Trauma and PTSD Symptoms in Rwanda: Implications for Attitudes Toward Justice and Reconciliation
CONTEXT The 1994 genocide in Rwanda led to the loss of at least 10% of the country's 7.7 million inhabitants, the destruction of much of the country's infrastructure, and the displacement of nearly 4 million people. In seeking to rebuild societies such as Rwanda, it is important to underst...
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| Published in: | JAMA : the journal of the American Medical Association 2004-08, Vol.292 (5), p.602-612 |
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| Main Authors: | , , |
| Format: | Article |
| Language: | eng |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | CONTEXT The 1994 genocide in Rwanda led to the loss of at least 10% of the country's
7.7 million inhabitants, the destruction of much of the country's infrastructure,
and the displacement of nearly 4 million people. In seeking to rebuild societies
such as Rwanda, it is important to understand how traumatic experience may
shape the ability of individuals and groups to respond to judicial and other
reconciliation initiatives. OBJECTIVES To assess the level of trauma exposure and the prevalence of posttraumatic
stress disorder (PTSD) symptoms and their predictors among Rwandans and to
determine how trauma exposure and PTSD symptoms are associated with Rwandans'
attitudes toward justice and reconciliation. DESIGN, SETTING, AND PARTICIPANTS Multistage, stratified cluster random survey of 2091 eligible adults
in selected households in 4 communes in Rwanda in February 2002. MAIN OUTCOME MEASURES Rates of exposure to trauma and symptom criteria for PTSD using the
PTSD Checklist–Civilian Version; attitudes toward judicial responses
(Rwandan national and gacaca local trials and International Criminal Tribunal
for Rwanda [ICTR]) and reconciliation (belief in community, nonviolence, social
justice, and interdependence with other ethnic groups). RESULTS Of 2074 respondents with data on exposure to trauma, 1563 (75.4%) were
forced to flee their homes, 1526 (73.0%) had a close member of their family
killed, and 1472 (70.9%) had property destroyed or lost. Among the 2091 total
participants, 518 (24.8%) met symptom criteria for PTSD. The adjusted odds
ratio (OR) of meeting PTSD symptom criteria for each additional traumatic
event was 1.43 (95% CI, 1.33-1.55). More respondents supported the local judicial
responses (90.8% supported gacaca trials and 67.8% the Rwanda national trials)
than the ICTR (42.1% in support). Respondents who met PTSD symptom criteria
were less likely to have positive attitudes toward the Rwandan national trials
(OR, 0.77; 95% CI, 0.61-0.98), belief in community (OR, 0.76; 95% CI, 0.60-0.97),
and interdependence with other ethnic groups (OR, 0.71; 95% CI, 0.56-0.90).
Respondents with exposure to multiple trauma events were more likely to have
positive attitudes toward the ICTR (OR, 1.10; 95% CI, 1.04-1.17) and less
likely to support the Rwandan national trials (OR, 0.90; 95% CI, 0.84-0.96),
the local gacaca trials (OR, 0.80; 95% CI, 0.72-0.89), and 3 factors of openness
to reconciliation: belief in nonviolence (OR, 0.92; 95% CI, 0.87-0.97), belief
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| ISSN: | 0098-7484 1538-3598 |