KENYA PSYCHITRIC ASSOCIATION 5TH ANNUAL

SCIENTIFIC CONFRENCE13TH 15TH JUNE 2013

VENUE LA MADA HOTEL; NAIROBI

PSYCHOTRUAMA AND GENDER ISSUES

SUBTHEME

TITLE POST TRAUMATIC STRESS DISORDER

AMONG WIDOW SURVIVORS OF THE 1994 RWANDESE GENOCIDE (2009)

AUTHORS DR.NGAMIJE K SHADRCK PROF,NDETEI D.M. DR.MBURU. J.M DR WANGARI KURIA

ABSTRACT

LARGEST GENOCIDE IN AFRICA BY 1994 AFFECTED THE WHOLE POPULATION ONE MILLION WERE KILLED(NEARLY 15% OF

THE POPULATION) TWO MILLION REFUGEES CREATED RESULTED IN GREAT SUFFERING

INTRODUCTION

WHAT IS THE PREVALENCE OF PTSD AMONG WIDOW SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

RESEARCH QUESTION

NULL HYPOTHESIS THERE IS NO PTSD AMONG WIDOW

SURVIVORS OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

ALTERNATIVE HYPOTHESIS THERE IS PTSD AMONG WIDOW SURVIVORS

OPF RWANDESE GENOCIDE 14 YRS AFTER THE EVENT

RESEARCH HYPOTHESIS

DETERMINE PTSD AMONG WIDOWS SURVIVORS OF 1994 RWANDESE GENOCIDE 14 YRS AFTER EVENT

CORRELATE SOCIO DEMOGRAPHIC PATTERNS AND PTSD

DETERMINE ASSOCIATED PSYCHIATRIC MORBIDITY

OBJECTIVES

THE YOUNGER THE WOMAN IS WIDOWED THE MORE INTENSE HER GRIEF(HAGENGIMAN A.NDETEI D.M,MBURU. J.M, KANGETHE ,R. 1996)

WOMEN AND YOUNG PERSONS AND THOSE WITH LOW LEVEL OF EDUCATION ARE MORE SUSECPTIBLE TO PTSD(CREAMER .M. et al 2001)

WOMEN WHO EXPERIENCED PTSD HAD DOUBLE RISK OF DEVELOPING A DEPRESSIVE DISORDER AND THREE TIMES THE RISK OF DEVELOPING ALCOHOL RELATED PROBLEMS IN FUTURE(KILONZO G. et al 2006)

LITERATURE REVIEW

OVERALL 7.8% IN (USA) 10.4 % IN WOMEN 5 % IN MEN IN MEN (KESSLER R.C. ET AL

1995)

7.4% HOSPITALIZED PATIENTS AT MATHATHARI HOSPITAL (NDETEI ET AL 2008)

EPIDEMIOLGY OF PTSD IN NON POST CONFLICT SOCIETIES

SOUTH LEBANON 29.3% IN CIVILIAN POPULATION(FARHOOD. L

ET AL 2006)WEST NILE REGION 31.6 % OF MALE.40.1%OF FEMALE(NEUNER

F ET AL 2004)

EPIDEMIOLGY OF PTSD IN POST CONFLICT SOCIETIES

UGANDA 39.9% PTSD, 52% DEPRESSION 60%

SOMATIZATION DISORDER AT 72.2% SUICIDE 22.7% ALCHOL ABUSE 18.2% (MUSISI S. 2005)

26.8% IN ABUCTED ADOLESENTS IN GULU DISTRICT (OKELLO.J.ET AL 2007)

RWANDA 20.3%((HAGENGIMAN A.NDETEI D.M,

KANGETHE ,R. 1996) WHOLE POULATION 35.5% HIV INFECTED WOMEN

SURVIVORS(FABRIC M ,KOVLER M 2007)

EPIDEMIOLGY OF PTSD-3

KENYA 33.8% SEXUALLY ABUSED

WOMEN(ONYANCHA N 2004) 52.5% WOMEN SURVIVORS OF DOMESTIC

VIOLENCE(HINGA ,S . 2006) 65.7% IN SURVIVORS OF MAU MAU

CONCENTRATION CAMPS(lUKOYE.A 2006)80.2 % IN INTERNALLY DISPLACED POPULATIONS IN RIFT VALLEY (NJAU J.W. 2005)

EPIDEMIOLGY OF PTSD-4

CROSS-SECTIONAL DESCRIPTIVE STUDY SAMPLE INCLUDED 110 WIDOW SURVIVORS

WHO COSENTED ALL REGISTERED WITH EVEGA (ASSOCITION

DES VEUVES DU GENOCIDE)AGAHOZO IE WIDOWS ASSOCIATION OF GENOCIDE SURVIVORS

SELECTED RANDOMLY IN 5 DIFFERENT SITES(PROVINCES IN RWANDA)

