Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda

Uwizeye, Glorieuse; Thayer, Zaneta M.; DeVon, Holli A.; McCreary, Linda L.; McDade, Thomas W.; Mukamana, Donatilla; Park, Chang Gi; Patil, Crystal L.; Rutherford, Julienne N.

doi:10.1016/j.socscimed.2021.113938

Cited by 11 publications

(19 citation statements)

References 37 publications

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“…Moreover, as children age, consistent and long-term psycho-social support to both mothers and children (individually and as a dyad) throughout early childhood and adolescence would have benefits to both groups in terms of child development, attachment, bonding, and truth-telling. For example, our findings are consistent with those of Hogwood et al (2014), who discuss the potential benefits of counselling groups for mothers with children born of genocidal rape in Rwanda, and Uwizeye et al (2021), who argue that interventions for youth born of genocidal rape during the 1994 genocide against the Tutsi in Rwanda should target individuals, their families, and their communities. Our findings expand upon this, pointing towards the importance of access to economic resources for mothers, particularly in instances in which extended families refuse to accept the mother and her child.…”

Section: Discussionsupporting

confidence: 91%

Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach

Kahn

Denov²

2022

Transcult Psychiatry

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Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families.

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Section: Discussionsupporting

confidence: 91%

Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach

Kahn

Denov²

2022

Transcult Psychiatry

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“…These findings suggest differences in mechanisms underlying adult health conditions. In our previous analysis, we reported a significant interaction between prenatal exposure and ACEs in predicting higher scores of depression but not anxiety (Uwizeye et al, 2021).…”

Section: Hypothesismentioning

confidence: 82%

“…We previously reported that adult health outcomes were associated with having been conceived during the genocide, with the worst outcomes experienced by those conceived via genocidal rape compared to those conceived during the genocide but not by rape (Uwizeye et al, 2021). Here, we explored whether the duration of first trimester exposure would be associated with adult mental health outcomes within three groups of adults prenatally exposed to genocide in utero across a range of severity of exposure .…”

Section: Discussionmentioning

confidence: 99%

“…The ACES IQ questionnaire consists of 13 constructs and the total score ranges from 0 to 13. In our previous work, we found adult health outcomes were influenced by adverse childhood experiences (Uwizeye et al, 2021), so we controlled for those in this study of the impact of prenatal exposure duration on outcomes. The ACEs instrument was developed by the World Health Organization (WHO) (World Health Organization, 2018).…”

Section: Methodsmentioning

confidence: 99%

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Associations between duration of first trimester intrauterine exposure to genocide against the Tutsi and health outcomes in adulthood

Uwizeye

Rutherford

Thayer

2023

American Journal of Biological Anthropology

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Objectives: Hundreds of thousands of Rwandans were conceived during the 1994 genocide against the Tutsi, including thousands conceived by genocidal rape. We explore whether the duration of first trimester exposure to the genocide is associated with variation in adult mental health outcomes in individuals exposed to varying degrees of genocide-related stress in utero. Materials and Methods:We recruited 30 Rwandans conceived via genocidal rape, 31 Rwandans conceived by genocide survivors not raped, and 30 individuals of Rwandan-descent who were conceived outside of Rwanda at the time of the genocide (control group). Individuals were age-and sex-matched across groups. Adult mental health was assessed through standardized questionnaires for vitality, anxiety, and depression.Results: Among the genocide only group, a longer duration of first trimester prenatal exposure was associated with higher anxiety scores and lower vitality (both p < 0.010), and higher depression scores (p = 0.051). Duration of first trimester exposure was not associated with any measures of mental health among the genocidal rape or control group.Discussion: Duration of exposure to genocide in the first trimester of gestation was associated with variation in adult mental health among the genocide only group. The lack of association between duration of first trimester exposure to genocide and adult mental health in the genocidal rape group may reflect the fact that stress associated with conception through rape persisted beyond the genocide period itself, encompassing all of gestation and likely beyond. Geopolitical and community interventions are needed in the context of extreme events during pregnancy to mitigate adverse intergenerational outcomes.

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“…This debate is important as it may help shed light on how to improve health outcomes of children and adolescents who experience trauma. Individuals who experience childhood trauma are at increased risk for a wide range of psychological, physiological, cognitive, and behavioral conditions, which are likely to be of clinical and public health relevance [ 1 – 3 ]. Refugee populations are deemed particularly vulnerable to the risks of war-related trauma, although there is no one-to-one association between risk exposures and mental health outcomes given differences in processes of recovery, resilience, and supportive social networks [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Novel GxE effects and resilience: A case:control longitudinal study of psychosocial stress with war-affected youth

et al. 2022

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Responses to early life adversity differ greatly across individuals. Elucidating which factors underlie this variation can help us better understand how to improve health trajectories. Here we used a case:control study of refugee and non-refugee youth, differentially exposed to war-related trauma, to investigate the effects of genetics and psychosocial environment on response to trauma. We investigated genetic variants in two genes (serotonin transporter, 5-HTT, and catechol-O-methyltransferase, COMT) that have been implicated in response to trauma. We collected buccal samples and survey data from 417 Syrian refugee and 306 Jordanian non-refugee youth who were enrolled in a randomized controlled trial to evaluate a mental health-focused intervention. Measures of lifetime trauma exposure, resilience, and six mental health and psychosocial stress outcomes were collected at three time points: baseline, ~13 weeks, and ~48 weeks. We used multilevel models to identify gene x environment (GxE) interactions and direct effects of the genetic variants in association with the six outcome measures over time. We did not identify any interactions with trauma exposure, but we did identify GxE interactions with both genes and resilience; 1) individuals with high expression (HE) variants of 5-HTTLPR and high levels of resilience had the lowest levels of perceived stress and 2) individuals homozygous for the Val variant of COMT with high levels of resilience showed stable levels of post-traumatic stress symptoms. We also identified a direct protective effect of 5-HTTLPR HE homozygotes on perceived insecurity. Our results point to novel interactions between the protective effects of genetic variants and resilience, lending support to ideas of differential susceptibility and altered stress reactivity in a cohort of war-affected adolescents.

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Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda

Cited by 11 publications

References 37 publications

Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach

Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach

Associations between duration of first trimester intrauterine exposure to genocide against the Tutsi and health outcomes in adulthood

Novel GxE effects and resilience: A case:control longitudinal study of psychosocial stress with war-affected youth

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