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In the current study we explore how Rwandan youth negotiate, within the family setting, a myriad of social and interpersonal dilemmas around silence and disclosure of genocide-related experiences of their parents. The study draws primarily on individual interviews and focus group discussions with 20 children of genocide survivor and perpetrator parents in the western and eastern provinces of Rwanda. Using the conceptual framework of social navigation which theorizes agency in a fluid, often unpredictable, and constantly moving social environment, we focus specifically on the difficult and often contradictory complex of factors that drive the communication strategies and tactics of the children as they seek information to understand the past of their parents. This includes the children’s urge to get to know the specific stories of their family but fearing the emotional disruption it may cause in the parent–child relationship; the push–pull dynamics of the parents wanting to disclose some experiences but admonishing silence on others; and the often ambiguous divergences between the public and private discourses. Our findings show that the steadiest navigational point guiding communication choices, made by both parents and their offspring, was a desire to contribute to a peaceful social environment, and to reduce the risk of future violence. We present emerging evidence suggesting that community-based sociotherapy, a program that includes healing the social space and not only intrapsychic wounds, may contribute to a steadier navigation of the tricky communication issues, enhancing psychosocial wellbeing.

Rationale: \ud Research into mental health and wellbeing recognises the role of positive mental health to enable people to lead healthy and emotionally fulfilling lives. Mental health difficulties continue to be associated with high levels of disability worldwide, and refugees fleeing conflict are known to suffer from poor mental health for years after their forced migration.\ud \ud Method: \ud Informed by Sen's Capability Approach and as part of a wider research project, we used semi-structured interviews to engage with 60 men and women in two refugee communities in Uganda and Rwanda to explore their aspirations and what a ‘good life’ meant to them.\ud \ud Findings: \ud While aspects of what constituted a good life were gendered, both men and women struggled to achieve their aspirations within their communities. Following the basic needs of food and shelter, the complex needs of being dressed well and being clean were consistently associated with be able to achieve a ‘good life’ by women and men across age groups. Looking good and being clean were highly valued and associated with gaining the respect of others, achieving good relationships with neighbours, and avoiding conflict. Participants identified personal appearance and related social status as critical precursors to their successful engagement with other gendered dimensions of social and economic life in their communities, such as finding employment and being well regarded in their religious community.\ud \ud Conclusions: \ud Our findings suggest that without the means to present a good appearance, people living in refugee communities may experience feelings of shame and isolation and are unable to gain self-respect and the respect of others needed to achieve the positive mental and physical health they associate with leading ‘a good life’.

Twenty years after the 1994 genocide, Rwanda shows all indications of moving quickly towards socio-economic prosperity. Rwanda's community justice system, Gacaca, was to complement this prosperity by establishing peace and stability through justice, reconciliation and healing. Evaluations of the Gacaca courts' achievements from 2002 to 2012 have had widely differing conclusions. This article adds to previous evaluations by drawing attention to specific forms of relatively neglected suffering (in literature and public space) that have emerged from the Gacaca courts or were amplified by these courts and jeopardize Gacaca's objectives. The ethnographic study that informs the article was conducted in southeastern Rwanda from September 2008-December 2012 among 19 ex-prisoners and 24 women with husbands in prison including their family members, friends and neighbors. Study findings suggest that large scale imprisonment of genocide suspects coupled with Gacaca court proceedings have tainted the suffering of ex-prisoners and women with imprisoned husbands in unique ways, which makes their plight unparalleled in other countries. We argue that the nature and scale of this suffering and the potentially detrimental impact on families and communities require humanitarian action. However, in Rwanda's post-genocide reality, the suffering of these two groups is overwhelmed by that of other vulnerable groups, such as genocide survivors and orphaned children; hence it is rarely acknowledged.

