A novel electroencephalography-based paradigm to measure intergroup prosociality: An intergenerational study in the aftermath of the genocide against Tutsis in Rwanda.

Studying how intergroup prosociality evolves in war-torn societies is critical for gaining a better understanding of conflict perpetuation. Rwanda provides a unique example of how two groups must reconcile and manage their intergroup biases following a genocidal process. In this study, we employed a novel intended behavior task to measure intergroup prosociality among former genocide perpetrators, genocide survivors, and their children in Rwanda. Participants were required to choose between various individuals representing their own in-group or their out-group as recipients of their prosocial intentions. We measured how frequently they selected in-group or out-group individuals and to what extent choosing each individual induced cognitive conflict, as measured by reaction times (RTs) and midfrontal theta (FMθ) activity. The results indicated that survivors and their children selected former perpetrators and their offspring less frequently. Furthermore, selecting them involved a higher cognitive conflict, as evidenced by longer RT and a higher FMθ, compared to choosing their own in-group. For the group composed of former perpetrators and their children, we observed a dissociation. They selected out-group individuals more frequently, perhaps as a compensatory behavior for their past wrongdoings. Nonetheless, selecting the out-group individuals involved a higher cognitive conflict than selecting their own in-group. Importantly, we observed a similar intergroup prosociality bias in the children of both survivors and former perpetrators, mirroring that of their parents. These results are important for understanding how past conflicts influence intergroup prosociality bias and the extent to which this bias is transmitted to the next generation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluation of Social Acknowledgment and Mental Health Among Kurdish Survivors of Genocide in 1988.

This cross-sectional study assesses whether higher levels of trauma were associated with less perceived social acknowledgment and higher psychopathology among Kurdish survivors of a chemical attack that took place in 1988.

Sociodemographic Characteristics and Mental and Physical Health Diagnoses of Yazidi Refugees Who Survived the Daesh Genocide and Resettled in Canada.

Importance: The health status of Yazidi refugees, a group of ethnoreligious minority individuals from northern Iraq who resettled in Canada between 2017 and 2018 after experiencing genocide, displacement, and enslavement by the Islamic State (Daesh), is unknown but important to guide health care and future resettlement planning for Yazidi refugees and other genocide victims. In addition, resettled Yazidi refugees requested documentation of the health impacts of the Daesh genocide. Objective: To characterize sociodemographic characteristics, mental and physical health conditions, and family separations among Yazidi refugees who resettled in Canada. Design, Setting, and Participants: This retrospective clinician- and community-engaged cross-sectional study included 242 Yazidi refugees seen at a Canadian refugee clinic between February 24, 2017, and August 24, 2018. Sociodemographic and clinical diagnoses were extracted through review of electronic medical records. Two reviewers independently categorized patients' diagnoses by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and ICD-10-CM chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. Five expert refugee clinicians used a modified Delphi approach to identify diagnoses likely to be associated with Daesh exposure, then corroborated these findings with Yazidi leader coinvestigators. A total of 12 patients without identified diagnoses during the study period were excluded from the analysis of health conditions. Data were analyzed from September 1, 2019, to November 30, 2022. Main Outcomes and Measures: Sociodemographic characteristics; exposure to Daesh captivity, torture, or violence (hereinafter, Daesh exposure); mental and physical health diagnoses; and family separations. Results: Among 242 Yazidi refugees, the median (IQR) age was 19.5 (10.0-30.0) years, and 141 (58.3%) were female. A total of 124 refugees (51.2%) had direct Daesh exposure, and 60 of 63 families (95.2%) experienced family separations after resettlement. Among 230 refugees included in the health conditions analysis, the most common clinical diagnoses were abdominal and pelvic pain (47 patients [20.4%]), iron deficiency (43 patients [18.7%]), anemia (36 patients [15.7%]), and posttraumatic stress disorder (33 patients [14.3%]). Frequently identified ICD-10-CM chapters were symptoms and signs (113 patients [49.1%]), nutritional diseases (86 patients [37.4%]), mental and behavioral disorders (77 patients [33.5%]), and infectious and parasitic diseases (72 patients [31.3%]). Clinicians identified mental health conditions (74 patients [32.2%]), suspected somatoform disorders (111 patients [48.3%]), and sexual and physical violence (26 patients [11.3%]) as likely to be associated with Daesh exposure. Conclusions and Relevance: In this cross-sectional study, Yazidi refugees who resettled in Canada after surviving the Daesh genocide experienced substantial trauma, complex mental and physical health conditions, and nearly universal family separations. These findings highlight the need for comprehensive health care, community engagement, and family reunification and may inform care for other refugees and genocide victims.

