Understanding locally, culturally, and contextually relevant mental health problems among Rwandan children and adolescents affected by HIV/AIDS

Abstract

In assessing the mental health of HIV/AIDS-affected children and adolescents in Sub-Saharan Africa, researchers often employ mental health measures developed in other settings. However, measures derived from standard Western psychiatric criteria are frequently based on conceptual models of illness or terminology that may or may not be an appropriate for diverse populations. Understanding local perceptions of mental health problems can aid in the selection or creation of appropriate measures. This study used qualitative methodologies (Free Listing, Key Informant interviews, and Clinician Interviews) to understand local perceptions of mental health problems facing HIV/AIDS-affected youth in Rwinkwavu, Rwanda. Several syndrome terms were identified by participants: agahinda kenshi, kwiheba, guhangayika, ihahamuka, umushiha, and uburara. While these local syndromes share some similarities with Western mood, anxiety, and conduct disorders, they also contain important culture-specific features and gradations of severity. Our findings underscore the importance of understanding local manifestations of mental health syndromes when conducting mental health assessments and when planning interventions for HIV/AIDS-affected children and adolescents in diverse settings.

Keywords:

• Rwanda
• HIV/AIDS
• children and adolescents
• mental health
• qualitative research

Acknowledgements

An outstanding team of collaborators made this work possible. We are endlessly grateful to all the local research assistants who carried out these interviews: Morris Munyanah, Kenneth Ruzindana, Mary Tengera, Claire Gasamagera Tuyishime, Theotime Rutaremerara, Yvonne Asiimwe Murebwayire, Françoise Murebwayire, Fredrick Kanyanganzi, and Anatole Manzi. We are also grateful to Partners In Health/Inshuti Mu Buzima for their collaboration and dedication, and to the Peter C. Alderman Foundation, the Harvard University Research Enabling Grants Program and the Julie Henry Family Development Fund for their support of this field research. This publication was also made possible by Grant #1K01MH077246-01A2 from the National Institute of Mental Health and by the François-Xavier Bagnoud Center for Health and Human Rights. Additional thanks go to Jim Yong Kim, Maggie Alegria, Elizabeth Barrera, Glenn Saxe, Brandi Harless, Laura Khan, Pamela Scorza, Sarah Meyers-Ohki, Ryan McBain, Natalie Stahl, Christina Mushashi, Ali Solange Nyirasafari, Jacqueline Umugwaneza, and Robert Gakwaya for their input on the project and/or their review of the data.