Prevalence and predictors of posttraumatic stress disorder and depression in HIV-infected and at-risk Rwandan women.
OBJECTIVE
During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms.


METHODS
The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean > 2) and depressive symptoms (CES-D > or = 16) for 850 women (658 HIV-positive and 192 HIV-negative).


RESULTS
PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p = 0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p < 0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making < $18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms.


CONCLUSIONS
The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts < 200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.
Cohen
Mardge H
MH
Departments of Medicine, John Stroger (formerly Cook County) Hospital and Rush University, Chicago, Illinois, USA. mardge.cohen@gmail.com
Fabri
Mary
M
Cai
Xiaotao
X
Shi
Qiuhu
Q
Hoover
Donald R
DR
Binagwaho
Agnes
A
Culhane
Melissa A
MA
Mukanyonga
Henriette
H
Karegeya
Davis Ksahaka
DK
Anastos
Kathryn
K
D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D013315:Stress, Psychological / Q000453:epidemiology; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*; D016387:Women's Health; D055815:Young Adult