Double Jeopardy: Young adult mental and physical health outcomes following conception via genocidal rape during the 1994 genocide against the Tutsi in Rwanda. (June 2021)

• Record Type: Journal Article
• Authors: Uwizeye, Glorieuse; Thayer, Zaneta M.; DeVon, Holli A.; McCreary, Linda L.; McDade, Thomas W.; Mukamana, Donatilla; Park, Chang; Patil, Crystal L.; Rutherford, Julienne N.
• Is Part Of: Social science & medicine. Volume 278(2021)
• Publication Date: 2021-06
• Subjects: Rwanda -- Prenatal exposure -- Adverse childhood experiences -- Depression -- Post-traumatic stress disorder (PTSD) -- Pain -- Quality of life -- Life course perspective; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; Medicine -- Periodicals; Médecine sociale -- Périodiques; Anthropologie médicale -- Périodiques; Santé publique -- Périodiques; Psychologie -- Périodiques; Médecine -- Périodiques; Electronic journals; 362.105
• DOI: 10.1016/j.socscimed.2021.113938
• Languages: English
• ISSNs: 0277-9536

Abstract

Abstract: Rwandans conceived by rape during the 1994 genocide against the Tutsi have endured a violent beginning and a troubled childhood. Given compelling evidence of the influence of prenatal environments and adverse childhood experiences (ACEs) on future health, these individuals are at high risk of poor mental and physical health outcomes. The purpose of the study was to characterize mental and physical health outcomes in young adults who were exposed prenatally to maternal stress due to the genocide in general and those conceived by genocidal rape, and to determine whether ACEs compound these effects. Ninety-one 24-year-old Rwandans – 30 conceived by genocidal rape, 31 born of genocide survivors not raped, and a control group of 30 born of women with neither exposure – completed the Adverse Childhood Experiences International Questionnaire and measures of multiple physical and mental health characteristics. Data were collected from March 7 to April 6, 2019. Findings demonstrated that 1) individuals conceived during the genocide had poorer mental function (p = 0.002) and higher scores in post-traumatic stress disorder (PTSD), anxiety, depression, physical function, pain intensity, and sleep disturbance compared to young adults who were not exposed to genocide (all p < 0.033); 2) individuals conceived by genocidal rape reported more depression, PTSD, and pain interference compared to those prenatally exposed to maternal genocide stress only (all p < 0.008); and 3) among the group conceived via genocidal rape, the effects of prenatal exposures on depression, physical function, pain intensity and pain interference were exacerbated by ACEs (all p < 0.041). Being conceived during genocide, especially through genocidal rape, is associated with poor adult physical and mental health. The role of ACEs in exacerbating prenatal genocide exposure highlights opportunities for interventions to reduce these effects. Highlights: Being conceived during genocide is associated with poor adult health outcomes. Being conceived by genocidal rape is a "double burden" that leads to poorer outcomes. Adverse childhood experiences exacerbate prenatal effects on adult health. Adversities across the life course lead to disparities in non-communicable diseases. Interventions addressing adverse childhood experiences could mitigate these effects.