Validity, reliability, and diagnostic cut-off of the Kinyarwandan version of the Hamilton depression rating scale in Rwanda

Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods: The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden's index was used for determining diagnostic cut-off. Results: The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32-0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion: The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap

A Mendelian randomization study of genetic liability to post-traumatic stress disorder and risk of ischemic stroke.

Observational studies have shown an association between post-traumatic stress disorder (PTSD) and ischemic stroke (IS) but given the susceptibility to confounding it is unclear if these associations represent causal effects. Mendelian randomization (MR) facilitates causal inference that is robust to the influence of confounding. Using two sample MR, we investigated the causal effect of genetic liability to PTSD on IS risk. Ancestry-specific genetic instruments of PTSD and four quantitative sub-phenotypes of PTSD, including hyperarousal, avoidance, re-experiencing, and total symptom severity score (PCL-Total) were obtained from the Million Veteran Programme (MVP) using a threshold P value (P) of <5 × 10-7, clumping distance of 1000 kilobase (Mb) and r2 < 0.01. Genetic association estimates for IS were obtained from the MEGASTROKE consortium (Ncases = 34,217, Ncontrols = 406,111) for European ancestry individuals and from the Consortium of Minority Population Genome-Wide Association Studies of Stroke (COMPASS) (Ncases = 3734, Ncontrols = 18,317) for African ancestry individuals. We used the inverse-variance weighted (IVW) approach as the main analysis and performed MR-Egger and the weighted median methods as pleiotropy-robust sensitivity analyses. In European ancestry individuals, we found evidence of an association between genetic liability to PTSD avoidance, and PCL-Total and increased IS risk (odds ratio (OR)1.04, 95% Confidence Interval (CI) 1.007-1.077, P = 0.017 for avoidance and (OR 1.02, 95% CI 1.010-1.040, P = 7.6 × 10-4 for PCL total). In African ancestry individuals, we found evidence of an association between genetically liability to PCL-Total and reduced IS risk (OR 0.95 (95% CI 0.923-0.991, P = 0.01) and hyperarousal (OR 0.83 (95% CI 0.691-0.991, P = 0.039) but no association was observed for PTSD case-control, avoidance, or re-experiencing. Similar estimates were obtained with MR sensitivity analyses. Our findings suggest that specific sub-phenotypes of PTSD, such as hyperarousal, avoidance, PCL total, may have a causal effect on people of European and African ancestry's risk of IS. This shows that the molecular mechanisms behind the relationship between IS and PTSD may be connected to symptoms of hyperarousal and avoidance. To clarify the precise biological mechanisms involved and how they may vary between populations, more research is required

Community resilience in post-conflict societies: experience of a training program in Central African Republic.

