Trauma Exposure and Psychological Reactions to Genocide Among Rwandan Children

Senter for Krisepsykologi, Bergen, Hordaland, Norway
Journal of Traumatic Stress (Impact Factor: 2.72). 12/1999; 13(1):3-21. DOI: 10.1023/A:1007759112499
Source: PubMed

ABSTRACT A total of 3030 children age 8–19 years from Rwanda was interviewed about their war experiences and reactions approximately 13 months after the genocide that started in April 1994. Rwandan children had been exposed to extreme levels of violence in the form of witnessing the death of close family members and others in massacres, as well as other violent acts. A majority of these children (90%) believed that they would die; most had to hide to survive, and 15% had to hide under dead bodies to survive. A shortened form of the Impact of Event Scale used in a group of 1830 of these children documented high levels of intrusion and avoidance. While children living in shelters were exposed to more trauma, they evidenced less posttraumatic reactions. Analyses showed that reactions were associated with loss, violence exposure, and, most importantly, feeling their life was in danger.

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    ABSTRACT: RIASSUNTO: Premesse teoriche: I traumi precoci hanno effetti sullo sviluppo che non necessariamen-te sono riconducibili alla sequela post-traumatica prevista dai criteri diagnostici del Disturbo Post Trauma-tico da Stress (PTSD). Obiettivo: Obiettivo di questa rassegna è quello di illustrare i recenti tentativi di ri-definizione del PTSD in termini evolutivi. Metodologia: Dopo aver descritto i criteri diagnostici previsti dal DSM-IV, vengono passati in rassegna i principali contributi che hanno indicato la necessità di criteri evolu-tivi per il PTSD, tra cui la proposta di una nuova diagnosi di "Developmental Trauma Disorder"(van der Kolk, 2005). Discussione critica e conclusioni: Le ricerche sulle sequele post-traumatiche in bambini esposti ad eventi di guerra, assieme a quelle relative ai correlati neurobiologici del PTSD, confermano la complessa ar-ticolazione ed i rischi relativi al trauma in età evolutiva. ABSTRACT: Background: Effects of early trauma are not inevitably those typical of the posttraumatic symptomatology as described by the Post Traumatic Stress Disorder (PTSD) diagnostic criteria. Objective: The aim of this review is to illustrate recent attempts to redefine PTSD diagnostic criteria in developmental terms. Method: After describing DSM-IV diagnostic criteria for PTSD, the main contributions towards their developmental redefinition are reviewed, including the recent proposal of a "Developmental Trauma Di-sorder" (van der Kolk, 2005). Critical discussion and conclusions: Studies on posttraumatic sequelae in children exposed to war, as well as those focusing on PTSD neurobiological correlates, indicate the com-plex phenomenology and the risks inherent to early trauma.
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    ABSTRACT: In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda. We conducted a population-based case-control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members. After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide. These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Journal of Epidemiology &amp Community Health 12/2014; 69(2). DOI:10.1136/jech-2014-204307 · 3.29 Impact Factor
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    ABSTRACT: Treatments for adolescents affected by long-term loss in low- and middle-income countries are lacking. As school-based interventions are cost-efficient and easy to disseminate, an evaluation of this treatment setting for adolescents is worthwhile. Examining the effect of a school-based unstructured emotional writing intervention (sensu Pennebaker, group 1) about the loss of a parent to reduce adaptation problems to loss, compared to writing about a hobby (group 2), and non-writing (group 3). We randomly assigned 14-18-year-old Rwandan orphans to one of the three conditions (n=23 per condition). Before and after the intervention, subjects completed the Prolonged Grief Questionnaire for Adolescents and the Mini International Neuropsychiatric Interview for Children and Adolescents, Part A, on depression as self-report measures of long-term effects of early parental loss. Repeated measures analyses of variance showed no differential effect for any of the three conditions but revealed a significant effect of time at posttest regarding grief severity. Reduction of grief symptoms was significantly higher in subjects with elevated grief. Depressive symptoms showed no significant change from pre- to posttest in the emotional writing condition, whereas they significantly decreased in the control condition. RESULTS imply that unstructured, brief emotional writing might not be indicated in adolescents affected by early parental loss who show severe and long-term distress; a more structured approach seems recommendable.
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