Rubanzana Wilson, Hedt-Gauthier Bethany L, Ntaganira Joseph, Freeman Michael D
Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda Rwanda National Police, Directorate of Medical Service, Kigali, Rwanda.
Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
J Epidemiol Community Health. 2015 Feb;69(2):117-22. doi: 10.1136/jech-2014-204307. Epub 2014 Dec 8.
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.
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.
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.
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.
在卢旺达，1994年种族灭绝期间估计有100万人丧生，国家支离破碎，社会结构遭到破坏。战争和种族灭绝等大规模创伤性事件与创伤后应激障碍、抑郁症和自杀行为的流行有关。本研究的目的是调查1994年种族灭绝经历是否与卢旺达的自杀行为有关。
我们开展了一项基于人群的病例对照研究。将自杀受害者与三名在世对照者按性别、年龄和居住地点进行匹配。暴露被定义为是种族灭绝幸存者、在种族灭绝中遭受身体/性虐待、在种族灭绝中失去一级亲属、因种族灭绝罪行被定罪或有一级亲属因种族灭绝被定罪。2011年5月至2013年5月，在全国范围内招募了162例病例和486名对照者。信息从警方、当地村庄管理人员和家庭成员处收集。
在对潜在混杂因素进行调整后，因种族灭绝罪行被定罪是自杀的一个重要预测因素（比值比=17.3，95%置信区间3.4至88.1）。作为幸存者、在种族灭绝期间遭受身体或性虐待以及因种族灭绝失去一级家庭成员与自杀无显著关联。
这些发现表明，因种族灭绝罪行被定罪的个体即使在事件发生20年后仍在经历持续的心理困扰，这影响了他们重新融入社区的社会进程。鉴于大量种族灭绝罪犯在刑事法庭和加卡卡传统和解审判后重新融入社会，如果不采取预防性补救措施，自杀可能成为严重的公共卫生负担。
