Rwanda – lasting imprints of a genocide: trauma, mental health and psychosocial conditions in survivors, former prisoners and their children

Abstract

BackgroundThe 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.MethodsA 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.ResultsSurvivors 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%, χ2(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.ConclusionsOur 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.

How Legacies of Genocide Are Transmitted in the Family Environment: A Qualitative Study of Two Generations in Rwanda

“…Our findings confirm the profound effects of the genocide and its aftermath on individuals, families and communities in Rwanda [22,34,[37][38][39]. Mothers testified to experiencing and witnessing many traumatizing events, and to bearing the psychological, physical, social and economic consequences of the past violence.…”

“…The model has originally been developed in contexts of family violence and has proven to be valuable for understanding continuity in offending. Since recently, the cycle of violence theory is receiving increasing attention in conflict-affected contexts [19][20][21][22][23][24][26][27][28][29], perhaps because rates of relapse into conflict are worrying [1]. Overall, insight into the mechanisms fostering intergenerational continuity is still limited, however.…”

“…Such forms of continuity may also entail experiences of victimization in one generation affecting anti-social behavior among the next generation. In conflict-affected societies, the theoretical perspective of the cycle of violence theory is receiving increasing attention [19][20][21][22][23][24]. The mechanisms responsible for intergenerational continuity in violence, however, are still poorly understood in this field [25].…”

History, trauma and remembering in Kivu Ruhorahoza’sGrey Matter(2011)

“…She goes on to note that 'often trauma survivors try very hard not to remember, but memories return anyway in the form of nightmares and flashbacks or "acting out", common symptoms of post-traumatic stress disorder ' (2013, 82). This form of recall and inability to process the experience temporarily and narratively is well documented in literature based on Rwandan survivor testimony (see for instance, Hatzfeld 2005Hatzfeld , 2009) but also numerous studies of the occurrence of PTSD in Rwanda (see, for instance, Pham, Weinstein, and Longman 2004;Rieder and Elbert 2013).…”

Post War Psychological Morbidity among Internally Displaced, Married Females in Northern Sri Lanka

“…We used a translated and validated Tamil questionnaire. The PSSR-17 is a questionnaire used to assess combat stress and PTSD among post war refugees in different countries [6]. It is a 17 item questionnaire with scores from 0 to 3 for each item, depending on severity of symptoms.…”