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Background: The alarming prevalence of non- or poor adherence to Home-based Exercise Programs (34–79.2 %, HEP) in parents of Children with Cerebral Palsy (C-CP) is a global health concern due to its detrimental effect on treatment outcomes. Objective: To examine whether Perceived Therapist Guidance and Advice (TGA) or social support moderate the effects of PTSD, depression, parenting stress, low self-efficacy, the burden of care, or the effects of perceived family stigma on adherence to HEP. Method: A stratified random sample of 301 mothers of C-CP attending the largest seven physical rehabilitation hospitals or centres in Rwanda participated in this study. Data were collected using validated measures of all investigated constructs. We conducted hierarchical multiple linear regressions, and the nature of moderation was scrutinized using the process macro 4.1 model number 1 within SPSS version 28. Results: The prevalence of adherence to HEP in the present sample was 32.9 %. Mothers' TGA and social support were positively associated with adherence to HEP; whereas mothers' stressors, including PTSD, parenting stress, depression symptoms, low self-efficacy, burden of care, and family stigma were negatively associated with adherence to HEP. In addition, TGA significantly moderated the associations of the different mothers' stressors with adherence to HEP, leading to increased HEP adherence for mothers with high stressor levels. Social support did not moderate any of these associations. Our respondents often reported poor family and friends’ social support due to family stigma-related to caring C-CP. Conclusions: Therapists play a vital role by providing education, support, and counselling to parents, emphasizing the importance of adherence, and addressing any stigma-related concerns, especially for mothers who experience high levels of stress. Therapists should be aware that mothers of C-CP frequently relied solely on their support to improve adherence to HEP.

The Domestic Violence Questionnaire (DVQ) is a measure that captures physical, sexual, economic, and psychological violence perpetrated against women. A team of local academicians and intervention experts evaluated several tools for domestic and gender-based violence, concluding that the DVQ fitted best in the context of evaluating the Living Peace intervention in conflict-affected eastern DRC. The purpose of this validation study was to: (1) validate the factor structure of the Swahili version of the DVQ, (2) to evaluate its convergent and divergent validity, and (3) to examine its internal consistency reliability. The factor structure was evaluated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) while concurrent validity and internal consistency reliability were evaluated using Pearson correlation and Cronbach's alpha coefficients, respectively. The study participants were women, partners of men that participated in the Living Peace program, a community-based intervention program that works on promoting positive masculinity among men that are perceived to be violent by their community. Data were obtained from two independent purposive samples of 704 participants for EFA and 878 participants for CFA, selected from 60 villages in North and South Kivu, DRC. The results indicated that five and three-factor structures could be meaningfully interpreted in EFA, each with 66% explained variance. For comparative purposes, CFA was conducted on the two newly created factor models and the original factor model. All models reach good fit indexes, with the three-factor model demonstrating the best fit. Its standardized factor loadings ranged from 0.57 to 0.91. The internal consistency was a = .90 for the total scale and ranged from a = .75 to .926 per dimension. Finally, scores of DVQ were negatively correlated with mental well-being (r =20.23, p \.001), and positively with depression (r = .435, p\.001), as hypothesized. The Swahili version of DVQ has excellent psychometric properties and can be applied to evaluate the physical, sexual, economic and psychological violence in victims of domestic violence in humanitarian crisis settings. [ABSTRACT FROM AUTHOR]

The genocide against the Tutsi in Rwanda left the country almost completely devastated, with tremendous consequences for mental health, social cohesion, and livelihoods. In the aftermath of such extreme circumstances and human rights violations, societal healing should be conceptualized and approached based on a multisystemic framework that considers these three sectors--mental health, social cohesion, and livelihoods--as well as their interactions. The aims of the present study are twofold: (1) to review evidence on multisystemic healing initiatives already applied in Rwanda using fieldwork notes from interviews and focus groups, alongside relevant scholarly and gray literature, and (2) to propose a scalable multisystemic framework for societal healing in Rwanda that builds on existing innovations. Within a participatory action research methodology, we used a grounded theory approach to synthesize fieldwork findings and compare them with literature to generate a set of principles for multisystemic recovery in Rwanda. Recognizing the strengths and limitations of the current mental health system and other initiatives, including sociotherapy and collaborative livelihood projects, we propose a scalable and rights-based multisystemic approach for recovery and resilience that would target mental health, social cohesion, and sustainable livelihoods within an integrative cross-sectoral framework, thus reducing the risk of post-genocide conflict. [ABSTRACT FROM AUTHOR]

Introduction : In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods : The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden's index was used for determining diagnostic cut-off. Results : The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32–0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion : The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap. [ABSTRACT FROM AUTHOR]

Objectives. Transmission of parental post-traumatic stress disorder (PTSD) to offspring might be explained by transmission of epigenetic processes such as methylation status of the glucocorticoid receptor (GR) gene ( NR3C1). Methods. We investigated PTSD and depression severity, plasma cortisol, GR and mineralocorticoid receptor (MR) levels, and methylation status of NR3C1 and NR3C2 promoter regions in 25 women exposed to the Tutsi genocide during pregnancy and their children, and 25 women from the same ethnicity, pregnant during the same period but not exposed to the genocide, and their children. Results. Transmission of PTSD to the offspring was associated with transmission of biological alterations of the HPA axis. Mothers exposed to the genocide as well as their children had lower cortisol and GR levels and higher MR levels than non-exposed mothers and their children. Moreover, exposed mothers and their children had higher methylation of the NR3C1 exon 1F than non-exposed groups. Finally, exposed mothers showed higher methylation of CpGs located within the NR3C2 coding sequence than non-exposed mothers. Conclusions. PTSD was associated with NR3C1 epigenetic modifications that were similarly found in the mothers and their offspring, modifications that may underlie the possible transmission of biological alterations of the HPA axis. [ABSTRACT FROM AUTHOR]