Caseness and comorbidity of probable (complex) post-traumatic stress disorder and depression in survivors of genocide against Tutsi in Rwanda: the role of social determinants

Abstract

Numerous studies have been conducted among survivors of the genocide against the Tutsi on the prevalence of depression and post-traumatic stress disorder. However, thus far, no studies provide information on the frequency of comorbidity of these disorders, the prevalence of the new trauma-related diagnostic disorder known as complex post-traumatic stress disorder, and the role of social determinants, such as age, sex, marital status, employment category, education, and location, in the occurrence of these disorders. The present study was conducted to address these gaps. Genocide survivors ( N = 261 participants; M = 46.30, SD = 11.95, females = 52.9%) took part in the study. They completed the International Trauma Questionnaire, the Public Health Depression Questionnaire, and the Harvard Trauma Questionnaire. Descriptive statistical analyses, bivariate analyses with two-tailed chi-square tests, and logistic regression were used to determine the prevalence of the above-mentioned disorders, comorbidity, and the associations between the social determinants and the assessed psychopathologies. Of the total sample, 47.1% presented with at least one of the assessed probable mental health disorders: 15.3% ( n = 40) met the criteria for probable post-traumatic stress disorder, 15.3% ( n = 40) for probable complex post-traumatic stress disorder, and 38.7% ( n = 101) for probable depression. Of the participants with probable post-traumatic stress disorder and complex post-traumatic stress disorder, nearly half met the criteria for probable depression. Being married but not living with the partner was associated with probable complex post-traumatic stress disorder, and unemployment was associated with probable depression. Our findings suggest clinicians and policymakers that they should consider comorbidity and social determinants in their interventions.

Elements of cultural scripts of trauma sequelae among trauma victims in East Africa

“…Several studies have identified trauma-related disorders in East African populations, including post-traumatic stress disorder (PTSD), its complex forms, depression (Mugisha et al, 2015;Familiar et al, 2016;Bapolisi et al, 2020;Mutuyimana et al, 2023) and clinical aspects of historical trauma (Mutuyimana and Maercker, 2022). However, clinical experience has shown that survivors of trauma in East Africa may present with symptoms that differ from those in the trauma-related disorder categories.…”

“…Although the processes described in the context of CSTs may play an important role in clinical practice and research, they have not been explored in populations exposed to traumatic events, such as in Africa. A recent study in East Africa showed that 52% of participants did not meet criteria for probable PTSD, complex PTSD, and depression, although they had other significant clinical symptoms (Mutuyimana et al, 2023). This could be due to many factors, including assessment inadequacy and mental disorder symptoms that do not fit the East African culture.…”