Cohort profile: mental health following extreme trauma in a northern Ugandan cohort of War-Affected Youth Study (The WAYS Study).

War experiences are associated with the risk of long-term mental health problems. The War-affected Youths (WAYS) Study comprises a cohort of 539 youths (61% female) aged between 18 to 25 (at baseline) randomly sampled from the population of war-affected youths in northern Uganda. The study aims to chart the trajectory of long-term mental health consequences of war and the roles of individual, family, and community contextual risk and protective factors in influencing the course of mental health using Social Ecology Model, thus, addressing both the individual and its social ecology. Knowledge of postwar contexts may inform policy and guide interventions on postwar psychosocial adjustment and reintegration in conflict-prone Great Lakes region of Africa (Rwanda, Burundi, DR Congo, Uganda, Central African Republic, and South Sudan). Two waves of data collection have been conducted and more data collection is planned. At baseline, information on demographic characteristics, pre-war experiences, psychosocial outcomes, coping, stigma/discrimination, family and community acceptance and relationship, family functioning, and post-war experiences were obtained. At follow-up, information on general health, gender-based violence, PTSD, social skills, trauma memory quality, rumination, self-esteem, and psychosocial outcomes were collected. Approval to access the data can be obtained on application to the Principal Investigator upon submission of a research proposal with ethical approval from the applicant's institution. This research is funded by Wellcome Trust and Gulu University.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Sexual violence and general functioning among formerly abducted girls in Northern Uganda: the mediating roles of stigma and community relations--the WAYS study.

BACKGROUND: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. METHOD: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. RESULTS: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. CONCLUSION: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities

Lay Counselors’ Mental Wellness in Suicide Prevention after Prolonged Mass Trauma: A Pre- and Post-Training Appraisal

Information on the mental wellness of lay counselors in Uganda is unavailable. Sixty representatives of three sub counties in Gulu District in Northern Uganda were equipped with counseling skills through 40 hours of training over 5 days. The trainees completed the 32-item Response Inventory for Stressful Life Events (RISLE) immediately before the commencement of the training and soon after the completion of the training. Pretest prevalence of suicide ideation was 9.3%, and posttest prevalence was 11.1%. Immediate post-training assessment showed better overall mental wellbeing as judged by overall RISLE scores, which were statistically significantly lower post-training than pre-training for gender (P = 0.05) and marital status (P = 0.001) on most RISLE scores. Qualitative assessment after 3 months of training showed that trainees were less suicidal, and they had improved psychosocial functioning. The current results point to the need to pay attention to the mental wellness of volunteer counselors and support them in their role in preventing suicide in areas of mass trauma. We recommend robust randomized community trials to determine the role of the mental wellbeing of volunteer lay counselors in the provision of psychological first aid to communities exposed to prolonged mass trauma

Depression and suicidal behavior in Uganda : Validating the response inventory for stressful life events (RISLE)

Background Depression and suicide ideation are prevalent in the general population but their recognition and detection in primary care is problematic. The present study investigated if the RISLE can be used to detect depressed and or suicidal individuals in the general population. Methods of study Members of the general population in two districts of Uganda, Adjumani and Bugiri districts of Uganda, and fresh students at the Faculty of Medicine, Makerere University, participated in the study. Two pilot studies were conducted before the collection of data, namely: at Makerere University among fresh students sampled from all faculties in 2001, and in each of the districts in the course of interviewer and research assistants training in 2002. . The ethical committee of the Faculty of Medicine, and Uganda National Council for Science and Technology granted ethical clearance. The Dean of Students and the health and civic leaderships of the respective study sites granted further permission for the study. Analysis Data analysis comprised of general descriptive analysis, correlation and reliability analyses, principal component analysis to determine the main factors that make up the RISLE, discriminant function analysis to determine the main items of the RISLE that together distinguish depressed and or suicidal individuals in the general population who are not depressed and or suicidal, the construction of receiver operating characteristic curves to determine sensitivity and specificity of the RISLE, determination of sensitivity, specificity, predictive values, and likelihood ratios, and the determination of Cohen s kappa values at several cut-off points to determine the level of agreement between the RISLE and clinical interview method as the gold standard in the study Results Results revealed that cut-off points varied according to the nature of population studied. Cut-off point for the population in Adjumani district was 10 for any current psychiatric disorder, and 6 for any psychiatric disorder among students. Sensitivity and specificity of the RISLE at cut-off point 10 and 6 were 74.6% and 77.1%, and 88.1% and 60.4% respectively. Positive predictive values for current psychiatric disorder were 82.0% and 75.6% at cut-off points of 10 and 6 respectively. Agreement between the RISLE and clinical interview was 0.508 at cut-off point 10, followed by 0.501 at cut-off points 6 and 12. Conclusions The results of the present study show that the RISLE can be used in conjunction with clinical interview method in the detection and confirmation of individuals with current psychiatric illness and suicidal feelings in the general population

