Unconditional Forgiveness, Reconciliation Sentiment, and Mental Health Among Victims of Genocide in Rwanda

The study assessed the relationships between mental health (loss, anxiety and depression), reconciliation sentiment (intra personal and interpersonal reconciliation sentiment), and dispositional forgiveness (lasting resentment, sensitivity to circumstances and unconditional forgiveness) among Rwandese survivors of the 1994 genocide. A sample of 72 females and 29 males living in the southern province of Rwanda, primary victims of the genocide (widows or children of killed people), was presented with questionnaires measuring these constructs. As hypothesized, (a) a strong, positive association was found between interpersonal reconciliation sentiment (trust and cooperation) and unconditional forgiveness, and (b) no significant associations were found between interpersonal reconciliation sentiment and the other two factors of the forgivingness construct: lasting resentment and sensitivity to circumstances. This pattern of associations was consistent with the view that, owing to the current situation in Rwanda where very few perpetrators have directly apologized, the only way for the victims to achieve a state of forgiveness is through unconditionally forgiving the people who harmed them.     

The Intergenerational Effect of Cambodia's Genocide on Children's Education and Health

We investigate the intergenerational impact of conflict on the educational and health outcomes of children born years after the conflict ended by exploiting geographical variation in the intensity of the genocide that occurred during the Khmer Rouge (KR) regime in Cambodia. We find that children of individuals who were of prime marriage age during the genocide and experienced greater intensity of genocide have worse educational and health outcomes. In particular, for each standard deviation increase in the intensity of the genocide, average children's normal grade progression rate decreases by 0.03 standard deviations and average children's height‐for‐ age Z‐score decreases by 0.06 standard deviations. We examine several channels through which genocide could affect children born to survivors after the conflict and find suggestive evidence that the marriage market acts as a channel that transmits the adverse impact of conflict across generations. Our findings are robust to alternative measures of mortality rates and post‐KR internal migration.     

Emplaced social vulnerability to technological disasters: Southeast Louisiana and the BP Deepwater Horizon oil spill

We examine the relationship between emplaced social vulnerability and impacts on mental health following the BP Deepwater Horizon oil spill. Through joint analysis of data from Community Oil Spill Survey and US Census Bureau products, a place-based index of social vulnerability is developed to examine how emplaced characteristics engender unique susceptibility to the disaster, with specific attention on the influence of natural resource employment and community sentiment. Results show negative mental health impacts to be more pronounced at baseline compared to later time points and that shifts in negative mental health were not uniform for localities with divergent levels of social vulnerability, where places identified with high levels of social vulnerability the effectiveness of attributes associated with resilience were muted, while the effect of vulnerability attributes was amplified. These findings contribute to the understanding of vulnerability as a multidimensional concept shaped by the social attributes that characterize people and places.     

Minority Stress in the Lives of Men Who Have Sex With Men in Cape Town,South Africa

The mental health outcomes of men who have sex with men (MSM) living in sub-Saharan Africa are understudied, despite evidence that discrimination and stigma are widespread. This article examines the occurrence and mental health effects of minority stress in a sample of diverse South African MSM. Twenty-two MSM living in Cape Town took part in exploratory qualitative in-depth interviews and completed mental health questionnaires. Results indicate that the majority of participants experienced minority stress, which affected their sexual relationships and coping strategies. Concealment behaviors and perceived discrimination levels were high and were associated with race, religion, SES, and geographical location.     

Trauma and Mental Health in South Africa

Prior to the first democratic elections, South Africa had experienced severe political violence. In this paper, we describe the effects of this violence on mental health, concentrating mainly on post-traumatic stress disorder (PTSD), and its symptoms, including reliving aspects of the trauma, avoiding situations which remind one of the experience, and heightened irritability. As part of a nationwide survey on health inequalities covering 4000 South African households, questions were put to 3870 respondents aged 16 to 64 years on their mental health status, feelings of powerlessness, exposure to violence and other traumatic situations, symptoms of PTSD and access to health care for these symptoms. Weighted survey results indicate that approximately five million adults (23% of the population aged 16 to 64 years) had been exposed to one or more violent events, for example, being attacked, participating in violence and witnessing one's home being burnt. Just under four-fifths (78%) of those who had experienced at least one traumatic event had one or more symptoms of PTSD. This syndrome was found to be related to feelings of powerlessness, anxiety and depression and fair or poor self-ratings of emotional well-being. The authors concluded that healing the people of South Africa involves revealing the full extent of political violence that was committed during the apartheid era, confronting the effects of this violence, and establishing both professional and community structures to deal with it on a large scale, for example, the training of lay people to give counselling.     