This study evaluated the reliability and criterion validity of the Byumba Social Functioning Questionnaire (BSFQ), an instrument to measure social functioning in Rwanda. The instrument was locally composed in concordance with a well-described method for culture-specific and sex-specific function assessment. Respondents in a Northern Province of Rwanda ( N = 393) were assessed with the BSFQ and a 19-item scale (SF-19) drawn from the Medical Outcomes Study 36-Item Short-Form (SF-36). The BSFQ’s internal consistency was just acceptable for women but poor for men, while the SF-19 had good to excellent internal consisteny. BSFQ total scores showed a strong floor effect, while the SF-19 showed more variation in total score distribution. The BSFQ did not perform as well as we expected, and appears not to be suitable for measuring social functioning in the study context. This outcome seems to reflect the conceptualization of social functioning used in constructing the BSFQ. Implications for the development of culture-specific measures of functional status are discussed.

A distinguishing feature of the 1994 genocide against the Tutsi and the preceding 1990-1994 war in Rwanda was the social intimacy of the crimes committed. The legacy of this kind of violence includes distrust in social relations within communities and families, an increase of violence in everyday social interaction, transgressive sexual engagements, and a range of psychological problems. Many people feel nostalgia for their past social life, but are unable to change their current situation. In 2005, a community-based sociotherapy programme was introduced into this context of mental and social distress. The goal was to help people regain feelings of dignity and safety and to reduce distress. This paper is based on qualitative research, in particular, case studies. It explores how sociotherapy, as a specific form of peer group counselling, may facilitate the healing of suffering related to issues of sexuality, violence within the family and the breakdown of social connections on a community level.Una característica que distingue al genocidio en 1994 contra los tutsi de la anterior guerra entre 1990-1994 en Ruanda es la intimidad social de los crímenes cometidos. El legado de este tipo de violencia es la desconfianza en las relaciones sociales dentro de las comunidades y las familias, un aumento de la violencia en la interacción social diaria, la participación en actividades sexuales transgresoras y toda una serie de problemas psicológicos. Aunque muchas personas sienten nostalgia por su vida social anterior, son incapaces de cambiar su situación actual. En 2005 se introdujo un programa socioterapéutico de la comunidad para abordar las dificultades mentales y sociales. Su objetivo fue ayudar a las personas a recobrar sus sentimientos de dignidad y seguridad y reducir la angustia. Este artículo se basa en un estudio cualitativo, en particular con estudios de casos. Analizamos el modo en que la socioterapia, como una forma específica de asesoramiento en grupo, puede facilitar la curación del sufrimiento relacionado con cuestiones de sexualidad, violencia dentro de la familia y el deterioro de las conexiones sociales en la comunidad.Une particularité du génocide de 1994 contre les Tutsis au Rwanda et de la guerre qui l'avait précédé entre 1990 et 1994 a été l'intimité sociale des crimes commis. Les séquelles de ce type de violences comprennent la méfiance vis-à-vis des rapports sociaux au sein des communautés et des familles, une augmentation de la violence dans l'interaction sociale de tous les jours, des engagements sexuels transgressifs et un ensemble de problèmes psychologiques. Nombreux sont les gens qui sont nostalgiques de leur vie sociale passée mais qui sont incapables de changer leur situation actuelle. En 2005, un programme communautaire de sociothérapie a été introduit dans ce contexte de désarroi mental et social. Il avait pour but d'aider les personnes à retrouver un sentiment de dignité et de sécurité et de diminuer leur détresse. Cet article s'appuie sur une recherche qualitative - en particulier des cas d'études. Il examine comment la sociothérapie, en tant que méthode spécifique de counselling dans un groupe de pairs, peut faciliter la guérison des souffrances relatives aux questions de la sexualité, de la violence au sein des familles et de la dégradation des connexions sociales au plan communautaire.

