{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T20:23:40Z","timestamp":1788294220540,"version":"build-2803163510"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2014,8,23]]},"published-print":{"date-parts":[[2015,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>In Rwanda, an estimated one million people were killed during the 1994 genocide, leaving the country shattered and social fabric destroyed. Large-scale traumatic events such as wars and genocides have been linked to endemic post-traumatic stress disorder, depression and suicidality. The study objective was to investigate whether the 1994 genocide exposure is associated with suicide in Rwanda.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a population-based case\u2013control study. Suicide victims were matched to three living controls for sex, age and residential location. Exposure was defined as being a genocide survivor, having suffered physical\/sexual abuse in the genocide, losing a first-degree relative in the genocide, having been convicted for genocide crimes or having a first-degree relative convicted for genocide. From May 2011 to May 2013, 162 cases and 486 controls were enrolled countrywide. Information was collected from the police, local village administrators and family members.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After adjusting for potential confounders, having been convicted for genocide crimes was a significant predictor for suicide (OR=17.3, 95% CI 3.4 to 88.1). Being a survivor, having been physically or sexually abused during the genocide, and having lost a first-degree family member to genocide were not significantly associated with suicide.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These findings demonstrate that individuals convicted for genocide crimes are experiencing continued psychological disturbances that affect their social reintegration into the community even 20\u2005years after the event. Given the large number of genocide perpetrators reintegrated after criminal courts and Gacaca traditional reconciling trials, suicide could become a serious public health burden if preventive remedial action is not identified.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2014-204307","type":"journal-article","created":{"date-parts":[[2014,12,8]],"date-time":"2014-12-08T23:56:00Z","timestamp":1418082960000},"page":"117-122","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Exposure to genocide and risk of suicide in Rwanda: a population-based case\u2013control study"],"prefix":"10.1136","volume":"69","author":[{"given":"Wilson","family":"Rubanzana","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda"},{"name":"Rwanda National Police, Directorate of Medical Service, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethany L","family":"Hedt-Gauthier","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda"},{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Ntaganira","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of Rwanda College of Medicine and Health Sciences, School of Public Health, Kigali, Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael D","family":"Freeman","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University, School of Medicine, Portland, Oregon, USA"},{"name":"Faculty of Medicine, Section of Forensic Medicine, Ume\u00e5 University, Ume\u00e5, Sweden"},{"name":"Faculty of Health Sciences, Department of Forensic Medicine, Aarhus University, Aarhus, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,12,8]]},"reference":[{"key":"2025100520311560000_69.2.117.1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007759112499"},{"key":"2025100520311560000_69.2.117.2","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-7-6"},{"key":"2025100520311560000_69.2.117.3","unstructured":"Kavuro C . Rwanda Reconciliation Process: Outcome Analysis of Gacaca Courts. Great Lakes Region Shareholders\u2019 Conference for Sustainable Peace Conference. Center for the Book, Cape Town, 2011."},{"key":"2025100520311560000_69.2.117.4","first-page":"2","article-title":"The adjudication of genocide: Gacaca and the road to reconciliation in Rwanda","volume":"36","author":"Sosnov","year":"2008","journal-title":"J Intern Law Policy"},{"key":"2025100520311560000_69.2.117.5","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/1043659606291549","article-title":"Exposure to war-related traumatic events, prevalence of PTSD, and general psychiatric morbidity in a civilian population from Southern Lebanon","volume":"17","author":"Farhood","year":"2009","journal-title":"J Transcult Nurs"},{"key":"2025100520311560000_69.2.117.6","doi-asserted-by":"publisher","DOI":"10.1097\/JTN.0b013e3181ac921f"},{"key":"2025100520311560000_69.2.117.7","unstructured":"Knox KL. Epidemiology of the relationship between trauma experience and suicidal behaviors. National Center for PTSD. PTSD Research Quartery. Vermont, National Center for PTSD, 2008."