Health-Related Quality of Life Among Abused Women One Year After Leaving a Violent Partner

This is the first follow up study measuring quality of life among abused women who have left their abusive partner. The women (n = 22) answered a questionnaire while staying at women’s shelter and one year later. The aim was to examine long-term effects of intimate partner violence against women on health-related quality of life. Health-related quality of life was measured using the SF-36 Health Survey and the WHOQOL-BREF. The meantime for living in a violent partnership was 11 years, most of the women had children under 10 years living with them, low income and were on sickness absence or disability pension. About half of the women had experienced threats of violence and 6 had experienced violent acts after leaving their partner. SF-36 scores after one year were significantly better in vitality (t-test, P < 0.001), mental health (t-test P < 0.001) and social domains (t-test, P < 0.04). WHOQOL-BREF scores did not change significantly from baseline, showing that the SF-36 showed more responsiveness in this population. Regression analysis showed that serious physical violence reported at baseline predicted significantly less improvement in physical and mental health and role-emotional in the SF-36 and in social relationships and environmental health in the WHOQOL-BREF. High psychological violence at baseline predicted significantly less improvement in mental health in the SF-36 and in social relationships and environmental health in the WHOQOL-BREF.     

Mental health issues: a comparison of lesbian, bisexual and heterosexual women

This study examines mental health issues among women of different sexual orientations. An anonymous survey was administered at 33 health care sites across the United States; the sample (N = 1304) included lesbians (n = 524), bisexual (n = 143) and heterosexual women (n = 637). Not only did sexual orientation influence the probability of experiencing emotional stress, but also whether a bisexual woman or lesbian had disclosed her sexual orientation (was "out") impacted the likelihood of having or having had mental health problems. Bisexual women and lesbians experienced more emotional stress as teenagers than did heterosexual women. Bisexual women were more than twice as likely to have had an eating disorder compared to lesbians. If a bisexual woman reported being out she was twice as likely to have had an eating disorder compared to a heterosexual woman. Lesbians who were not out and bisexual women who were out were 2-2.5 times more likely to experience suicidal ideation in the past 12 months. Lesbians and bisexual women who were not out were more likely to have had a suicide attempt compared to heterosexual women. Lesbians used psychotherapy for depression more commonly than did heterosexual or bisexual women. This is one of the few studies that compares lesbians, bisexual and heterosexual women. The implications of these findings are discussed.     

Effects of Three Caregiver Interventions: Support,Educational Literature,and Creative Movement

The primary focus of this study is to compare the effectiveness of three distinct intervention techniques in relieving some of the stress experienced by midlife daughters' caregiving for their frail mothers. The three techniques are: (a) a home-based literature “tip of the week” group, (b) a caregiver's support group, and (c) a creative-movement group. Based on a review of caregiving literature, no other studies have utilized a home-based literature intervention or a creative-movement intervention with midlife daughters providing informal care to frail mothers. As part of the weekly assessment evaluation, participants were asked to rate how helpful the previous week's session was with respect to five mental health variables: irritability, depression, anxiety, stress, and concentration. Overall, the support-based group had higher average scores for each of the five mental health variables and the highest overall mental health score. Future research and promising applications of future intervention programs are discussed.     

Death and survival during the 1994 genocide in Rwanda

This paper reports a quantitative study of the genocide in the prefecture of Kibuye in western Rwanda in 1994. It uses a database produced from a house-to-house survey of victims by the organization of genocide survivors, Ibuka. For a total of 59,050 victims of the genocide, data were collected on age, sex, occupation, commune of residence before the genocide, and place and date of death. An analysis conducted for one commune (Mabanza), showed that the chance of surviving the genocide was higher in those sectors of the commune where the Tutsi population did not congregate at a football stadium in Kibuye. Those who went to a mountainous area and defended themselves were almost the only Tutsi still alive in the prefecture after the month of April 1994. Other determinants of survival included age, sex, and occupation. The number of deaths each day while the killing lasted is estimated for the whole of the prefecture.     

