title: Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide.
abstract: OBJECTIVE
  To investigate mental health effects associated with exposure to trauma in Rwanda during the 1994 genocide period, and over the lifetime, in Rwandan men and women aged 20-35 years.
  
  
  METHODS
  This was a cross-sectional population-based study conducted in the southern province of Rwanda. Data was collected during December 2011 to January 2012.
  
  
  METHODS
  A total population of 917 individuals were included, 440 (48%) men and 477 (52%) women aged 20-35 years. Number of households for inclusion in each village was selected proportional to the total number of households in each selected village. The response rate was 99.8%. Face-to-face interviewing was done by experienced and trained clinical psychologists, following a structured questionnaire.
  
  
  RESULTS
  Women were slightly less exposed during the genocide period (women 35.4% and men 37.5%; p=0.537), but more women than men were exposed to traumatic episodes over their lifetime (women 83.6%, n=399; men 73.4%, n=323; p<0.001). Current major depressive episodes (MDE) were twice as prevalent in women as in men. Traumatic episodes experienced in the genocide period severely affected men's current mental health status with relative risk (RR) 3.02 (95% CI 1.59 to 5.37) for MDE past and with RR 2.15 (95% CI 1.21 to 3.64) for suicidality. Women's mental health was also affected by trauma experienced in the genocide period but to an even higher extent, by similar trauma experienced in the lifetime with RR 1.91 (95% CI 1.03 to 3.22) for suicidality and RR 1.90 (95% CI 1.34 to 2.42) for generalised anxiety disorder, taking spousal physical/sexual violence into consideration.
  
  
  CONCLUSIONS
  Depression, post-traumatic stress disorder, anxiety and suicidal attempts are prevalent in Rwanda, with rates twice as high in women compared with men. For women, exposure to physical and sexual abuse was independently associated with all these disorders. Early detection of gender-based violence through homes and community interventions is important.
authors.affiliation: Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rugema
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umea, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Mogren
authors.affiliation: Department of Community Health, School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.affiliation: Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors.forename: Gunilla
authors.initials: G
authors.lastname: Krantz
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D005191:Family Characteristics; D005260:Female; D063365:Genocide / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000209:etiology*; D008603:Mental Health; D015995:Prevalence; D011902:Rape / Q000523:psychology*; D012111:Residence Characteristics; D012306:Risk; D012432:Rwanda / Q000453:epidemiology; D012737:Sex Factors; D013179:Spouse Abuse / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology; D013406:Suicide, Attempted; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HEALTH SERVICES ADMINISTRATION & MANAGEMENT; PSYCHIATRY; PUBLIC HEALTH; REHABILITATION MEDICINE; SOCIAL MEDICINE