The mental health prognosis of offspring born of genocidal rape is influenced by family members, the community and their perceptions toward them.

BACKGROUND: There is little known about the family and community maltreatment of the offspring born of the genocidal rape and the offspring's self-perceptions and how they influence their recovery from mental health problems. This study aimed to examine how the mental health prognosis of these offspring could be influenced by the family or community perceptions and attitudes toward them and their self-perception and coping strategies. METHODS: Thirty-two semi-structured qualitative interviews were conducted on 16 dyads of mothers and their offspring who were selected from countrywide. The interviews were audio-recorded and transcribed verbatims that were analysed inductively using thematic analysis within the NVivo 12 software. RESULTS: Participants reported long-term psychological and psychosomatic consequences stemming from being born of genocidal rape. Notably, family and community maltreatment of the offspring and their self-perception exacerbated psychological distress and affected their capacity to recover. The majority of the offspring were using coping strategies such as sole collaboration with peers with the same history, efforts to hide their birth history, social Isolation (silence, untrusting, involvement in media etc), hardworking, reversed roles in the parental relationship, extreme involvement in praying, and harmful alcohol use. CONCLUSION: Given the documented detrimental effects of individual, family and community attitudes and perceptions on psychological, and psychosomatic symptoms as well as the offspring coping strategies, culturally relevant mental health interventions are required to support the well-being and social reintegration of individuals born of genocidal rape while minimizing stigma and their maladaptive coping strategies.

Perceptions of the Intervention Utility and Effectiveness in Supporting and Reintegrating Youths Born of Genocidal Rape in Rwanda.

Background: Birth through genocidal rape has a detrimental impact on the health of the offspring; however, there is scarce literature that focuses on efforts to support and reintegrate people born of this crime due to the lack of needs assessments that can inform policies and interventions. Objective: This study sought to explore perceptions of the intervention utility and effectiveness in supporting and reintegrating offspring born of the 1994 genocidal rape against the Tutsi in Rwanda. Methods: A purposive sample of 16 dyads of non-partnered mothers raped in the 1994 genocide against the Tutsi and their offspring participated in semi-structured qualitative interviews. The transcribed interview verbatims were uploaded to NVivo 12 and analyzed inductively using thematic analysis. Results: The analysis resulted in several subthemes that were grouped into four main themes based on research questions. These themes included the reconstruction of a positive image (ie, hardworking, contribution to the community, supporting vulnerable people, etc.), the benefits of collaborating with peers in a similar situation (ie, a sense of belonging, self-acceptance, relieving distress and emotional pain, etc.), the support obtained from Survivors Fund Rwanda (ie, psychosocial support, financial support for school fees, support to get a job), and the intervention and strategies needed (ie, continuous psychosocial support, catch-up learning programs, accompaniment support, advocacy to get a job, supporting the parents, etc.). Conclusion: Our results highlight how the youth born of genocidal rape are reconstructing a positive image and self-advocacy, their perception of obtained support, and the recommended intervention. These findings will help in initiating or strengthening interventions targeting this population, especially strategies to support and reintegrate them.

Sleep quality among undergraduate medical students in Rwanda: a comparative study.