Associations of Perceived Parental Psychopathology with Mental Health Burden and Lifetime Drug Use in Gay,Bisexual, and other YMSM: The P18 Cohort Study

Parental mental health may be a critical component in understanding the overlapping health burdens of mental health symptomatology and drug use in young men who have sex with men (YMSM), yet studies of YMSM have not fully examined these associations. To understand these relationships, data drawn from a study of gay, bisexual, and other YMSM were used to examine associations between perceived parental psychopathology and the health of YMSM. Findings suggest that YMSM reporting at least one parent with perceived depression, manic depression, schizophrenia, or antisocial behavior anytime during their childhoods were more likely to report higher levels of both depressive symptomatology and post-traumatic stress disorder (PTSD) than those reporting no perception of any of these psychopathologies in their parents. Number of different drugs used in one’s life were higher among participants who perceived at least one parent as depressed. Mediation analyses indicated that the relationship between perceived parental depression and lifetime drug use of YMSM was mediated both by YMSM depression and YMSM PTSD. These results suggest that parental psychopathology plays an important role in the health of sexual minority men, a population with elevated levels of mental health burden and drug use across the lifespan.     

Questioning Psychosocial Resilience After Flooding and the Consequences for Disaster Risk Reduction

This paper questions George Bonanno’s concept of resilience as “relatively stable, healthy levels of psychological and physiological functioning” (Bonanno in Am Psychol 59(1):20–28, 2004) following potentially traumatic events (PTE). It agrees with Bonanno’s claim that significant numbers of people may suffer from mental disorders following a PTE, but disagrees that the majority of people are resilient. Furthermore it argues that we should not see PTEs as one event, but as involving a number of stressors and having a variety of consequences. Drawing on fieldwork carried out in Rajni village, Bihar following the 2008 Kosi River flooding, it documents, 18 months post flood, that flood onset gave rise to symptoms related to Post Traumatic Stress Disorder (primarily re-experiencing). The villagers’ primary concern was livelihood loss which, together with their lack of hope for the future, led to symptoms of depression. It argues that mental health issues should be fully integrated into Disaster Risk Reduction plans and policies, which are likely to be included in the Post-2015 Millennium Development Goals. In addition to supporting mental health interventions, the paper suggests that deep socio-cultural changes are necessary to ensure improvements in mental health.     

Breastfeeding experiences and perspectives among women with postnatal depression: A qualitative evidence synthesis

BackgroundStudies show that postnatal depression affects around 10–16% of women globally. It is associated with earlier cessation of breast feeding, which can negatively impact infants’ long-term development. Mechanisms underpinning associations between mental health and women’s decision to commence and continue to breastfeed are complex and poorly understood.AimThe aim of this review was to investigate breastfeeding experiences, perspectives, and support needs of women with postnatal depression. No previous reviews were identified which had addressed this aim.MethodA systematic search was conducted of six databases to identify relevant qualitative studies. Six included studies were critically appraised and synthesised using thematic synthesis.FindingsFive themes were identified: (1) desire to breastfeed and be a ‘good mother’, (2) struggles with breastfeeding, (3) mixed experiences of support from healthcare professionals, (4) importance of practical and social support, (5) support for mental health and breastfeeding. Most women with postnatal depression expressed strong intentions to breastfeed, although some perceived ‘failure’ to breastfeed triggered their mental health problems. Practical and non-judgemental support for their mental health needs and for successful breastfeeding from healthcare professionals, family and friends are needed.ConclusionMost women with postnatal depression desired to breastfeed but experienced breastfeeding difficulties that could impact on their mental health. By offering women with postnatal depression tailored and timely support, healthcare professionals could help women minimize breastfeeding problems which could consequently impact on their mental well-being and ensure they and their infants have opportunity to benefit from the advantages that breastfeeding offers.     

Domestic Harm and Neglect Among Lesbian,Gay, and Bisexual Older Adults

This study examined harm, hurt, and neglect by caregivers as well as self-neglect and physical and mental health status among 113 lesbian, gay, and bisexual (LGB) older adults aged 60–88 years, who attended community-based social and recreation programs or groups in the United States. Reporting on their experiences with caregivers, 22.1% of the participants experienced at least one type of harm, including physical, emotional, verbal, sexual, financial, and neglectful; additionally, 25.7% of the participants reported they knew LGB older adults who experienced at least one type of harm from his or her caregiver. With regard to self-neglect, 62.8% reported experiencing it; those indicating positive psychological health reported fewer experiences with self-neglect.     

