title: Mental and physical health in Rwanda 14 years after the genocide.
abstract: OBJECTIVE
  To examine the socio-demographic determinants of post-traumatic stress disorder (PTSD) and its association with major depressive episode and self-perceived physical and mental health in a large random sample of the Rwandan population 14 years after the 1994 genocide.
  
  
  METHODS
  Using the Mini International Neuropsychiatric Interview and Medical Outcomes Study 36-Item Short-Form (SF-36) translated in Kinyarwanda, we interviewed 1,000 adult residents from the five provinces of Rwanda. Socio-demographic data and specific somatic symptoms were also recorded. Data analysis included 962 questionnaires.
  
  
  RESULTS
  Participants were predominantly female (58.9%), aged between 16 and 34 years (53.2%), with a low level of education (79.7% below secondary school). Prevalence of PTSD was estimated to be 26.1%. In multivariable analysis, factors associated with PTSD were being aged between 25 and 34 years, living in extreme poverty, having endured the murder of a close relative in 1994, being widowed or remarried, having lost both parents and living in the South Province. Participants who fulfilled diagnostic criteria for PTSD were significantly more often affected with major depression (68.4 vs. 6.6%, P < 0.001) and substance dependence (7.6 vs. 3.5%, P = 0.013) than respondents without PTSD. They scored significantly lower on all SF-36 subscales. Somatic symptoms such as hiccups, fainting and loss of speech or hearing delineated a specific pattern of post-traumatic stress syndrome.
  
  
  CONCLUSIONS
  PTSD remains a significant public health problem in Rwanda 14 years after the genocide. Facilitating access to appropriate care for all those who need it should be a national priority.
authors.affiliation: Psychosocial Consultation Centre, Kigali, Rwanda.
authors.forename: Naasson
authors.initials: N
authors.lastname: Munyandamutsa
authors.forename: Paul
authors.initials: P
authors.lastname: Mahoro Nkubamugisha
authors.forename: Marianne
authors.initials: M
authors.lastname: Gex-Fabry
authors.forename: Ariel
authors.initials: A
authors.lastname: Eytan
mesh_terms: D000293:Adolescent; D000328:Adult; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D063365:Genocide / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D010809:Physical Fitness; D011569:Psychiatric Status Rating Scales; D012432:Rwanda / Q000453:epidemiology; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult