Individual-level factors associated with mental health in Rwandan youth affected by HIV/AIDS



Prevention of mental disorders worldwide requires a greater understanding of protective processes associated with lower levels of mental health problems in children who face pervasive life stressors. This study aimed to identify culturally appropriate indicators of individual-level protective factors in Rwandan adolescents where risk factors, namely poverty and a history of trauma, have dramatically shaped youth mental health.


The sample included 367 youth aged 10–17 in rural Rwanda. An earlier qualitative study of the same population identified the constructs “kwihangana” (patience/perseverance) and “kwigirira ikizere” (self-esteem) as capturing local perceptions of individual-level characteristics that helped reduce risks of mental health problems in youth. Nine items from the locally derived constructs were combined with 25 items from an existing scale that aligned well with local constructs—the Connor-Davidson Resilience Scale (CD-RISC). We assessed the factor structure of the CD-RISC expanded scale using exploratory factor analysis and determined the correlation of the expanded CD-RISC with depression and functional impairment.


The CD-RISC expanded scale displayed high internal consistency (α = 0.93). Six factors emerged, which we labeled: perseverance, adaptability, strength/sociability, active engagement, self-assuredness, and sense of self-worth. Protective factor scale scores were significantly and inversely correlated with depression and functional impairment (r = −0.49 and r = − 0.38, respectively).


An adapted scale displayed solid psychometric properties for measuring protective factors in Rwandan youth. Identifying culturally appropriate protective factors is a key component of research associated with the prevention of mental health problems and critical to the development of cross-cultural strength-based interventions for children and families.

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This work would not have been possible without the enormous contributions of the Rwandan families that participated in this study, the research team who carried out this work in the field: Charles Ingabire, Sharon Teta, Josee Mukandanga, and Valentine Tuyishime, the collaboration of Partners in Health/Inshuti Mu Buzima, and the Rwandan Ministry of Health. This study was funded by Grant K01MH077246 and T32MH096724 from the National Institute of Mental Health, the Harvard Center for the Developing Child, the Julie Henry Junior Faculty Development Fund, the Peter C. Alderman Foundation, and Fogarty D43TW009335. The authors have no conflicts of interest to report.

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Correspondence to Theresa S. Betancourt.

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Scorza, P., Duarte, C.S., Stevenson, A. et al. Individual-level factors associated with mental health in Rwandan youth affected by HIV/AIDS. Soc Psychiatry Psychiatr Epidemiol 52, 867–875 (2017).

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  • Protective factors
  • Youth
  • Rwanda
  • Mental health
  • Resilience