Mental health 15 years after the killings in Rwanda: Imprisoned perpetrators of the genocide against the Tutsi versus a community sample of survivors

Abstract

Objectives of this study were to compare rates of mental health disorders in Rwandan genocide perpetrators with those of genocide survivors and to investigate potential predictors of symptoms of posttraumatic stress disorder (PTSD) and depression for both groups. We expected high rates of mental disorders in both study groups and hypothesized that symptom severity would be predicted by female gender, older age, lower level of education, higher level of trauma exposure, lower level of agreement to reconciliation, and the participation in killing. Structured clinical interviews were carried out with 269 imprisoned perpetrators (66% men) and 114 survivors (64% women). Significantly more survivors than perpetrators met symptom criteria for PTSD (46% vs. 14%) and suffered from anxiety symptoms (59% vs. 36%). A substantial proportion of both groups suffered from clinically significant depression (46% vs. 41%). PTSD severity in perpetrators was associated with trauma exposure, high levels of agreement to reconciliation, and no participation in killing; the severity of depression was associated with trauma exposure and no participation in killing. In the survivor sample, the severity of PTSD and depression were both correlated with female gender, trauma exposure, and low levels of agreement to reconciliation. Results suggest that both groups exhibit considerable psychiatric morbidity.

Posttraumatic Stress Disorder and Appetitive Aggression in Rwandan Genocide Perpetrators

“…Previous studies in Rwanda have consistently reported high rates of PTSD among adult survivors, 8 to 13 years following the genocide, ranging from 25% to 51% (Brounéus, 2010;Pham et al, 2004;Schaal et al, 2011). A recent study with imprisoned perpetrators found that 14% fulfilled diagnostic criteria for PTSD (Schaal et al, 2012). The study reported here demonstrates that diagnostic criteria for current PTSD were met by 5% of the perpetrators.…”

“…There are several possible explanations for this difference in PTSD rates. One potential explanation is that perpetrators in the TIG camps reported exposure to fewer potentially traumatic events compared to the Schaal et al (2012) study with imprisoned perpetrators. Another plausible explanation is that the enduring marginalization and stigmatization that people constantly experience in the prisons might aggravate their mental health problems.…”

“…Interviewers asked if the person had ever committed any of 16 different types of crimes (Offense Scale) in the past. This list has already been used in a previous study (Schaal et al, 2012). Participants were asked to indicate the most frightening event ever experienced (from the Event Scale or the Offense Scale) to which the rating of PTSD symptoms referred.…”

“…Some have argued that participation in mass violence and the infliction of harm on others could be considered a potentially traumatizing event that could also cause trauma-related symptoms (MacNair, 2002a;Staub, 2006). Indeed, the results of a recent study showed that imprisoned perpetrators of the Rwandan genocide exhibit a considerable degree of psychiatric morbidity (Schaal, Weierstall, Dusingizemungu, & Elbert, 2012).…”

Forensic psychiatry in Rwanda

“…Rwanda has developed, during the last two decades, several international collaborations in the field of mental health and psychiatry, notably with European academic institutions in Sweden [20], Germany [21] and Switzerland [10]. There is currently an expressed need for expanding these collaborations in order to develop a modern forensic psychiatry system in the country.…”