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Abstract

Depressive symptoms in youth heads of household in Rwanda (PDF) 
Boris,Neil W.; Brown,Lisanne; Thurman,Tonya R.; Rice,Janet C.; Snider,Leslie M.; Ntaganira,Joseph; Nyirazinyoye,Laetitia N.
Archives of Pediatrics and Adolescent Medicine 162(9): 836-843
Publication date: 2008


Objective
To examine the level of depressive symptomsand their predictors in youth from one region of Rwanda whofunction as heads of household (ie, those responsible for caringfor other children) and care for younger orphans.

Design
Cross-sectional survey

Setting
Four adjoining districts in Gigonkoro, an impoverishedrural province in southwestern Rwanda.

Participants
Trained interviewers met with the eldestmember of each household (n = 539) in which a youth24 years old or younger was caring for 1 child or more.

Main Exposure
Serving as a youth head of household.

Main Outcome Measures
Rates and severity of depressivesymptoms using the Center for Epidemiologic Studies Depressionscale; measures of grief, adult support, social marginalization,and sociodemographic factors using scales developed for thisstudy.

Results
Of the 539 youth heads of household, 77% weresubsistence farmers and only 7% had attended school for 6 yearsor more. Almost half (44%) reported eating only 1 meal a dayin the last week, and 80% rated their health as fair or poor.The mean score on the Center for Epidemiologic Studies Depressionscale was 24.4, exceeding the most conservative published cutoffscore for adolescents. Multivariate analysis revealed that reportsof depressive symptoms that exceeded the clinical cutoff wereassociated with having 3 basic household assets or fewer, suchas a mattress and a spare set of clothes (odds ratio [OR], 1.69;95% confidence interval [CI], 1.06-2.70), eating less than 1meal per day (OR, 1.68; 95% CI, 1.09-2.60), reporting fair health(OR, 1.32; 95% CI, 0.76-2.29) or poor health (OR, 2.33; 95%CI, 1.17-4.64), endorsing high levels of grief (OR, 2.67; 95%CI, 1.73-4.13), having at least 1 parent die in the genocideas opposed to all other causes of parental death (OR, 1.83;95% CI, 1.10-3.04), and not having a close friend (OR, 1.91;95% CI, 1.17-3.12). There was an interaction between marginalizationfrom the community and alcohol use; youth who were highly marginalizedand did not drink alcohol were more than 3 times more likelyto report symptoms of depression (OR, 3.07; 95% CI, 1.73-5.42).When models were constructed by grouping theoretically relatedvariables into blocks and controlling for other blocks, theemotional status block of variables (grief and marginalization)accounted for the most variance in depressive symptoms.

Conclusions
Orphaned youth who head households in ruralRwanda face many challenges and report high rates of depressivesymptoms. Interventions designed to go beyond improving foodsecurity and increasing household assets may be needed to reducesocial isolation of youth heads of household. The effect ofhead-of-household depressive symptoms on other children livingin youth-headed households is unknown.