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ABSTRACT: The factor structure of posttraumatic stress disorder (PTSD) symptoms in Euro-American populations has been extensively studied, but confirmatory factor analytic studies from non-Western societies are lacking. Alternative models of DSM-IV symptoms were tested among Rwandan adults (N=465) who experienced trauma during the 1994 genocide. A cluster random survey was conducted with interviews held in Rwandan households. PTSD was assessed with the Posttraumatic Stress Disorder Checklist-Civilian version. Competing models were the DSM-IV, emotional numbing, dysphoria, aroused intrusion, and dysphoric arousal models. Results showed that the emotional numbing, dysphoria, and dysphoric arousal models had almost identical, good fit indices and fit the data significantly better than the other models. The emotional numbing and dysphoric arousal models also exhibited good construct validity. Results suggest that the latent structure of PTSD symptoms in Rwanda are comparable to that found in Euro-American samples, thereby lending further support to the cross-cultural validity of the construct. Copyright © 2015. Published by Elsevier Ltd.
samedi 20 février 2016
The factor structure PTSD among Rwandans exposed to the 1994 genocige
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.
samedi 10 août 2013
Effect of Parenting and Social Support on PTSD Symptoms in Children who Experienced Upsetting Events
Charles Ingabire,1 Lauren Ng,2 Catherine Kirk,2
Vincent Sezibera,3 Theresa Betancourt3-4
1 Partners in Health Rwanda – Inshuti Mu Buzima, Rwinkwavu, Rwanda
2 Francois Xavier Bagnoud Center for Health and Human Rights, Boston, USA
3 National University of Rwanda, Butare, Rwanda
4 Department Global Health and Population,
Harvard School of Public Health, Boston, USA
ABSTRACT
Background: Families and communities often provide primary support to children who
have experienced upsetting events. This may be particularly true in Rwanda
where families face multiple stressors and mental health services are limited.
This study analyzes the relationship between parenting and social support on
posttraumatic stress disorder (PTSD) symptoms in children who experienced
potentially traumatic events in Rwanda.
Methods:
681 HIV+, HIV-affected, and non-HIV-affected children
aged 10-18, were interviewed (51.5% female, mean age 13.6). Children verbally
completed the UCLA PTSD-RI assessing PTSD symptoms and upsetting events.
Multiple linear regressions were run in which reporting an upsetting event and
locally-adapted measures of parenting and social support predicted PTSD
symptoms, after controlling for sex, age, and HIV stratification.
Results: 64.1% of children reported an event that continues to upset them. PTSD
symptoms ranged from 0 to 22 (mean 7.23); only 17.7% reported no symptoms.
Parenting and social support negatively predicted PTSD symptoms while age and
reporting an upsetting event positively predicted symptoms (all p<.01).
Conclusions: Good parenting and social support may reduce PTSD symptoms in children
who have experienced upsetting events. Interventions that strengthen parents,
families, and communities may help children cope with multiple adversities.
Sezibera Bios
Vincent Sezibera, PhD
A Senior Lecturer in the Department of Psychology (Chairperson) at the
National University of Rwanda (NUR) and an outpatient consultant and therapist
at the NUR University Center for Mental Health, Dr. Sezibera specializes in
PTSD and child and adolescent traumatic grief. His doctorate in psychology,
from the Catholic University of Louvain, Belgium focuses on trauma and
bereavement among young survivors of the 1994 genocide in Rwanda.
A Rwanda national specialized
in the field of clinical psychology; Dr. Sezibera has conducted different
researches and developed some protocols aiming at the Post-Traumatic Stress
Disorder (PTSD) and Complicated Grief (CG) treatment. Among the protocols, Dr.
Sezibera developed a treatment protocol on rumination change and its effect on
the PTSD prevalence. In the population of children and adolescents, Dr.
Sezibera is developing the “Memory Box” method for healing bereaved and
traumatized children. His ongoing research endeavors are oriented on the
assessment of these treatment protocols’ effectiveness in the population of
multi-traumatized survivors of the 1994 genocide against Tutsi in Rwanda. His
teaching load is related to Psychopathology, Psychotherapies: Cognitive and
Behavioral approach, Personality theories, Grief and Mourning, etc.
The spring and summer 2011,
Dr. Sezibera was visiting as a Fulbright Scholar-in-Residence at TCSPP-Chicago
and Harold Washington Community College. From August 2011 to date, Dr. Sezibera
is a Part-Time Dissertation Affiliate Faculty in the International PhD
Department, Associate Professor.
March 30-April 29, 2012; Dr. Sezibera was hosted
at the Harvard School of Public Health, FXB Center for Health and Human Rights,
as Research Associate where he delivered lectures and conferences related to
his extensive research on Trauma and PTSD.
For contact:
E-mail: vsezibera@nur.ac.rw
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