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Exposure to genocide and risk of suicide in Rwanda: a population-based case–control study
  1. Wilson Rubanzana1,2,
  2. Bethany L Hedt-Gauthier1,3,
  3. Joseph Ntaganira1,
  4. Michael D Freeman4,5,6
  1. 1Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda
  2. 2Rwanda National Police, Directorate of Medical Service, Kigali, Rwanda
  3. 3Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
  4. 4Oregon Health & Science University, School of Medicine, Portland, Oregon, USA
  5. 5Faculty of Medicine, Section of Forensic Medicine, Umeå University, Umeå, Sweden
  6. 6Faculty of Health Sciences, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
  1. Correspondence to Dr Wilson Rubanzana, Rwanda University, College of Medicine and Health Sciences, School of Public Health. P.O. Box: 5229 Kigali, Rwanda; wrubanzana{at}nursph.org

Abstract

Background In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda.

Methods We conducted a population-based case–control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members.

Results After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide.

Conclusions These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20 years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified.

  • EPIDEMIOLOGY
  • SUICIDE
  • HEALTH STATUS

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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