Despite the abundance of literature highlighting poor sleep quality among medical students and its detrimental impact on their mental well-being and academic performance, no study has been conducted to investigate the sleep quality of undergraduate medical students in Rwanda to date. Therefore, this study sought to determine the magnitude of sleep quality of undergraduate medical students in Rwanda and to compare the scores of seven components of sleep quality across classes. This cross-sectional study was conducted among 290 undergraduate medical students aged 18-35 years (mean = 24, SD = 2.9) randomly recruited countrywide from 1st November 2021 to 1st March 2022. The questionnaire was self-administered with 2 sections: characteristics of medical students, and Pittsburgh Sleep Quality Index (PSQI). The Pearson Chi-square test was used to test whether the categories of seven components of sleep quality differ between classes, then ANOVA followed by the post hoc test was used to test if the seven components and global score of Pittsburgh Sleep Quality Index differ between classes. The results revealed that the global PSQI mean score was 7.73 (SD = 2.83), with fifth-year medical students reporting the highest PSQI mean score (M = 8.44, SD = 2.77), followed by first-year (M = 8.15, SD = 3.31). One-way ANOVA showed that the global PSQI score (F = 2.76, p = 0.028), subjective sleep quality (F = 3.35, p = 0.011), habitual sleep efficiency (F = 10.20, p < 0.001), and daytime dysfunction (F = 3.60, p = 0.007) were significantly different across classes. Notably, the post hoc test revealed significant scores differences in the global PSQI score between class II and V (p = 0.026), in subjective sleep quality between class I and II (p = 0.043), and between class I and IV (p = 0.016); habitual sleep efficiency between class V and all other classes (p < 0.001); and daytime dysfunction between class III and IV (p = 0.023). This paper concludes by arguing that poor sleep quality is highly prevalent among medical students in Rwanda, with final and first-year students reporting the poorest sleep quality. There were significant differences across classes in the global PSQI, subjective sleep quality, habitual sleep efficiency, and daytime dysfunction. Intervention approaches such as sleep education, behavioral changes, and relaxing techniques are recommended to address contributing factors and ultimately maximize the academic goals of Rwandan medical students.

Efficacy of narrative therapy for orphan and abandoned children with anxiety and attention deficit and hyperactivity disorders in Rwanda: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Although narrative therapy (NT) is globally practiced for alleviating psychological disorders, studies of its efficacy for vulnerable children are still scarce, especially in African post-conflict settings. Thus, this study was aimed at assessing the efficacy of NT for Rwandan Orphans and abandoned children (OAC) with ADHD and anxiety disorders. METHOD: This study was a parallel randomized controlled trial in which participants (n = 72) were recruited from SOS Children's Villages. A half of participants (n = 36) were randomly allocated to either the NT group or the waitlist control group (WCG). Outcomes were collected at baseline before randomization and 10 weeks post-randomization. RESULTS: ANOVA results indicated a significant main effect of time for anxiety disorders (p < .001, ηp2= 0.176), and the main effects of group were significant for anxiety disorders (p < .001, ηp2= 0.254) and ADHD disorders (p < .001, ηp2= 0.260). There was a significant time by group interaction effect for anxiety disorders (p < .001, ηp2= 0.328) and for ADHD (p < .001, ηp2= 0.193). Between group analyses showed that the difference in symptoms was significant for anxiety disorders (p < .001, Cohen's d = 1.28) and for ADHD (p < .001, Cohen's d = 1.6) during the posttest, and the effect sizes were large. LIMITATION: The long-term effects of the intervention for the current sample were not assessed in this study. CONCLUSION: Despite its limitations, this study provides initial support for the safety, efficacy, and usefulness of NT among Rwandan OAC with ADHD and anxiety disorders. Health professionals must implement the new intervention as an everyday tool.

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.

Trends and correlates of intimate partner violence (IPV) victimization in Rwanda: results from the 2015 and 2020 Rwanda Demographic Health Survey (RDHS 2015 and 2020).