INTRODUCTION Norris et al. (2008) define community resilience as a process made of four adaptive capacities: economic development, communication and information, community competence, social capital. Community resilience is typically applied in cases of climate disasters or in post-conflict contexts. While in the first case the impact on social capital is secondary, in the second one, as Somasundaram and Sivayokan (2014) stated, social capital is a specific war target in order to isolate members of communities. For this reason, we propose that the restoration of social capital is the first step to address community resilience in such situations, especially in socio-centric societies (Somasundaram, 2014). As Ager et al. (2005) suggest, to be effective, the construction of community resilience, requires a network within local resources. In line with this, the creation of local Communities of Practice, defined by Wenger (1998) as communities where participants experience mutual engagement, joint enterprise and shared repertoire, represents a result in post-conflict societies. Consistent with literature, the following proposal is about an underway project started in July 2017 and carried out by Sapienza University of Rome, in partnership with University of Rwanda and Université de Bangui, aimed at fostering community resilience in Central African Republic (CAR) where a political and military crisis is occurring since 1996. Because of conditions of extreme violence lots of civilians show PTSD symptoms and other mental disorders with only a few mental health specialists able to intervene. PROJECT AIM Developing a training program aimed at creating a Community of Practice of professionals with psychosocial competences, in order to foster resilience within CAR communities. PARTICIPANTS To easily spread the competences acquired through the training project within the whole target communities, the group of participants includes the following reliable members: psychology students belonging to Université de Bangui; members of local ONGs; proponents of civil and religious communities. TRAINING CONTENT AND METHODOLOGY The training program is provided according to a blended learning methodology. In addition to some specific contents about trauma evaluation and psychosocial intervention, the training is about the development of mutual interdependence within participants in order to give them the chance to directly experience how to create human capital. WORK IN PROGRESS To date, two on-site trainings have been arranged aimed at creating the bases for the construction of a Community of Practice and to transmit some of the aforementioned contents. The development of this process is constantly supervised through some e-learning sessions. BIBLIOGRAPHY Ager, A., Strang, A., Abebe, B. (2005) Conceptualizing community development in war- affected populations: illustrations from Tigray. Community Development journal, Vol 40 No 2, pp. 158-168 Norris, F.H., Stevens, S.P., Pfefferbaum, B., Wyche, K.F., Pfefferbaum, R.L. (2008) Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness. Community Psychology, 41:127–150 DOI 10.1007/s10464-007-9156-6 Somasundaram, D., Sivayokan, S. (2013) Rebuilding community resilience in a post-war context: developing insight and recommendations - a qualitative study\u2028 in Northern Sri Lanka. International Journal of Mental Health Systems, 7:3. Somasundaram, D. (2014) Addressing collective trauma: conceptualisations and interventions, Intervention, 43: 60 Volume 12, Supplement 1. Wenger, E.C. (1998) Communities of Practice: Learning, Meaning, and Identity. Cambridge University Pres

Résilience communautaire dans les sociétés sortant d’un conflit : programme de formation en République Centrafricaine

INTRODUCTION Norris et al. (2008, pp. 131) define community resilience as “a process linking a set of adaptive capacities to a positive trajectory of functioning and adaptation after a disturbance”. In the same article the authors divided these adaptive capacities into four categories: economic development, communication and information, community competence, social capital. Community resilience is typically applied in cases of climate disasters or in post-conflict contexts. While in the first case the impact on social capital is secondary, in the second one, as Somasundaram and Sivayokan (2014) stated, social capital is a specific war target in order to isolate members of the communities. For this reason, we propose that the restoration of social capital is the first step to address community resilience in such situations, especially in socio-centric societies (Somasundaram, 2014). Consistent with literature, the following proposal is about an underway project aimed at developing community resilience in Central African Republic (CAR) where a political and military crisis is occurring since 1996. Because of conditions of extreme violence lots of civilians show PTSD symptoms and other mental disorders with only a few mental health specialists able to intervene. PROJECT AIM In July 2017 the Departments of Developmental and Social Psychology and Dynamic and Clinical Psychology of Sapienza University of Rome, in partnership with University of Rwanda and University of Bangui, started a training program aimed at creating a Community of Practice (Wenger, 1998) of professionals with psychosocial competences in order to foster resilience within the communities of CAR. PARTICIPANTS To easily spread the competences acquired through the training project within the whole target communities, the group of participants includes the following reliable members: psychology students belonging to University of Bangui; members of local ONGs; proponents of civil and religious communities. TRAINING CONTENT AND METHODOLOGY The training program is provided according to a blended learning methodology. The on-site training is focused on: • Trauma-based theories and screening instruments; • Community resilience approaches; • Application of Word-Groups, a psychosocial intervention technique consisting of groups where participants can share experiences, feelings and meanings related to past events. The e-learning training is instead meant to supervise the participants’ job in the field. WORK IN PROGRESS To date an on-site training session about some of the contents aforementioned has been carried out. Supervised by Professors of Sapienza University and University of Rwanda, participants are currently engaged in the translation and administration of some PTSD screening instruments