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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.

Intergenerational trauma - trauma relating to the genocide that affects younger generations who did not directly experience it - remains a challenge for mental-health services in Rwanda. [...]a decade old and launched by the UK-based charity Aegis Trust in Nottingham, this programme invites Rwandan scholars to submit research proposals; external researchers support them with advice and expertise to get the works published in international venues, such as peer-reviewed journals. Much of the research on the genocide against the Tutsi has neglected the testimonies of survivors, particularly women, says Noam Schimmel, a scholar of international studies and human rights at the University of California, Berkeley.

During a one-hundred-day period in 1994, Hutus murdered between half a million and a million Tutsi in Rwanda. The numbers are staggering; the methods of killing were unspeakable. Utilizing personal interviews with trauma survivors living in Rwandan cities, towns, and dusty villages, We Cannot Forget relates what happened during this period and what their lives were like both prior to and following the genocide. Through powerful stories that are at once memorable, disturbing, and informative, readers gain a critical sense of the tensions and violence that preceded the genocide, how it erupted and was carried out, and what these people faced in the first sixteen years following the genocide.

Background: Dissemination of psychotherapeutic modules to local counselors seems a key requirement for coping with mental health disasters in conflict regions. We tested a train-the-trainer (TTT) dissemination model for the treatment of posttraumatic stress disorder (PTSD). Methods: We randomly assigned widowed or orphaned survivors of the 1994 Rwandan genocide with a PTSD diagnosis to narrative exposure therapy (NET) treatment (NET-1, n = 38) or to a 6-month waiting list (WL) condition to be followed by treatment (WL/NET-2, n = 38). Expert therapists trained a first dissemination generation of local Rwandan psychologists in NET complemented by 2 sessions of interpersonal psychotherapy modules. Under the supervision of the experts, these Rwandan psychologists (a) provided NET to the NET-1 participants and (b) subsequently trained and supervised a second generation of local psychologists. This second dissemination generation provided treatment to the WL/NET-2 group. The primary outcome measure was the Clinician-Administered PTSD Scale total score before therapy and at 3- and 12-month follow-ups. Results: At the 3-month follow-up, the NET-1 participants suffered significantly and substantially less from PTSD symptoms than the participants in the WL group. The treatment gains of NET-1 were maintained and increased at follow-up, with a within-group effect size of Cohen's d = 1.47 at the 12-month follow-up. After treatment by the second dissemination generation of therapists, the WL/NET-2 participants improved to an extent similar to that of the NET-1 group at follow-ups, with an effect size of Cohen's d = 1.37 at the 12-month follow-up. Conclusions: A TTT model of PTSD treatment dissemination can be effective in resource-poor postconflict societies.

Background The concept of Prolonged Grief Disorder (PGD) has been defined in recent years by Prigerson and co-workers, who have developed and empirically tested consensus and diagnostic criteria for PGD. Using these most recent criteria defining PGD, the aim of this study was to determine rates of and risks for PGD in survivors of the 1994 Rwandan genocide who had lost a parent and/or the husband before, during or after the 1994 events. Methods The PG-13 was administered to 206 orphans or half orphans and to 194 widows. A regression analysis was carried out to examine risk factors of PGD. Results 8.0% ( n = 32) of the sample met criteria for PGD with an average of 12 years post-loss. All but one person had faced multiple losses and the majority indicated that their grief-related loss was due to violent death (70%). Grief was predicted mainly by time since the loss, by the violent nature of the loss, the severity of symptoms of posttraumatic stress disorder (PTSD) and the importance given to religious/spiritual beliefs. By contrast, gender, age at the time of bereavement, bereavement status (widow versus orphan), the number of different types of losses reported and participation in the funeral ceremony did not impact the severity of prolonged grief reactions. Conclusions A significant portion of the interviewed sample continues to experience grief over interpersonal losses and unresolved grief may endure over time if not addressed by clinical intervention. Severity of grief reactions may be associated with a set of distinct risk factors. Subjects who lose someone through violent death seem to be at special risk as they have to deal with the loss experience as such and the traumatic aspects of the loss. Symptoms of PTSD may hinder the completion of the mourning process. Religious beliefs may facilitate the mourning process and help to find meaning in the loss. These aspects need to be considered in the treatment of PGD.

