mardi 19 août 2014

Intimate Partner Violence (IPV) : Expolring predictors, mental health burden and drawing interventions


Authors :
        Vincent Sezibera (PhD) & Claire Bahati (MSc)
          Department of Clinical Psychology, University of Rwanda, Rwanda
        E-mail: V.SEZIBERA@ur.ac.rw 

 

 

Background and Purpose of the study


The concept of violence against women has been used to describe a wide range of acts, including murder, rape and sexual assault, physical assault, emotional abuse, battering, stalking, prostitution, genital mutilation, sexual harassment, and pornography.


Such concepts could not distinguish violence between two persons engaged in romantic relationship from violence between intimate partners. Therefore, particular attention should be made to intimate partner violence (IPV) to better understand factors predicting violence in couples and drawn healing strategies.
The IPV is no longer considered as a situation where female is victims and male to be perpetrators. Hence, the IPV is estimated to be a “bidirectional situation” where each partner is both an aggressor and a victim (Friend et al., 2011). Moreover, IPV is a serious forensic and clinical problem that deserves particular attention and systematic intervention strategies.


Objectives


This study aimed at assessing the predicting and mental health burden from the intimate partner violence (IPV).

Methods

Aged between 24 and 77 years (M= 39; SD=11), and slightly males (54.7%), participants (N=76) were recruited from the association of IPV in the Mageragere Sector, Nyarugenge District, Kigali. It was assumed that IPV is caused by a number of factors including psycho-socio-economic factors and which affect in turn mental health. A mixed methods approach was used to serve the purpose of the study. Standardized questionnaires were used to assess the level of victimization and perpetration of the IPV and mental health poor outcomes. The quantitative data were supplemented by the qualitative data collected from interview.

Results

The major findings from this study indicate significant correlation between IPV severity, medical conditions, beliefs, past traumas/neglect and the mental health burden. The data analysis yielded that a significant number of the participants are likely to develop PTSD (36.8%), severe (28.9%) and extreme depression (27.6%) leading to suicide risk and risk behaviors (25%) as a result of being exposed to IPV. Although participants are assisted by a local association to handle the IPV issues, the Life Wounds Healing Association (LIWOHA), 25.8% reported on-going conflicts and abusive relationship at the time of the screening.

Conclusion

Results from this study are expected to raise awareness on the IPV prevalence and its detrimental effect to mental health.

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This abstract was accepted for an oral presentation at the "International German and Rwandan Medical Congress and Forensic Summer School 2014". Theme ; "The Developments of Medico-Legal Services under the perspective of Rwanda and Germany", 18th-23rd Augst 2014. Kigali/Rwanda.

mercredi 9 juillet 2014

Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial


Abstract

Objective:
The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda.

Design:
Pre-post design, including 6-month follow-up.

Methods:
The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child–caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N = 39 children) with at least one HIV-positive caregiver and one child 7–17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI.

Results:
Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P < 0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P < .05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P < 0.05).

Conclusion:
The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.

Authors :  
Betancourt, Theresa S.a,b; Ng, Lauren C.b; Kirk, Catherine M.b; Munyanah, Morrisc; Mushashi, Christinac; Ingabire, Charlesc; Teta, Sharonc; Beardslee, William R.d; Brennan, Robert T.b; Zahn, Istab; Stulac, Sarae; Cyamatare, Felix R.c; Sezibera, Vincentf



Web link :
http://journals.lww.com/aidsonline/Abstract/2014/07001/Family_based_prevention_of_mental_health_problems.16.aspx

dimanche 15 juin 2014

Trauma and PTSD in Rwanda : Prevalence and clinical implications


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Introduction: Exposure to traumatic events is hypothesized to have deleterious effect resulting in considerable psychological (cognitive and affective/emotional), physical and social impairments. In contrast to natural disasters, victims of human-made disasters have been reported to be vulnerable to severe psychological and psychiatric disorders affecting a large number of abilities and lasting for many years. Among the most common psychiatric diagnosis associated with violence exposure is the Posttraumatic Stress Disorder (PTSD). Like adults, children and adolescents are not exempt from this situation. In 1994, Rwanda experienced an unprecedented genocide in which about 800.000 Tutsi, for their majority, were atrociously murdered (UN). This genocide generated multiple and massive stressors that may lead to severe and long-lasting PTSD among its survivors.

Methods: Selective review of the literature.

Results: A recent study on mental and physical health (Munyandamutsa et al. 2012) estimated at 26.1% the prevalence rate of PTSD in the general population 14 years after the genocide. The same study established that participants meeting the full criteria for PTSD diagnosis were also likely to report major depression symptoms (68.4% vs 6.6%, P <0 .00="" 3.5="" addiction="" and="" as="" assumed="" auto-destructive="" availing="" behaviours="" between="" chronic="" clinic="" comorbid="" comorbidities="" compared="" could="" crimes="" decrease="" dependance="" developing="" domestic="" dysfuction="" equally="" evidenced="" existing="" focusing="" font="" from="" in="" including="" interventions="" is="" it="" like="" literature="" moving="" murders="" nbsp="" on="" p="0.013)" participants="" promote="" psycho-social="" psychosocial="" ptsd.="" ptsd="" relationship="" resilience="" social="" specialized="" substance="" sufferers.="" suicide.="" that="" the="" thus="" to="" trauma="" use="" violence="" vs.="" vulnerability="" without="">
Conclusion: In this specific case, there is a number of lessons to learn from the post-genocide Rwanda experience. Withstanding cultural differences, it is postulated that in-depth studies can contribute in setting up proper therapeutic interventions addressing PTSD in Rwanda.