Mental and physical health in Rwanda 14 years after the genocide

To examine the socio-demographic determinants of post-traumatic stress disorder (PTSD) and its association with major depressive
episode and self-perceived physical and mental health in a large random sample of the Rwandan population 14 years after the
1994 genocide.

Using the Mini International Neuropsychiatric Interview and Medical Outcomes Study 36-Item Short-Form (SF-36) translated in
Kinyarwanda, we interviewed 1,000 adult residents from the five provinces of Rwanda. Socio-demographic data and specific somatic
symptoms were also recorded. Data analysis included 962 questionnaires.

Participants were predominantly female (58.9%), aged between 16 and 34 years (53.2%), with a low level of education (79.7%
below secondary school). Prevalence of PTSD was estimated to be 26.1%. In multivariable analysis, factors associated with
PTSD were being aged between 25 and 34 years, living in extreme poverty, having endured the murder of a close relative in
1994, being widowed or remarried, having lost both parents and living in the South Province. Participants who fulfilled diagnostic
criteria for PTSD were significantly more often affected with major depression (68.4 vs. 6.6%, P < 0.001) and substance dependence (7.6 vs. 3.5%, P = 0.013) than respondents without PTSD. They scored significantly lower on all SF-36 subscales. Somatic symptoms such as
hiccups, fainting and loss of speech or hearing delineated a specific pattern of post-traumatic stress syndrome.

PTSD remains a significant public health problem in Rwanda 14 years after the genocide. Facilitating access to appropriate
care for all those who need it should be a national priority.