“If you don’t ask … you don’t tell”: Refugee women’s perspectives on perinatal mental health screening

ProblemNational guidelines recommending mental health screening in pregnancy have not been implemented well in routine maternity care. Women of refugee background are likely to have experienced traumatic events and resettlement stressors, yet are not often identified with mental health issues in the perinatal period.BackgroundGlobally, perinatal mental health conditions affect up to 20% of women. Many difficulties in accessing mental health care in pregnancy exist for women of refugee background including stigma, and cultural and language barriers. Technology can provide an efficient and effective method to overcome some of these barriers.AimTo determine if a digital perinatal mental health screening program is feasible and acceptable for women of refugee background.MethodsThis qualitative evaluation study used focus group and semi-structured telephone interviews with refugee and migrant women from four communities. Interpreters were used with women who spoke little or no English. Data were analysed using both an inductive and deductive approach to thematic analysis.FindingsUnder the three key themes: ‘Women’s experiences of perinatal mental health screening in pregnancy’; ‘Barriers and enablers to accessing ongoing mental health care’ and ‘Improvements to the program: the development of audio versions’, women found the program feasible and acceptable.DiscussionScreening using a mobile device offered women more privacy and opened up discussions with midwives on emotional health. Improvements in service coordination and access to further mental health management for women is required.ConclusionPerinatal mental health screening is an acceptable and feasible option for women of refugee background. Integrated models of care, case management, and patient navigators are options for improvements in uptake of referral and treatment services.     

The Interaction of Same-Sex Marriage Access With Sexual Minority Identity on Mental Health and Subjective Wellbeing

Previous psychological and public health research has highlighted the impact of legal recognition of same-sex relationships on individual identity and mental health. Using a sample of U.S. sexual minority (N = 313) and heterosexual (N = 214) adults, participants completed a battery of mental health inventories prior to the nationwide legalization of same-sex marriage. Analyses of covariance (ANCOVAs) examining identity revealed sexual minority participants living in states where same-sex marriage was banned experienced significantly higher levels of internalized homonegativity than sexual minority participants living in states where same-sex marriage was legal, even after controlling for state-level political climate. Mental health ANCOVAs revealed sexual minority participants residing in states without same-sex marriage experienced greater anxiety and lower subjective wellbeing compared to sexual minority participants residing in states with same-sex marriage and heterosexual participants residing in states with or without same-sex marriage. Implications for public policy and future research directions are discussed.     

社会资本与身心健康--概念辨析基础上的关系再检验

社会资本与健康研究领域存在核心概念界定不清与理论解释欠缺两大不足。文章在社会网络的视角下对社会资本、社会凝聚和社会支持三个相互杂糅的概念进行辨析区分，并在此基础上以调查数据实证检验了社会资本对身心健康的作用效果与影响机制。结果显示，在控制社会凝聚和社会支持作用的条件下，社会资本依然对自评健康和心理健康存在显著的独立影响，但其对两种健康在影响因素和影响方向上呈现一些差异。其中，网络规模和网络顶端对自评健康和心理健康都具有显著的正向作用，而心理健康同时还受到网络差异的负向影响。从这个角度而言，社会资本对个体身心健康的影响并不必然是积极正向的。     

Healthy Days,Health Satisfaction and Satisfaction with the Overall Quality of Life

