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      Rates of trauma spectrum disorders and risks of posttraumatic stress disorder in a sample of orphaned and widowed genocide survivors

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          Abstract

          Background

          During the Rwandan genocide of 1994, nearly one million people were killed within a period of 3 months.

          Objective

          The objectives of this study were to investigate the levels of trauma exposure and the rates of mental health disorders and to describe risk factors of posttraumatic stress reactions in Rwandan widows and orphans who had been exposed to the genocide.

          Design

          Trained local psychologists interviewed orphans ( n=206) and widows ( n=194). We used the PSS-I to assess posttraumatic stress disorder (PTSD), the Hopkins Symptom Checklist to assess depression and anxiety symptoms, and the M.I.N.I. to assess risk of suicidality.

          Results

          Subjects reported having been exposed to a high number of different types of traumatic events with a mean of 11 for both groups. Widows displayed more severe mental health problems than orphans: 41% of the widows (compared to 29% of the orphans) met symptom criteria for PTSD and a substantial proportion of widows suffered from clinically significant depression (48% versus 34%) and anxiety symptoms (59% versus 42%) even 13 years after the genocide. Over one-third of respondents of both groups were classified as suicidal (38% versus 39%). Regression analysis indicated that PTSD severity was predicted mainly by cumulative exposure to traumatic stressors and by poor physical health status. In contrast, the importance given to religious/spiritual beliefs and economic variables did not correlate with symptoms of PTSD.

          Conclusions

          While a significant portion of widows and orphans continues to display severe posttraumatic stress reactions, widows seem to constitute a particularly vulnerable survivor group. Our results point to the chronicity of mental health problems in this population and show that PTSD may endure over time if not addressed by clinical intervention. Possible implications of poor mental health and the need for psychological intervention are discussed.

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          Most cited references55

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          Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: outcome at academic and community clinics.

          Female assault survivors (N=171) with chronic posttraumatic stress disorder (PTSD) were randomly assigned to prolonged exposure (PE) alone, PE plus cognitive restructuring (PE/CR), or wait-list (WL). Treatment, which consisted of 9-12 sessions, was conducted at an academic treatment center or at a community clinic for rape survivors. Evaluations were conducted before and after therapy and at 3-, 6-, and 12-month follow-ups. Both treatments reduced PTSD and depression in intent-to-treat and completer samples compared with the WL condition; social functioning improved in the completer sample. The addition of CR did not enhance treatment outcome. No site differences were found: Treatment in the hands of counselors with minimal cognitive- behavioral therapy (CBT) experience was as efficacious as that of CBT experts. Treatment gains were maintained at follow-up, although a minority of patients received additional treatment. ((c) 2005 APA, all rights reserved).
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            Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale

            The Clinician-Administered PTSD Scale (CAPS) is one of the most frequently used measures of posttraumatic stress disorder (PTSD). It has been shown to be a reliable and valid measure, although its psychometric properties in nonveteran populations are not well known. One problem with the CAPS is its long assessment time. The PTSD Symptom Scale--Interview Version (PSS-I) is an alternative measure of PTSD severity, requiring less assessment time than the CAPS. Preliminary studies indicate that the PSS-I is reliable and valid in civilian trauma survivors. In the present study we compared the psychometric properties of the CAPS and the PSS-I in a sample of 64 civilian trauma survivors with and without PTSD. Participants were administered the CAPS, the PSS-I, and the Structured Clinical Interview for DSM-IV (SCID) by separate interviewers, and their responses were videotaped and rated by independent clinicians. Results indicated that the CAPS and the PSS-I showed high internal consistency, with no differences between the two measures. Interrater reliability was also high for both measures, with the PSS-I yielding a slightly higher coefficient. The CAPS and the PSS-I correlated strongly with each other and with the SCID. Although the CAPS had slightly higher specificity and the PSS-I had slightly higher sensitivity to PTSD, overall the CAPS and the PSS-I performed about equally well. These results suggest that the PSS-I can be used instead of the CAPS in the assessment of PTSD, thus decreasing assessment time without sacrificing reliability or validity.
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              Symptoms of emotional distress in a family planning service: stability over a four-week period.

              The 25-item Hopkins Symptom Checklist ( HSCL -25) was used on two occasions four weeks apart to identify self-reported symptoms of anxiety and depression in patients attending a family planning service. Only 28 per cent of patients classified as anxious to start with remained so four weeks later, but 62 per cent of those with high depression scores and 74 per cent of those with high depression and high anxiety scores maintained significant levels of depression. The implications of these findings for routine screening are discussed.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                EJPT
                European Journal of Psychotraumatology
                Co-Action Publishing
                2000-8198
                2000-8066
                03 June 2011
                2011
                : 2
                : 10.3402/ejpt.v2i0.6343
                Affiliations
                [1 ]Department of Clinical Psychology, University of Konstanz, Germany
                [2 ]Department of Clinical Psychology, University of Butare, Rwanda
                Author notes
                [* ] Susanne Schaal, Department of Clinical Psychology, University of Konstanz, Germany. Email: Susanne.Schaal@ 123456uni-konstanz.de
                Article
                EJPT-2-6343
                10.3402/ejpt.v2i0.6343
                3402134
                22893816
                7b7c4d43-2e6f-474f-bd81-67a08deb2df6
                © 2011 Susanne Schaal et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 February 2011
                : 14 May 2011
                : 20 May 2011
                Categories
                Clinical Research Article

                Clinical Psychology & Psychiatry
                depression,risk factors,posttraumatic stress disorder,anxiety,rwanda,genocide

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