More than 20 years have passed since the Rwandan genocide, yet we know little about how Rwandans remember the violence. This article draws upon more than 100 interviews with genocide survivors to assess collective memories of the atrocity. We find that survivors organize their narratives by conceptualizing the genocide as a watershed event that divides time into two distinct eras. When discussing the pregenocide period, survivors focus on macrolevel events and structures, locating blame for the genocide in institutions rather than on Rwandan citizens. By contrast, narratives of life after the genocide focus on perceived progress since 1994. We interpret these findings in light of the state's memory projects, the potential functionality of the memories, and the time needed for collective memories to resonate.

Extensive pharmacologic, genetic, and epigenetic research has linked the glucocorticoid receptor (GR) to memory processes, and to risk and symptoms of posttraumatic stress disorder (PTSD). In the present study we investigated the epigenetic pattern of 12 genes involved in the regulation of GR signaling in two African populations of heavily traumatized individuals: Survivors of the rebel war in northern Uganda (n = 463) and survivors of the Rwandan genocide (n = 350). The strongest link between regional methylation and PTSD risk and symptoms was observed for NTRK2, which encodes the transmembrane receptor tropomyosin-related kinase B, binds the brain-derived neurotrophic factor, and has been shown to play an important role in memory formation. NTRK2 methylation was not related to trauma load, suggesting that methylation differences preexisted the trauma. Because NTRK2 methylation differences were predominantly associated with memory-related PTSD symptoms, and because they seem to precede traumatic events, we next investigated the relationship between NTRK2 methylation and memory in a sample of nontraumatized individuals (n = 568). We found that NTRK2 methylation was negatively associated with recognition memory performance. Furthermore, fMRI analyses revealed NTRK2 methylation-dependent differences in brain network activity related to recognition memory. The present study demonstrates that NTRK2 is epigenetically linked to memory functions in nontraumatized subjects and to PTSD risk and symptoms in traumatized populations.

Background The 1994 genocide of the Tutsi in Rwanda left about one million people dead in a period of only three months. The present study aimed to examine the level of trauma exposure, psychopathology, and risk factors for posttraumatic stress disorder (PTSD) in survivors and former prisoners accused of participation in the genocide as well as in their respective descendants. Methods A community-based survey was conducted in four sectors of the Muhanga district in the Southern Province of Rwanda from May to July 2010. Genocide survivors ( n  = 90), former prisoners ( n  = 83) and their respective descendants were interviewed by trained local psychologists. The PTSD Symptom Scale Interview (PSS-I) was used to assess PTSD, the Hopkins Symptom Checklist (HSCL-25) to assess symptoms of depression and anxiety and the relevant section of the M.I.N.I. to assess the risk for suicidality. Results Survivors reported that they had experienced on average twelve different traumatic event types in comparison to ten different types of traumatic stressors in the group of former prisoners. According to the PSS-I, the worst events reported by survivors were mainly linked to witnessing violence throughout the period of the genocide, whereas former prisoners emphasized being physically attacked, referring to their time spent in refugee camps or to their imprisonment. In the parent generation, when compared to former prisoners, survivors indicated being more affected by depressive symptoms ( M  = 20.7 (SD = 7.8) versus M  = 19.0 (SD = 6.4), U  = 2993, p  < .05) and anxiety symptoms ( M  = 17.2 (SD = 7.6) versus M  = 15.4 (SD = 7.8), U  = 2951, p  < .05) but not with regard to the PTSD diagnosis (25% versus 22%, χ 2 (1,171) = .182, p  = .669). A regression analysis of the data of the parent generation revealed that the exposure to traumatic stressors, the level of physical illness and the level of social integration were predictors for the symptom severity of PTSD, whereas economic status, age and gender were not. Descendants of genocide survivors presented with more symptoms than descendants of former prisoners with regard to all assessed mental disorders. Conclusions Our study demonstrated particular long-term consequences of massive organized violence, such as war and genocide, on mental health and psychosocial conditions. Differences between families of survivors and families of former prisoners accused for participation in the Rwandan genocide are reflected in the mental health of the next generation.