Exposure to intimate partner violence (IPV) is a common feature of women living in low- and middle-income countries. Several studies have shown a significant association between IPV against women and mental health in both developed and in low- and middle-income countries. In postconflict settings, the relationship between IPV and mental health is likely more complex, given the high levels of violence experienced by the population as a whole. In this cross-sectional study the authors explore the association between IPV and common mental health disorders (CMD), and more specifically, suicidal ideation, among inhabitants of postgenocide Rwanda. The authors use the concept of “mutual partner violence,” thereby exploring the association between IPV and CMD in victims, perpetrators, and those who state they are both. Data of 241 married men and women were used. Symptoms suggestive of CMD were established by use of the Self-Reporting Questionnaire (SRQ-20), and physical intimate partner violence was measured using the Conflict Tactics Scale, Short Version (CTS2S). The authors applied multivariate logistic regressions with total SRQ-20 scores (above/below cutoff) and suicidal ideation as the outcome measures and corrected for age and gender. The study findings suggest that reported IPV is associated with CMD (odds ratio [OR] = 1.7, 95% confidence interval [95% CI] = 0.92-3.15) and suicidal ideation (OR = 1.6, 95% CI = 0.70-3.53). Those who state to be both victim and perpetrator (OR = 1.75, 95% CI = 0.82-3.72), or only perpetrator (OR = 3.13, 95% CI = 0.49-20.0), are more likely to report mental health problems than victims and people who do not report IPV. In a postconflict situation, perpetrators of IPV may suffer from mental health problems as much as, or even more than, victims. Longitudinal data are needed to clarify the complex relationship between CMD and IPV, especially if outcomes may also be related to other forms of violence experienced in the past.

Background This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting. Methods The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis. Results The reliability of the SRQ-20 in women (α = 0.85) and men (α = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area under the curve (AUC) of 0.76 for women and 0.74 for men. Cut-off scores were different for women (10) and men (8). Factor analysis yielded five factors, explaining 38% of the total variance. The factor structure proved to be time invariant. Conclusions The SRQ-20 can be used as a screener to detect mental disorder in a Rwandan community setting, but cut-off scores need to be adjusted for women and men separately. The instrument also shows longitudinal factorial invariance, which is an important prerequisite for assessing changes in symptom severity. This is a significant finding as in non-western post-conflict settings the relevance of diagnostic categories is questionable. The use of the SRQ-20 can be considered an alternative option for measuring the effect of a psychosocial intervention on mental health. Trial registration Nederlands Trial Register NTR1120.

BackgroundWar has serious and prolonged mental health consequences. It is argued that post-emergency mental health interventions should not only focus on psychological factors but also address the social environment. No controlled trials of such interventions exist. We studied the effect on mental health of a large scale psychosocial intervention primarily aimed at social bonding in post-genocide Rwanda. The programme is implemented at population level without diagnostic criteria for participation. It is open to any person older than 15 years, and enables participation of over 1500 individuals per year. We postulated that the mental health of programme participants would improve significantly relative to non-participants.Methods and findingsWe used a prospective quasi-experimental study design with measurement points pre and post intervention and at 8 months follow-up. 100 adults from both sexes in the experimental condition entered the study; follow-up measurements were taken from 81. We selected a control group of 100 respondents with similar age, sex and symptom score distribution from a random community sample in the same region; of these, 73 completed the study. Mental health was assessed by use of the Self Reporting Questionnaire (SRQ-20), a twenty item instrument to detect common mental disorders in primary health care settings. Mean SRQ-20 scores decreased by 2.3 points in the experimental group and 0.8 in the control group (p = 0.033). Women in the experimental group scoring above cut-off at baseline improved with 4.8 points to below cut-off (pConclusionsA large scale psychosocial intervention primarily aimed at social bonding caused a lasting improvement of mental health in survivors of mass violence in Rwanda. This approach may have a similar positive effect in other post-conflict settings.Trial registrationNederlands Trial Register 1120.

Rwanda experienced extreme violence and genocide during a three month period starting in April 1994. In the northern regions, there had been ongoing violence since 1990. Many inhabitants still suffer emotionally from the consequences of this era. We performed a quantitative study to measure the effe