Health and social consequences for survivors of genocidal rape: A systematic scoping review.

The unique forms of trauma experienced by survivors of genocidal rape are not well understood. Hence, we conducted a systematic scoping review regarding the consequences for survivors of rape during genocide. Searches conducted in PubMed, Global Health, Scopus, PyscInfo, and Embase produced a total of 783 articles. After completing the screening process, 34 articles were eligible for inclusion in the review. The included articles focus on survivors from six different genocides, with most focusing on either the genocide of the Tutsis in Rwanda or the Yazidis in Iraq. The study findings consistently show that survivors deal with stigmatization as well as a lack of both financial and psychological social support. This lack of support is partly due to social ostracization and shame but is also attributed to the fact that many survivors' families and other providers of social support were murdered during the violence. Many survivors, particularly young girls, reported dealing with intense forms of trauma both as a direct result of sexual violence and due to witnessing the death of their community members during the period of genocide. A notable proportion of survivors became pregnant from genocidal rape and contracted HIV. Group therapy was shown to improve mental health outcomes across numerous studies. These findings have important implications and can inform recovery process efforts. Psychosocial supports, stigma reduction campaigns, community reestablishment, and financial assistance are integral in facilitating recovery. These findings can also play an important role in shaping refugee support programs.

"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.

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.

Associations between duration of first trimester intrauterine exposure to genocide against the Tutsi and health outcomes in adulthood.

OBJECTIVES: Hundreds of thousands of Rwandans were conceived during the 1994 genocide against the Tutsi, including thousands conceived by genocidal rape. We explore whether the duration of first trimester exposure to the genocide is associated with variation in adult mental health outcomes in individuals exposed to varying degrees of genocide-related stress in utero. MATERIALS AND METHODS: We recruited 30 Rwandans conceived via genocidal rape, 31 Rwandans conceived by genocide survivors not raped, and 30 individuals of Rwandan-descent who were conceived outside of Rwanda at the time of the genocide (control group). Individuals were age- and sex-matched across groups. Adult mental health was assessed through standardized questionnaires for vitality, anxiety, and depression. RESULTS: Among the genocide only group, a longer duration of first trimester prenatal exposure was associated with higher anxiety scores and lower vitality (both p < 0.010), and higher depression scores (p = 0.051). Duration of first trimester exposure was not associated with any measures of mental health among the genocidal rape or control group. DISCUSSION: Duration of exposure to genocide in the first trimester of gestation was associated with variation in adult mental health among the genocide only group. The lack of association between duration of first trimester exposure to genocide and adult mental health in the genocidal rape group may reflect the fact that stress associated with conception through rape persisted beyond the genocide period itself, encompassing all of gestation and likely beyond. Geopolitical and community interventions are needed in the context of extreme events during pregnancy to mitigate adverse intergenerational outcomes.

"We (still) charge genocide": A systematic review and synthesis of the direct and indirect health consequences of police violence in the United States.

Building on historical and contemporary efforts to eliminate police and other forms of state violence, and on the understanding that police violence is a social determinant of health, we conducted a systematic review in which we synthesize the existing literature around 1) racial disparities in police violence; 2) health impacts of direct exposure to police violence; and 3) health impacts of indirect exposure to police violence. We screened 336 studies and excluded 246, due to not meeting our inclusion criteria. Forty-eight additional studies were excluded during the full text review, resulting in a study sample size of 42 studies. Our review showed that Black people in the US are far more likely than white people to experience a range of forms of police violence: from fatal and nonfatal shootings, to assault and psychological violence. Exposure to police violence increases risk of multiple adverse health outcomes. Moreover, police violence may operate as a vicarious and ecological exposure, producing consequences beyond those directly assaulted. In order to successfully eliminate police violence, scholars must work in alignment with social justice movements.

Evaluating the impact of Community-Based Sociotherapy on social dignity in post-genocide Rwanda: study protocol for a cluster randomized controlled trial.

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.

On the cognitive mechanisms supporting prosocial disobedience in a post-genocidal context.

