TY - JOUR
T1 - Prevalence and predictors of posttraumatic stress disorder and depression in HIV-infected and at-risk Rwandan women
AU - Cohen, Mardge H.
AU - Fabri, Mary
AU - Cai, Xiaotao
AU - Shi, Qiuhu
AU - Hoover, Donald R.
AU - Binagwaho, Agnes
AU - Culhane, Melissa A.
AU - Mukanyonga, Henriette
AU - Karegeya, Davis Ksahaka
AU - Anastos, Kathryn
PY - 2009/11/1
Y1 - 2009/11/1
N2 - Objective: During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms. Methods: The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean >2) and depressive symptoms (CES-D≥16) for 850 women (658 HIV-positive and 192 HIV-negative). Results: PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p=0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p<0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making <$18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. Conclusions: The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts <200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.
AB - Objective: During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms. Methods: The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean >2) and depressive symptoms (CES-D≥16) for 850 women (658 HIV-positive and 192 HIV-negative). Results: PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p=0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p<0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making <$18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. Conclusions: The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts <200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.
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U2 - 10.1089/jwh.2009.1367
DO - 10.1089/jwh.2009.1367
M3 - Article
C2 - 19951212
AN - SCOPUS:71449101010
SN - 1540-9996
VL - 18
SP - 1783
EP - 1791
JO - Journal of Women's Health
JF - Journal of Women's Health
IS - 11
ER -