In this note we report results of 6 surveysusing the United States Centers for DiseaseControl and Prevention indicators of healthstatus, taken from the Behavioral Risk FactorSurveillance System. Generally speaking, wefound that the CDC healthy days variables couldplay a useful role in survey research aimed atassessing the impact of measured health statuson people's satisfaction with their own healthand with the overall quality of their lives.More precisely, using stepwise regressions wefound: (1) The three healthy days variablesexplained from 16 to 27 percent of the variancein General Health scores. The limited activitydays variable remained as a significantpredictor in only one of the six regressionsand the not good physical health days variablewas most influential in every sample. (2) Thethree healthy days variables explained from 19to 32 percent of the variance in healthsatisfaction scores, and the not good physicalhealth days variable was again most influentialin every sample. (3) The three healthy daysvariables explained from 12 to 39 percent ofthe variance in quality-of-life satisfactionscores, with the not good mental healthvariable most influential in every sample. (4)The four CDC variables together explained from40 to 55 percent of the variance in healthsatisfaction scores, with the General Healthvariable always dominating the set ofpredictors by a fairly wide margin. (5) Thefour CDC variables together explained from 17to 28 percent of the variance inquality-of-life satisfaction scores, with theGeneral Health variable most influential inthree samples and the not good mental healthvariable most influential in the other three.(6) When the four CDC variables plus the healthsatisfaction variable were used as potentialpredictors, we were able to explain from 29 to40 percent of the variance in quality-of-lifesatisfaction scores. In every sample, theGeneral Health and limited activity daysvariables had no significant impact. (7) Usingstructural equation modeling, we found GeneralHealth does not have a direct effect onsatisfaction with the overall quality of lifebut rather only an indirect effect throughhealth satisfaction. The General Health, notgood physical health, and not good mentalhealth days variables account for 51% of thevariation in health satisfaction, and healthsatisfaction, not good physical health and notgood mental health days variables account for30% of the variation in satisfaction with theoverall quality of life.     

Health Needs and Experiences of a LGBT Population in Georgia and South Carolina

ABSTRACT

The 2016 Municipal Equality Index rated Augusta, the largest city in the Central Savannah River Area (CSRA), as one of the least lesbian, gay, bisexual, and transgender (LGBT) friendly cities in America. To understand the context of our region in relation to LGBT wellness, we conducted the first LGBT health needs assessment of the CSRA, assessing physical and mental health status and health care needs and experiences in the community. Participants (N = 436) were recruited using venue and snowball sampling and completed an anonymous online survey. Overall, the health problems experienced (i.e., obesity, depression) were not uniformly experienced across sexual orientation and gender identity; some groups experienced significantly higher rates of these conditions than others. Similarly, transgender individuals in particular reported higher rates of negative experiences with health care providers. Regional and national dissemination of these findings is critical to reducing health disparities and improving wellness of our local LGBT community.     

西部农村留守妇女的身心健康及其影响因素——来自四川农村的报告

本文采用西部地区24个行政村千余名农村妇女的调查数据,探讨了农村留守妇女的身心健康及影响因素。研究发现,留守确实影响了农村妇女的身心健康,留守妇女比非留守妇女更担心自己的身体健康状况,更倾向认为自己的身体健康状况不及同龄女性和比以前更差了,更容易出现一些生理和心理不健康的症状;留守妇女的家庭压力、社会支持网络、当地医疗卫生状况等因素对其身心健康有不同程度的影响。文章最后提出建立夫妻间良好的沟通机制、构建社会支持网络、改善农村医疗卫生状况三点建议。     

The effect of COVID-19 lockdowns on women's perinatal mental health: a systematic review

BackgroundRisk factors for poor maternal perinatal mental health include a previous mental health diagnosis, reduced access to perinatal services, economic concerns and decreased levels of social support. Adverse maternal perinatal mental health can negatively influence the psychological wellbeing of infants. The outbreak of the COVID-19 pandemic presented an additional stressor. While literature on the impact of COVID-19 on perinatal mental health exists, no systematic review has focused specifically on maternal perinatal mental health during periods of COVID-19 lockdown.AimsThis systematic review explores how periods of COVID-19 lockdown impacted women’s perinatal mental health.MethodsSearches of CINAHL, PsycARTICLES, PsycINFO, PubMed, Scopus and Web of Science were conducted for literature from 1st January 2020–25th May 2021. Quantitative, peer-reviewed, cross-sectional studies published in English with perinatal women as participants, and data collected during a period of lockdown, were included. Data was assessed for quality and narratively synthesized.FindingsSixteen articles from nine countries met the inclusion criteria. COVID-19 lockdowns negatively impacted perinatal mental health. Risk factors for negative perinatal mental health noted in previous literature were confirmed. In addition, resilience, educational attainment, trimester, and ethnicity were identified as other variables which may influence mental health during perinatal periods experienced during lockdown. Understanding nuance in experience and harnessing intra and interpersonal support could advance options for intervention.ConclusionDeveloping resources for perinatal women that integrate informal sources of support may aid them when normal routine is challenged, and may mediate potential long-term impacts of poor perinatal maternal health on infants.