009) Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care 21(9):1163–1168PubMedCrossRef Spies G et al (2009) Validity of the K-10 in detecting DSM-IV-defined depression and anxiety disorders among HIV-infected individuals. AIDS Care 21(9):1163–1168PubMedCrossRef
18.
Zurück zum Zitat Durieux-Paillard S et al (2006) Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context. Can J Psychiatry 51(9):587–597PubMed Durieux-Paillard S et al (2006) Screening for major depression and posttraumatic stress disorder among asylum seekers: adapting a standardized instrument to the social and cultural context. Can J Psychiatry 51(9):587–597PubMed
19.
Zurück zum Zitat Eytan A et al (2007) Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees. J Nerv Ment Dis 195(9):723–728PubMedCrossRef Eytan A et al (2007) Transcultural validity of a structured diagnostic interview to screen for major depression and posttraumatic stress disorder among refugees. J Nerv Ment Dis 195(9):723–728PubMedCrossRef
20.
Zurück zum Zitat Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483PubMedCrossRef Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483PubMedCrossRef
21.
Zurück zum Zitat Tseng HM, Lu JF, Gandek B (2003) Cultural issues in using the SF-36 Health Survey in Asia: results from Taiwan. Health Qual Life Outcomes 1:72PubMedCrossRef Tseng HM, Lu JF, Gandek B (2003) Cultural issues in using the SF-36 Health Survey in Asia: results from Taiwan. Health Qual Life Outcomes 1:72PubMedCrossRef
22.
Zurück zum Zitat Li L, Wang HM, Shen Y (2003) Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health 57(4):259–263PubMedCrossRef Li L, Wang HM, Shen Y (2003) Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health 57(4):259–263PubMedCrossRef
23.
Zurück zum Zitat Lim LL, Seubsman SA, Sleigh A (2008) Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women. Health Qual Life Outcomes 6:52PubMedCrossRef Lim LL, Seubsman SA, Sleigh A (2008) Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women. Health Qual Life Outcomes 6:52PubMedCrossRef
24.
Zurück zum Zitat Leplege A et al (1998) The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51(11):1013–1023PubMedCrossRef Leplege A et al (1998) The French SF-36 Health Survey: translation, cultural adaptation and preliminary psychometric evaluation. J Clin Epidemiol 51(11):1013–1023PubMedCrossRef
25.
Zurück zum Zitat Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036PubMedCrossRef Apolone G, Mosconi P (1998) The Italian SF-36 Health Survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036PubMedCrossRef
26.
Zurück zum Zitat Wagner AK et al (1998) Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51(11):925–932PubMedCrossRef Wagner AK et al (1998) Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51(11):925–932PubMedCrossRef
27.
Zurück zum Zitat Leplège A (2001) Le questionnaire MOS SF-36, manuel de l’utilisateur et guide d’interprétation des scores. ESTEM éditions, Paris Leplège A (2001) Le questionnaire MOS SF-36, manuel de l’utilisateur et guide d’interprétation des scores. ESTEM éditions, Paris
28.
Zurück zum Zitat Gjersing L, Caplehorn JR, Clausen T (2010) Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol 10:13PubMedCrossRef Gjersing L, Caplehorn JR, Clausen T (2010) Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol 10:13PubMedCrossRef
29.
Zurück zum Zitat Solomon Z, Mikulincer M (2007) Posttraumatic intrusion, avoidance, and social functioning: a 20-year longitudinal study. J Consult Clin Psychol 75(2):316–324PubMedCrossRef Solomon Z, Mikulincer M (2007) Posttraumatic intrusion, avoidance, and social functioning: a 20-year longitudinal study. J Consult Clin Psychol 75(2):316–324PubMedCrossRef
30.
Zurück zum Zitat de Jong JT, Komproe IH, Van Ommeren M (2003) Common mental disorders in postconflict settings. Lancet 361(9375):2128–2130PubMedCrossRef de Jong JT, Komproe IH, Van Ommeren M (2003) Common mental disorders in postconflict settings. Lancet 361(9375):2128–2130PubMedCrossRef
31.
Zurück zum Zitat Steel Z et al (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549PubMedCrossRef Steel Z et al (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549PubMedCrossRef
32.
Zurück zum Zitat Bramsen I, van der Ploeg HM (1999) Fifty years later: the long-term psychological adjustment of ageing World War II survivors. Acta Psychiatr Scand 100(5):350–358PubMedCrossRef Bramsen I, van der Ploeg HM (1999) Fifty years later: the long-term psychological adjustment of ageing World War II survivors. Acta Psychiatr Scand 100(5):350–358PubMedCrossRef
33.
Zurück zum Zitat Yehuda R et al (1998) Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors. Am J Psychiatry 155(9):1163–1171PubMed Yehuda R et al (1998) Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors. Am J Psychiatry 155(9):1163–1171PubMed
34.
