title: Individual-level factors associated with mental health in Rwandan youth affected by HIV/AIDS.
abstract: Prevention of mental disorders worldwide requires a greater understanding of protective processes associated with lower levels of mental health problems in children who face pervasive life stressors. This study aimed to identify culturally appropriate indicators of individual-level protective factors in Rwandan adolescents where risk factors, namely poverty and a history of trauma, have dramatically shaped youth mental health.
  
  
  
  The sample included 367 youth aged 10-17 in rural Rwanda. An earlier qualitative study of the same population identified the constructs "kwihangana" (patience/perseverance) and "kwigirira ikizere" (self-esteem) as capturing local perceptions of individual-level characteristics that helped reduce risks of mental health problems in youth. Nine items from the locally derived constructs were combined with 25 items from an existing scale that aligned well with local constructs-the Connor-Davidson Resilience Scale (CD-RISC). We assessed the factor structure of the CD-RISC expanded scale using exploratory factor analysis and determined the correlation of the expanded CD-RISC with depression and functional impairment.
  
  
  
  The CD-RISC expanded scale displayed high internal consistency (α = 0.93). Six factors emerged, which we labeled: perseverance, adaptability, strength/sociability, active engagement, self-assuredness, and sense of self-worth. Protective factor scale scores were significantly and inversely correlated with depression and functional impairment (r = -0.49 and r = - 0.38, respectively).
  
  
  
  An adapted scale displayed solid psychometric properties for measuring protective factors in Rwandan youth. Identifying culturally appropriate protective factors is a key component of research associated with the prevention of mental health problems and critical to the development of cross-cultural strength-based interventions for children and families.
authors.affiliation: New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Scorza
authors.affiliation: New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., New York, NY, 10032, USA.
authors.forename: Cristiane S
authors.initials: CS
authors.lastname: Duarte
authors.affiliation: The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, 5 Longfellow Place, Suite 215, Boston, MA, 02114, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Stevenson
authors.affiliation: Partners In Health-Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Christine
authors.initials: C
authors.lastname: Mushashi
authors.affiliation: Partners In Health-Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kanyanganzi
authors.affiliation: Partners In Health-Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
authors.forename: Morris
authors.initials: M
authors.lastname: Munyana
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 665 Huntington Ave., 12th floor, Boston, MA, 02115, USA. theresa_betancourt@harvard.edu.
authors.forename: Theresa S
authors.initials: TS
authors.lastname: Betancourt
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D065840:Protective Factors; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012432:Rwanda / Q000453:epidemiology
keywords: Mental health; Protective factors; Resilience; Rwanda; Youth