BACKGROUND: Intimate partner violence (IPV) is reported to be a public health issue given its magnitude and long-lasting consequences. Men are generally thought to be perpetrators of IPV, but they can also be victims. In Rwanda, the experience of men as victims has not yet been described and characterized. The aim of this study is to examine the trends and correlates of IPV victimization for men and women in Rwanda. METHODS: The data for this study were extracted from the Rwanda Demographic and Health Survey (RDHS) in 2014/15 (female: n = 8292, male: n = 3470) and 2019/2020 (female = 8574, male: n = 3590). The survey had used a structured measure of IPV (i.e. physical, sexual, or emotional) and its related demographic characteristics to collect data in a nationally representative sample of ever-married women aged 15-49 years and men aged 15-59 years. Multiple logistic regression was applied to examine the association between demographic characteristics and IPV in both women and men. RESULT: The prevalence of IPV among women increased from 40% in 2015 to 46% in 2020, while it decreased from 21 to 18% in men during the same time period. The associated factors for women IPV victimization in 2015 were: uneducated husband (Adjusted Odds Ratios (AOR) = 5.570, 95% CI 1.29-24.02), woman from the poorest household (AOR = 2.834, 95% CI 1.9-93.12), husband aged from 30 to 39 years (AOR = 2.797, 95% CI 1.517-5.158), husband consuming alcohol (AOR = 3.021, 95% CI 1.517-5.158); women involved in decisions about their own earnings (AOR = 0.576, 95% CI 0.37-0.88); and purchases (AOR = 0.472, 95% CI 0.27-0.82). However, the factors such as uneducated husbands (AOR = 3.032, 95% CI 1.117-8.24); husbands consuming alcohol (AOR = 1.712, 95% CI 2.408-4.486); a woman's involvement in decisions on her personal health (AOR = 0.443, 95% CI 0.30-0.63) and visits from her family or relatives (AOR = 0.405, 95% = 0.41-0.22) were factors of IPV in 2020. On the other hand, the associated factors for men IPV victimization in 2015 were being from richer wealth index (AOR = 0.21, 95% CI 0.04-1.04), frequency of being hit in last 12 months by other than partner (AOR = 5.49, 95% CI 1.65-18.25), woman often consuming alcohol (AOR = 13.30, 95% CI 1.9-93.12); whereas its associated factor in 2020 were women consuming alcohol (3.91, 95% CI 0.55-9.87). CONCLUSION: The present study revealed a significant increase in IPV against women, and slight decrease of IPV against men in Rwanda from 2015 to 2020, as well as its associated risks and protective factors over time. This increase needs further exploration given that government and partners have invested in policies and strategies to mitigate the IPV with limited impact. Since there is a relationship between IPV prevalence and education, the existing laws on domestic violence need to be known by the citizens. Findings from this study evidenced also visits from extended families to be a protective factor and therefore suggesting the necessity of a family and community-based approach in managing IPV in Rwanda. Future studies to assess the effectiveness of community-based approach in preventing IPV.

Negative emotions and personal well-being among incarcerated filicide mothers in Rwanda.

Despite the tremendous evidence of the harmful effects of maternal filicide on the lives of offenders, there is a scarcity on studies of their negative emotions and personal wellbeing especially in sub-Saharan Africa. Thus, this study was primarily aimed at assessing the prevalence of negative emotions experienced by filicide mothers and how they were associated with personal wellbeing in Rwanda. With an institutional-based cross-sectional study design, we measured the symptoms of anxiety, anger, shame, guilt, depression and personal well-being in a convenient sample of 55 filicidal mothers (mean age = 26.69; SD = 6.88) who were incarcerated in Nyarugenge prison. SPSS (version 24) was used to compute descriptive, Pearson correlation, independent t-test and regression analyses. The results indicated that the rates of shame were (100%), guilt (98.2%), anxiety (92.7%), depression (92.7%), low happiness and satisfaction with life (81.8%), and anger was (76.4%) in the current sample. Based on age category, there was no significant difference in anger scores, depression, guilt, shame and personal well-being scores between young and adult filicide mothers (p>.05). Young filicide mothers (M = 14.55, SD = 4.03), on the other hand, had higher anxiety scores than adult filicide mothers (M = 11.57, SD = 4.72), t = 2.52, p = .015. Finally, anxiety (ß = -.507, t = -3.478, p = .001) and age (ß = -.335, t = -2.685, p < .001) were negatively associated with personal well-being. The results emerged from this study highlight that filicide mothers experience substantial negative emotions and poor personal wellbeing regardless of their age category. However, poor personal wellbeing was associated with anxiety and age. Based on these results, mental health professionals should examine their mental state with respect to negative emotions and initiate programs that decrease the emotions as well as increase personal well-being.

A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda.

BACKGROUND: Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies. METHODS: This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows. RESULTS: Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants. Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources. DISCUSSION: Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.

The prevalence of mental disorders among intimate partner violence exposed and non-exposed Rwandans: Findings from a national cross-sectional survey.

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.

Intimate partner violence as a predictor of antenatal care services utilization in Rwanda.