35.
Zurück zum Zitat Andrews B et al (2007) Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164(9):1319–1326PubMedCrossRef Andrews B et al (2007) Delayed-onset posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164(9):1319–1326PubMedCrossRef
36.
Zurück zum Zitat Eytan A et al (2011) Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 46(10):953–963PubMedCrossRef Eytan A et al (2011) Mental and physical health of Kosovar Albanians in their place of origin: a post-war 6-year follow-up study. Soc Psychiatry Psychiatr Epidemiol 46(10):953–963PubMedCrossRef
37.
Zurück zum Zitat Johnson H, Thompson A (2008) The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev 28(1):36–47PubMedCrossRef Johnson H, Thompson A (2008) The development and maintenance of post-traumatic stress disorder (PTSD) in civilian adult survivors of war trauma and torture: a review. Clin Psychol Rev 28(1):36–47PubMedCrossRef
38.
Zurück zum Zitat Schaal S et al (2011) Rates of trauma spectrum disorders and risks of posttraumatic stress disorder in a sample of orphaned and widowed genocide survivors. Eur J Psychotraumatol 2:6343 Schaal S et al (2011) Rates of trauma spectrum disorders and risks of posttraumatic stress disorder in a sample of orphaned and widowed genocide survivors. Eur J Psychotraumatol 2:6343
39.
Zurück zum Zitat Brewin CR, Dalgleish T, Joseph S (1996) A dual representation theory of posttraumatic stress disorder. Psychol Rev 103(4):670–686PubMedCrossRef Brewin CR, Dalgleish T, Joseph S (1996) A dual representation theory of posttraumatic stress disorder. Psychol Rev 103(4):670–686PubMedCrossRef
40.
Zurück zum Zitat Fu SS et al (2007) Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res 9(11):1071–1084PubMedCrossRef Fu SS et al (2007) Post-traumatic stress disorder and smoking: a systematic review. Nicotine Tob Res 9(11):1071–1084PubMedCrossRef
41.
Zurück zum Zitat Weisberg RB et al (2002) Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv 53(7):848–854PubMedCrossRef Weisberg RB et al (2002) Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv 53(7):848–854PubMedCrossRef
42.
Zurück zum Zitat Mitchell AJ, Vaze A, Rao S (2009) Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 374(9690):609–619PubMedCrossRef Mitchell AJ, Vaze A, Rao S (2009) Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 374(9690):609–619PubMedCrossRef
44.
Zurück zum Zitat Kirmayer LJ, Sartorius N (2007) Cultural models and somatic syndromes. Psychosom Med 69(9):832–840PubMedCrossRef Kirmayer LJ, Sartorius N (2007) Cultural models and somatic syndromes. Psychosom Med 69(9):832–840PubMedCrossRef
45.
Zurück zum Zitat Hinton DE, Lewis-Fernandez R (2011) The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depress Anxiety 28(9):783–801PubMedCrossRef Hinton DE, Lewis-Fernandez R (2011) The cross-cultural validity of posttraumatic stress disorder: implications for DSM-5. Depress Anxiety 28(9):783–801PubMedCrossRef
46.
Zurück zum Zitat Bamage A (2009) La dépression affecte plus d’un quart des Rwandais. Grands Lacs Hebdo, Kigali Bamage A (2009) La dépression affecte plus d’un quart des Rwandais. Grands Lacs Hebdo, Kigali
47.
Zurück zum Zitat Munyandamutsa N, Mahoro Nkubamugisha P (2009) Prévalence de l’état de stress post-traumatique dans la population rwandaise. Ministère de la Santé Munyandamutsa N, Mahoro Nkubamugisha P (2009) Prévalence de l’état de stress post-traumatique dans la population rwandaise. Ministère de la Santé
48.
Zurück zum Zitat Logie DE, Rowson M, Ndagije F (2008) Innovations in Rwanda’s health system: looking to the future. Lancet 372(9634):256–261PubMedCrossRef Logie DE, Rowson M, Ndagije F (2008) Innovations in Rwanda’s health system: looking to the future. Lancet 372(9634):256–261PubMedCrossRef
49.
Zurück zum Zitat Saksena P et al (2011) Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy 99(3):203–209PubMedCrossRef Saksena P et al (2011) Mutual health insurance in Rwanda: evidence on access to care and financial risk protection. Health Policy 99(3):203–209PubMedCrossRef
Metadaten
Titel
Mental and physical health in Rwanda 14 years after the genocide
verfasst von
Naasson Munyandamutsa
Paul Mahoro Nkubamugisha
Marianne Gex-Fabry
Ariel Eytan
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Social Psychiatry and Psychiatric Epidemiology / Ausgabe 11/2012
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-012-0494-9

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