Burden of alcohol use in the Uganda police in Kampala district

Background: Alcohol dependence is one of the leading causes of the global burden of disease. Among members of the Uganda Police Force, alcohol dependence has been a major contributor of poor mental health, poor work output and forced retirement. Objective: This study was carried out to determine the prevalence of alcohol dependence and associated psychosocial problems in the Uganda Police Force in Kampala District. Methods of Study: A sample of police officers selected by systematic sampling strategy from two large barracks in Kampala District participated. A semi-structured questionnaire designed to elicit information on the perceived impact of alcohol use was used. Prevalence rate was derived from ICD-10 criteria for alcohol dependence, and psychosocial problems in alcohol dependence. Results: Twenty respondents (19.2%) met criteria for alcohol use disorder, 26.0% met criteria for alcohol use problems and 9.6% reported that their health was poor. Alcohol use disorder or problems were significantly associated with lack of job satisfaction, poor health, problems in implementing personal plans, disciplinary problems, inability to save from personal earnings, debts, and absenteeism from work. Conclusion: One in five police officers met criteria for alcohol use disorder while one in four experienced psychosocial problems related to alcohol use. The results suggest serious implications for the quality of services provided by the Uganda Police. There is a need to establish measures to provide services for those affected, and a further need to establish preventative measures against alcohol dependence in the police force. African Health Sciences Vol. 6(1) 2006: 14-2

Burden of alcohol use in the Uganda Police in Kampala District

BACKGROUND: Alcohol dependence is one of the leading causes of the global burden of disease. Among members of the Uganda Police Force, alcohol dependence has been a major contributor of poor mental health, poor work output and forced retirement. OBJECTIVE: This study was carried out to determine the prevalence of alcohol dependence and associated psychosocial problems in the Uganda Police Force in Kampala District. METHODS OF STUDY: A sample of police officers selected by systematic sampling strategy from two large barracks in Kampala District participated. A semi-structured questionnaire designed to elicit information on the perceived impact of alcohol use was used. Prevalence rate was derived from ICD-10 criteria for alcohol dependence, and psychosocial problems in alcohol dependence. RESULTS: Twenty respondents (19.2%) met criteria for alcohol use disorder, 26.0% met criteria for alcohol use problems and 9.6% reported that their health was poor. Alcohol use disorder or problems were significantly associated with lack of job satisfaction, poor health, problems in implementing personal plans, disciplinary problems, inability to save from personal earnings, debts, and absenteeism from work. CONCLUSION: One in five police officers met criteria for alcohol use disorder while one in four experienced psychosocial problems related to alcohol use. The results suggest serious implications for the quality of services provided by the Uganda Police. There is a need to establish measures to provide services for those affected, and a further need to establish preventative measures against alcohol dependence in the police force

“I Forgive to Forget”: Implications for Community Restoration and Unity in Northern Uganda

As the people in northern Uganda begin to rebuild their lives after the devastating war that lasted more than twenty years, reconciliation and community restoration becomes paramount. Forgiveness of wrongs committed and past hurts is an important vehicle to achieve reconciliation and co-existence in a society that is wrought with past social upheavals, fragile relationships and painful memories. This study aimed at exploring and understanding the ‘local’ meanings and notions of forgiveness and its importance in re-cementing a ‘broken’ Acholi society. Personal accounts of wrongs committed and processes of forgiveness were recorded, edited and shared with the public in Awach sub-County, Gulu District. The significance of this study is that among other things it has had a rippling effect and inspired other people to tell their own accounts and share their experiences of forgiveness and what it means for them. The findings illustrate that forgiveness is “personal” and aids ‘repair’ of not only inter-personal but intra-personal broken relationships as it fosters healing, personal freedom, the lifting of heavy burdens from the heart, rebuilding of trust between people and giving individuals a second chance at life’s pursuits. Furthermore, forgiveness is important for co-existence and unity because for many, it has helped them to live with their former tormenters by accepting tormentors’ ‘humanness’ especially when they have owned up to their past mistakes. In conclusion forgiveness has an important place in rebuilding northern Uganda by harnessing people’s ability to, move past the wrong and draw strength from the memories that haunt them and yet are vital in shaping a lasting peace for the future

“I Forgive to Forget”: Implications for Community Restoration and Unity in Northern Uganda

As the people in northern Uganda begin to rebuild their lives after the devastating war that lasted more than twenty years, reconciliation and community restoration becomes paramount. Forgiveness of wrongs committed and past hurts is an important vehicle to achieve reconciliation and co-existence in a society that is wrought with past social upheavals, fragile relationships and painful memories. This study aimed at exploring and understanding the ‘local’ meanings and notions of forgiveness and its importance in re-cementing a ‘broken’ Acholi society. Personal accounts of wrongs committed and processes of forgiveness were recorded, edited and shared with the public in Awach sub-County, Gulu District. The significance of this study is that among other things it has had a rippling effect and inspired other people to tell their own accounts and share their experiences of forgiveness and what it means for them. The findings illustrate that forgiveness is “personal” and aids ‘repair’ of not only inter-personal but intra-personal broken relationships as it fosters healing, personal freedom, the lifting of heavy burdens from the heart, rebuilding of trust between people and giving individuals a second chance at life’s pursuits. Furthermore, forgiveness is important for co-existence and unity because for many, it has helped them to live with their former tormenters by accepting tormentors’ ‘humanness’ especially when they have owned up to their past mistakes. In conclusion forgiveness has an important place in rebuilding northern Uganda by harnessing people’s ability to, move past the wrong and draw strength from the memories that haunt them and yet are vital in shaping a lasting peace for the future