Post-traumatic stress reactions among Rwandan children and adolescents in the early aftermath of genocide.
BACKGROUND
Epidemiological investigations of post-traumatic stress reactions in Sub-Saharan Africa, where atrocious violence against civilians is endemic, are rare. This article is the first complete report of the key community-based findings of a 1995 psychiatric epidemiological survey of young survivors of the 1994 Rwandan Genocide.


METHODS
The National Trauma Survey (NTS) of Rwandans aged 8-19 measured traumatic exposures using an inventory of possible war time experiences and post-traumatic stress reactions with a checklist of symptoms of Post-traumatic stress disorder (PTSD). Individuals meeting assessed PTSD diagnostic criteria are classified as cases of 'probable PTSD'. The NTS interviewed youth residing in the community and others institutionalized in unaccompanied children's centres; the former (n = 1547) are the subject of the present report. Instrument change midway into the study divides respondents into two samples.


RESULTS
Among respondents, over 90% witnessed killings and had their lives threatened; 35% lost immediate family members; 30% witnessed rape or sexual mutilation; 15% hid under corpses. In Sample 1, 95% of respondents reported one or more re-experiencing symptom, 95% reported three or more avoidance/blunting symptoms and 63% reported two or more arousal symptoms; in Sample 2, these figures were 96%, 95% and 56%, respectively. The overall rate of 'probable PTSD' was 62% and 54% in Samples 1 and 2, respectively, and exhibited a dose-response relationship with exposure. Among the most heavily exposed individuals the rate was 100%. Rates of 'probable PTSD' were higher among females than among males. Results for age were inconsistent.


CONCLUSIONS
In industrialized societies, most survivors of traumatizing violence experience symptoms only transiently. In the Rwanda survey, symptom levels and rates of 'probable PTSD' were exceptionally elevated, suggesting that at the limits of catastrophic man-made violence, psychological resilience among youth is all but extinguished.
Neugebauer
Richard
R
Division of Epidemiology, NYS Psychiatric Institute, New York, NY 10032, USA. rn3@columbia.edu
Fisher
Prudence W
PW
Turner
J Blake
JB
Yamabe
Saori
S
Sarsfield
Julia A
JA
Stehling-Ariza
Tasha
T
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006306:Health Surveys; D006708:Homicide / Q000523:psychology*; D006801:Humans; D008297:Male; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014754:Violence / Q000523:psychology; D014857:Warfare; D055815:Young Adult