The aim of the present study was to offer a first investigation of the neuro-cognitive processes and the temporal dynamics at the neural level, together with cultural, social and psychological dimensions, that may support resistance to orders to harm another person. Using a novel experimental approach to study experimentally disobedience, we recruited individuals from the first generation born after the 1994 genocide in Rwanda. Seventy-two were recruited and tested in Rwanda and 72 were recruited and tested in Belgium. Results indicated that a higher neural response to the pain of others and a higher feeling of responsibility when people obeyed orders were associated with more resistance to immoral orders. We also observed that participants who had a higher processing, as measured through mid-frontal theta activity, when listening to the orders of the experimenter disobeyed less frequently to immoral orders. Further, participants experiencing a higher conflict before administering a shock to the 'victim' also disobeyed more frequently to immoral orders. Finally, a low cultural relationship to authority and a high estimated family suffering during the genocide were also associated with more disobedience to immoral orders. The present study opens new paths for interdisciplinary field research dedicated to the study of obedience.

Holocaust and Genocide Studies in Nursing Education: Nurse Practitioners as Critical Intellectuals.

BACKGROUND: In most nursing schools, Holocaust and genocide studies are not part of the curriculum. However, studying past horrors involving health care professionals is essential for forming a clear moral compass to navigate future nursing practice. This article analyzes a unique Holocaust and genocide curriculum for graduate nurse practitioner students and its effects on participants. METHOD: The students wrote reflective accounts, which were analyzed using qualitative content analysis. RESULTS: The studies had a profound effect on the students, who adopted a critical perspective and became more sensitive to wrongdoing and social suffering, more involved in current ethical and social issues, and more willing to engage in social advocacy. The course strengthened the moral responsibility of the students, transforming them into critical intellectuals. CONCLUSION: Holocaust and genocide studies enhance nurses' humanistic approach and help them confront dogma, challenge social denial, and resist oppression, discrimination, and structural racism. [J Nurs Educ. 2022;61(11):624-632.].

Beauty.

Beauty is not race neutral. It is a racialized category/ perception which emerged through centuries of European colonization, Indigenous genocide, African/Black enslavement and indenture resulting in an aesthetic hierarchy with Blackness at the bottom. The coloniality of aesthetics means that still today hair perceived as Black in texture and styling and darker skin on African descent bodies are the repositories of anti-Blackness. However, Black women, children and men continue to fight back by (re)creating Black antiracist aesthetics focused on valorizing Black skin and hair.

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?

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.

[The mental health nurse as a cornerstone of mental health care in Rwanda]. / L'infirmier en santé mentale, pierre angulaire des soins de santé mentale au Rwanda.

In the aftermath of the genocide against the Tutsis in Rwanda in 1994, the country was left with a collapsed health system and a huge burden of mental health problems to deal with. With only one psychiatrist at the time, a health ecosystem had to be reinvented to deal with these fragilities. The training of mental health nurses since 1998 has forged the professionals who have contributed significantly to the rebuilding of the mental health system in Rwanda.

Implementation of mental health policies and reform in post-conflict countries: the case of post-genocide Rwanda.

The global burden of mental illness is rising, with populations in post-conflict countries contributing significantly to the numbers. Governments in these countries face the dual challenge of responding to increased mental health needs and implementing this response with institutions and economies weakened by war. This research studies the process, successes and challenges of implementing mental health reform in a low-resource, post-conflict country, a subject that is rarely studied. Based on fieldwork conducted in Rwanda in 2019, the study focuses on the implementation of this African country's post-genocide mental health policy, which relies primarily on strategies of decentralization and integration into the primary health care system. The results are based on 30 interviews conducted in Kigali and Ngoma with primary stakeholders including government officials, representatives from nongovernmental organizations, service providers and academics. These stakeholders held a positive view of the main strategies of the policy as they resulted in increased accessibility and availability of care for Rwandans. However, they also noted the institutionalization and individualization of mental health care as gaps in the implementation that do not respond to the Rwandan context. Building on complexity theory, the analysis found that many of these gaps, as well as opportunities to address them, are missed by the government due to top-down implementation and a lack of collaboration with local organizations and service providers working in the domain. The research results suggest that although it is possible to prioritize mental health in low-resource, complex settings, the implementation of such reform requires collaborative, adaptive and horizontal approaches in order to adequately address and respond to citizen needs and ensure quality mental health care for all.