ObjectivesTo investigate mental health effects associated with exposure to trauma in Rwanda during the 1994 genocide period, and over the lifetime, in Rwandan men and women aged 20–35 years.SettingThis was a cross-sectional population-based study conducted in the southern province of Rwanda. Data was collected during December 2011 to January 2012.ParticipantsA total population of 917 individuals were included, 440 (48%) men and 477 (52%) women aged 20–35 years. Number of households for inclusion in each village was selected proportional to the total number of households in each selected village. The response rate was 99.8%. Face-to-face interviewing was done by experienced and trained clinical psychologists, following a structured questionnaire.ResultsWomen were slightly less exposed during the genocide period (women 35.4% and men 37.5%; p=0.537), but more women than men were exposed to traumatic episodes over their lifetime (women 83.6%, n=399; men 73.4%, n=323; p<0.001). Current major depressive episodes (MDE) were twice as prevalent in women as in men. Traumatic episodes experienced in the genocide period severely affected men's current mental health status with relative risk (RR) 3.02 (95% CI 1.59 to 5.37) for MDE past and with RR 2.15 (95% CI 1.21 to 3.64) for suicidality. Women's mental health was also affected by trauma experienced in the genocide period but to an even higher extent, by similar trauma experienced in the lifetime with RR 1.91 (95% CI 1.03 to 3.22) for suicidality and RR 1.90 (95% CI 1.34 to 2.42) for generalised anxiety disorder, taking spousal physical/sexual violence into consideration.ConclusionsDepression, post-traumatic stress disorder, anxiety and suicidal attempts are prevalent in Rwanda, with rates twice as high in women compared with men. For women, exposure to physical and sexual abuse was independently associated with all these disorders. Early detection of gender-based violence through homes and community interventions is important.

Background During Rwanda’s genocide period in 1994, about 800,000 people were killed. People were murdered, raped and seriously injured. This retrospective study investigated prevalence and frequency of traumatic episodes and associated psychosocial effects in young adults in Rwanda over the lifetime, during the genocide period and in the past three years. Methods This is a cross-sectional population-based study conducted among men and women, aged 20 to 35 years, residing in the Southern province of Rwanda. The study population, randomly selected in a multi stage procedure, included 477 females and 440 males. Data collection was performed through individual interviewing with a structured questionnaire during the period December 2011- January 2012. The Harvard Trauma Questionnaire was used to assess traumatic episodes. All data was sex-disaggregated. Differences between groups were measured by chi square and Fischer’s exact test. Associations with socio-demographic and psychosocial factors were estimated by use of odds ratios with 95% confidence intervals in bi- and multivariate analyses. Results The participants in this study were 3 to 18 years of age in 1994, the year of the genocide. Our sample size was 917 participants, 440 men and 477 women. Women were to a higher extent exposed to traumatic episodes than men during their lifetime, 83.6% (n = 399) and 73.4% (n = 323), respectively. During the genocide period, 37.5% of the men/boys and 35.4% of the women/girls reported such episodes while in the past three years (2009-2011) 25.0% of the men and 23.1% of the women did. Women were more exposed to episodes related to physical and sexual violence, while men were exposed to imprisonment, kidnapping and mass killings. Victims of such violence during the genocide period were 17 years later less educated although married (men OR 1.47; 0.98-2.19; women OR 1.54; 1.03-2.30), without children (men OR 1.59; 1.08-2.36; women OR 1.86; 1.11-3.08) and living under extremely poor circumstances. Conclusion The participants in this population-based study witnessed or experienced serious traumatic episodes during the genocide, which influenced their life circumstances 17 years later. Such traumatic episodes are however still taking place. The reasons for this need further investigation.