},{"key":"2025100520311560000_69.2.117.8","unstructured":"Handicap International. Healing individual trauma by reweaving social and community ties. An example of community approach in mental health after the genocide against Tutsi in Rwanda 2009. Kigali: HI, 2009 (in French)."},{"key":"2025100520311560000_69.2.117.9","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajgp.12.1.65"},{"key":"2025100520311560000_69.2.117.10","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajgp.13.8.701"},{"key":"2025100520311560000_69.2.117.11","unstructured":"Institute of Research and Dialogue for Peace (IRDP). Mechanisms to fight against the negation of the Tutsi genocide. Research Report 2008, Kigali: IRDP, 2008."},{"key":"2025100520311560000_69.2.117.12","unstructured":"United Nations Security Council. Resolutions and statements on DRC. New York, January 29, 2014, resolution 2136"},{"key":"2025100520311560000_69.2.117.13","doi-asserted-by":"publisher","DOI":"10.1186\/1752-1505-7-6"},{"key":"2025100520311560000_69.2.117.14","first-page":"21","article-title":"Suicide in the Lodz ghetto 1941\u201344","volume":"33","author":"Krysinska","year":"2002","journal-title":"Pol Psychol Bull"},{"key":"2025100520311560000_69.2.117.15","unstructured":"Leenaars AA Brown C Taparti L . Genocide and suicide among indigenous people: the North meets the South. Can J Native Stud 19:337\u201363."},{"key":"2025100520311560000_69.2.117.16","unstructured":"Human Right Watch. Rwanda country summary. World Report 2011, New York: HRW, 2011."},{"key":"2025100520311560000_69.2.117.17","first-page":"219","article-title":"Suicide in urban Kampala, Uganda: a preliminary exploration","volume":"11","author":"Kiyanda","year":"2011","journal-title":"Afr Health Sci"},{"key":"2025100520311560000_69.2.117.18","doi-asserted-by":"publisher","DOI":"10.1136\/jech.57.8.594"},{"key":"2025100520311560000_69.2.117.19","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291708003644"},{"key":"2025100520311560000_69.2.117.20","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244X-9-45"},{"key":"2025100520311560000_69.2.117.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11681-3"},{"key":"2025100520311560000_69.2.117.22","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.108.063347"},{"key":"2025100520311560000_69.2.117.23","first-page":"1","article-title":"Suicide and HIV\/AIDS in Transkei, South Africa.Anil Aggrawal's Internet","volume":"4","author":"Meel","year":"2003","journal-title":"J Forensic Med Toxicol"},{"key":"2025100520311560000_69.2.117.24","doi-asserted-by":"publisher","DOI":"10.1159\/000082719"},{"key":"2025100520311560000_69.2.117.25","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.94.1.37"},{"key":"2025100520311560000_69.2.117.26","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000093367.07960.E4"},{"key":"2025100520311560000_69.2.117.27","unstructured":"Center for Control Diseases and Prevention. National Center for Injury Prevention and Control. Division of Violence Prevention Suicide due to alcohol and\/or drug overdose. A data brief from the national violent death reporting system. http:\/\/www.cdc.gov\/violenceprevention\/pdf\/NVDRS_Data_Brief-a.pdf (accessed 22 Jun 2013)."},{"key":"2025100520311560000_69.2.117.28","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2005.042903"},{"key":"2025100520311560000_69.2.117.29","doi-asserted-by":"crossref","unstructured":"Karl Foster . Doctoral Thesis, Criminal law. The Khmer Rouge and the Crime of Genocide. Issues of Genocide Intent With Regard to the Khmer Rouge Mass Atrocities . Berne: University of Berne, 2011.","DOI":"10.2139\/ssrn.1986858"},{"key":"2025100520311560000_69.2.117.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.avb.2007.09.001"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2014-204307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T03:31:27Z","timestamp":1759721487000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2014-204307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12,8]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2015,1,13]]},"published-print":{"date-parts":[[2015,2]]}},"alternative-id":["10.1136\/jech-2014-204307"],"URL":"https:\/\/doi.org\/10.1136\/jech-2014-204307","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12,8]]}}}