BACKGROUND: Although compelling evidence shows that exposure to intimate partner violence (IPV) during pregnancy is detrimental to both physical and mental health of the victims and their fetuses, studies on negative impact of IPV on antenatal care (ANC) services utilization are scarce. METHODS: The aim of the current study was to determine the impact of IPV exposure on ANC services utilization indicators such as (i) initiation of care within the first 3 months of pregnancy, (ii) receipt of at least four ANC visits and (iii) receipt of care from skilled providers among reproductive age women in Rwanda. This study used the data from the 2014-15 Rwanda Demographic and Health Survey. Multiple logistic regression was used to estimate the effects of physical and sexual IPV on the ANC services utilization indicators. RESULTS: Among married women living with their partners with at least one child aged 5 years or under (N = 5116), 17% of them reported physical violence, 22.8% reported psychological violence and 9.2% reported sexual violence. We found that there was a significant negative relationship between physical IPV and both early ANC and sufficient ANC. Women who had experienced physical violence by their partners during the preceding 12 months were less likely to receive more than four ANC visits, (O.R = 0.61, CI = 0.417-0.908) and they were less likely to attend the first ANC visits within the first 3 months (O.R = 0.656, CI = 0.445-0.967). CONCLUSION: In this study, the prevalence of IPV still remains high and there is evidence that it does have significant impact on ANC. Therefore, the results provide support for continued efforts to reduce intimate partner violence, through the improvement of screening for IPV during ANC visits.

Mental disorders and substance abuse among Rwandan university students: the moderating effects of interpersonal violence.

Background: There is an abundance of evidence suggesting that interpersonal violence commonly co-occurs with mental disorders and substance abuse. Interpersonal violence is one of the most well-documented and salient factors of mental disorders and substance abuse; however, there are no studies investigating the moderating role of interpersonal violence in post-conflict Rwanda. Objective: The aim of the present study was to explore the relationship between mental disorders and substance abuse among Rwandan university students, and whether the role of interpersonal violence is a moderating factor. Method: A purposive sample of 143 undergraduate university students (mean age = 22.4 years, SD = 2.6) from University of Rwanda-Remera Campus were selected for participation in this cross-sectional study. We used linear regression analysis to examine the relationships between mental disorders, substance abuse and interpersonal violence. Results: Substance abuse was significantly associated with post-traumatic stress disorder (PTSD), anxiety, depression and interpersonal violence. Interpersonal violence was a significant moderator of the associations between PTSD symptoms (ß = 0.43, p < 0.001), anxiety symptoms (ß = 0.47, p < 0.001), depressive symptoms (ß = 0.48, p < 0.001) and substance use. Conclusion: The results imply that PTSD, depression and anxiety symptoms are associated with increased risk of substance abuse, and this risk appears to become substantially more elevated when there are also current or historic reports of interpersonal violence.

Antecedentes: Existe una gran cantidad de evidencia que sugiere que la violencia interpersonal comúnmente coexiste con los trastornos mentales y el abuso de sustancias. La violencia interpersonal es uno de los factores relativos a los trastornos mentales y el abuso de sustancias más destacado y mejor documentado; sin embargo, no hay estudios que investiguen el papel moderador de la violencia interpersonal posterior al conflicto de Ruanda.Objetivos: El objetivo del presente estudio fue explorar la relación entre los trastornos mentales y el abuso de sustancias entre los estudiantes universitarios ruandeses, y si el papel de la violencia interpersonal es un factor moderador.Métodos: Se seleccionó una muestra intencional de 143 estudiantes universitarios de pregrado (edad media = 22,4, DE = 2,6) del Campus de la Universidad de Ruanda-Remera para participar en este estudio transversal. Utilizamos el análisis de regresión lineal para examinar las relaciones entre los trastornos mentales, el abuso de sustancias y la violencia interpersonal.Resultados: El abuso de sustancias se asoció significativamente con TEPT, ansiedad, depresión y violencia interpersonal. La violencia interpersonal fue un moderador significativo de las asociaciones entre los síntomas de TEPT (ß=.43, p<0.001), síntomas de ansiedad (ß=.47, p<0.001), síntomas depresivos (ß=.48, p<0.001 y abuso de sustancias.Conclusión: Los resultados implican que los síntomas de TEPT, depresión y ansiedad están asociados con un mayor riesgo de abuso de sustancias, y estos riesgos parecen ser sustancialmente más elevados cuando también hay reportes actuales o históricos de violencia interpersonal.