METHODOLGY

INSTRUMENTS1. RESEARCHER DESIGNED

SOCIODEMOGRAPHIC QUESWTIONNAIRE2. THE HARVARD TRAUMA QUESTIONNNAIRE3. THE ALCOHOL SMOKING AND SUBSTANCE

INVOLVEMENT SCREENING TEST(ASSIST)4. THE STRUCTURED CLINICAL INTERVIEW

FOR THE DIAGNOSTIC AND STATISTICAL MANUAL IV

METHODOLOGY

N=11O AGE ; 36-65 YRS LIFETIME PTSD; 53.2% CURRENT PTSD; 28.2%

RESULTS -

PTSD VS VARIABLE STATISTICAL FINDINGS

SIGNIFICAT NON SIGNIFICAT

1. RAPE(P=0.02)2. FORCED SEPARTION FROM FAMILY

MEMBERS(P=0.002)3. MURDER OF A FAMILY MEMBER OR

FRIEND(P=0.00)4. BEING SLASHED (P=0.001)5. BEING TIED UP(P=0.032)6. INABILITY TO HELP RELATIVE(P=)

(P=0.018)7. SUICIDE IDEATION(P=)8. SATISFACTION WITH

ASSISTANCE(P=0.001)9. BEING ILL AND INACCESSSIBILITY TO

CARE(P=0.011)10. BEING SHOT(P=0.000)11. BEING SEVERLY WOUNDED(P=0.00)12. MURDER OF A FAMILY OR

FRIEND(P=0.001)

1. AGE(P=0.5)2. NO. OF CHILDREN((P=0.126)3. LEVEL OF EDUCATION(P=0.627)4. OCCUPATION(P=0.218)5. RELIGION(P=0.610)6. BEING BEATEN(P=0.110)7. NO WHERE TO HIDE(P=0.074)8. MONTHLY INCOME(P=0.082)9. BEING TRATED WITH ANOTHER MENTAL

ILLNES(P=0.258)10. FAMILY HX OF MENRTAL ILLNESS(P=0.66)11. MATERIAL ASSISTANCE(P=0.06)12. SATISFACTION WITH TRIAL OF GENOCIDE

PERPETRATORS((P=0.87)13. BEING FORCED TO KILL(P=0.069)14. HIDING FOR A LONG TIME(P=0.209)15. BEING BURIED ALIVE(P=0.161)16. DENYING YOUR TRIBE

RELATIVES ,ORIGIN(P=0.81217. LYING AMONG CORPSES(P=0.794)

SIGNIFICANT ALCOHOL(P=0.014

) SUCIDALITY(P=0.0

02)

NON SIGNIFICANT

SMOKING(P=0.082)

SUICIDE PLAN(P=0.0.3239)

PTSD VS ASSIT

PTSD AND PSYCHIATRIC MORBIDITY

SIGNIFICANT NON SIGNIFICANT

MAJOR DEPRESSIVE DISORDER(N 12 =10.8%)

GENERALIZED ANXIETY DISORDER(N 25=22.7%)

DEPRESSIVE DISORDER NOT OTHERWISE CLASSIFIED

CYLOTHYMIC DISORDER

DYSTHYMIC DISORDER(N7=6.4%)

SOMATIZATION DISODER(N3=2.7%)

RESULTS PTSD=28.2%HIGHER THAN

20.3%((HAGENGIMAN A.NDETEI D.M, KANGETHE ,R. 1996) WHOLE POULATION

THIS IS SPECIAL POPULATION UNLIKE HAGENGIMANA’S WHICH INCLUDED GENERAL POPULATION

LOWER THAN 35.5% HIV INFECTED

WOMEN SURVIVORS(FABRIC M ,KOVLER M 2007)

THE SURVIVORS DON’T HAVE SERIOUS ILLNESS LIKE HIV INFECTION WHICH MAY BE EXTRA SOURCE OF TRAUMA

DISCUSSION

PSCHIATRIC MORBIDITY

PTSD IS ASSOCITED WITH

MAJOR DEPRESSIVE DISORDER(N 12 =10.8%)

GENERALIZED ANXIETY DISORDER(N 25=22.7%)

IN 1996 PSYCHIATRIC MORBIDITY WAS 50.3% WHICH INCLUDED ABNORMAL GRIEF REACTION FOLLOWED BY MAJOR DEPRESSSION AND THEN PTSD

DISCUSSION

THE STUDY DEMOSTRATED THAT WAR RELATED VICTIMS ARE AT RISK OF DEVELOPING PROLONGED SYMPTOMS OF PTSD

FORTY YEARS FOLLOW UP STUDIES OF FORMER WORLD WAR 11 PRISONERS OF WAR INDICATED THAT SEVERE TRAUMATIZATION CAN PRODUCE PERSITENT PTSD (BLANK 1989)

ENHANCE MENTAL HEALTH SERVICES TO SCREEN GENOCIDE SURVIVORS FOR PTSD AND OTHER CO-MORBIDITIES

RECOMMENDATIONS

SENSITIVE AREA OF STUDY GUARDED INFORMATION FUNDING AND SCALE OF THE STUDY LIMITING MAKING GENERALIZTIONS

LIMITATIONS

14 YRS AFTER THE 1994 RWANDESE GENOCIDE,WIDOW SURVIVORS ARE STILL SUFFERING FROM PTSD AND OTHER PSYCHIATRIC MORBIDITIES.

ACCEPT THE ALTERNATIVE NULL HYPOTHESIS

PTSD RUNS A LONGITUDINAL COURSE

CONCLUSION