Factors of postpartum depression among teen mothers in Rwanda: a cross- sectional study.

OBJECTIVE: To identify the factors of postpartum depression among teen mothers. METHOD: A convenient sample of 120 teen mothers who were aged 15 to 19 years (M = 18.02, SD = 1.16) were recruited. Depression and its related factors were assessed with Edinburgh Postnatal Depression Scale, Eating Disorder Inventory (Body Dissatisfaction and Drive for Thinness subscales), Parental stress index (Parental distress and Parental-child dysfunctional interaction subscales), Frost Multidimensional Perfectionism Scale (parental criticism of parenting subscale) and Multidimensional Scale of Perceived Social Support. Both descriptive and analytical analyses were performed using Statistical Package for the Social Sciences (SPSS version 22). RESULTS: Results showed that 48% of sample had clinically high levels of depressive symptoms. Its associated factors were parental distress (ß = .297, t = 3.378, p = .001), weight/shape disturbances (ß = .217, t = 2.42, p = .017), economic income (ß = -.210, t = -2.32, p = .022) and parental-child dysfunctional interaction (ß = .20, t = 2.08, p = .03) among seven factors considered. CONCLUSION: Regression analyses showed that parental distress, weight/shape disturbances, economic income and parental-child dysfunctional interaction predicted unique variance associated with depression level. These findings are discussed in light of future work and the persistent need to inform prevention and treatment programs for teen mothers.

Gambling, Family Dysfunction and Psychological Disorders: A Cross- Sectional Study.

The present study aimed to identify predictors and effects of problem gambling and examine the moderating role of family dysfunction between problem gambling and its effects. A sample of 104 gamblers (all were men, Mean = 26.2, SD = 6.8), was recruited from gambling venues in an urban area of Musanze district, Northern Province of Rwanda. Participants were aged above the legal age of 16 years. Data were collected using the Problem Gambling Severity Index (PGSI), the Brief Michigan Alcoholism Screening Test (Brief MAST), Drug Abuse Screening Test (DAST-10), the Psychopathy Checklist-Revised (PCL-R), the Big Five Inventory (BFI), the Insomnia Severity Index (ISI) and the Family Dysfunction Test. SPSS (version22) was used to carry out all statistical analyses. Results showed that personality traits predicted problem gambling. Additionally, problem gambling was associated with alcohol use, drug abuse, sleep deprivation, antisocial tendency and family dysfunction. Family dysfunction moderated the effects of problem gambling on drug abuse, alcohol use and sleep deprivation. Gambling is a complex but assessable phenomenon and future studies may explore further its correlates.

Parental family violence and mental health among parents and their offspring in the southern province, Rwanda

Background Children who witness violence between parents have an elevated risk of developing mental disorders as well as being victims or perpetrator of family violence (FV) in their future relationships when compared with children from non-violent family. Objectives To assess links between both parental FV and mental disorders, and mental disorders in their offspring. Methods One hundred and thirty eight (138) participants dispatched in two categories: spouses/partners (N: 89; 40 Males) and offspring (N: 49; 20 Males) have been recruited from eight District Police Unities (DPU) of the Rwandan Southern Province to participate in this cross-sectional study during a 7 months period. This study used the student "t" to examine the links between parental FV and mental disorders in offspring. Results Parental FV was linked with PTSD, psychopathic and addiction behavior symptoms in offspring. Parental anxious attachment was linked with anxiety and addiction behavior symptoms in offspring and the risk of being perpetrator or victims of FV. Parental avoidant attachment was linked with depression symptoms in offspring. Further, both parental low self-esteem and PTSD were linked with depression and PTSD symptoms in offspring. Conclusion The results indicate that FV and mental disorders experienced by parents seem to affect offspring's mental health and generate specific mental disorders. Therefore, the intervention programs should focus on the treatment of both parental and children mental disorders