Youth self-harm in Rwanda: Taking a closer look
There is a worrying recent trend of rising rates of self-harm and suicide among adolescents in Rwanda.
Over 90% of deaths by suicide among young people happen in less wealthy countries, including many regions of Africa. Yet medical research in this area has predominantly taken place in high-income countries like the UK, US and Australia.
A new study funded by the Foundation and led by Dr Faith Martin reveals much-needed insight into the social, cultural, and psychological factors influencing suicidality in settings such as Rwanda.
Published recently in BMC Psychology, the study explores a range of factors that contribute to self-harm behaviours. Dr Faith Martin from the University of Bath highlights the need for cross-sectoral strategies in policy to prevent self-harm in Rwanda, including those that address poverty, health, education and violence at home.
We wanted to address the lack of research in the Global South by understanding how social, cultural and structural factors shape pathways to harm and recovery from self-harm.Dr Faith Martin
University of Bath
Suicide prevention is part of the UN’s Sustainable Development Goals to reduce premature deaths and promote better mental health and wellbeing by 2030. There is a worrying recent trend of rising rates of self-harm and suicide among adolescents in lower-income countries. Despite this, research to date has been dominated by countries in the Global North.
Self-harm issues in less-advantaged regions are often exacerbated by poverty, trauma, limited mental health infrastructure, and higher levels of stigma. In Rwanda, for instance, it is estimated that in 2019, 4.7% of females and 1.4% of males aged 20–35 had ‘attempted suicide’ in a single month at the time of reporting.
Adolescents in Rwanda face a complex web of risk factors for self-harm, including intergenerational trauma stemming from the 1994 Genocide against the Tutsi.
Dr Martin explains, “The 1994 genocide in Rwanda continues to affect mental health in the country, not least for parents who lived through this period. We want to understand more about this impact on parents, and in turn how this affects their children.”
In this study, Dr Martin and her team carried out interviews with 102 participants across two distinct regions of Rwanda - Gasabo (urban) and Nyagatare (rural). Both districts report a high prevalence of self-harm and suicidality. The interviews were semi-structured to explore the experiences and perceptions of self-harm among young people, their parents and healthcare professionals.
“We wanted to address the lack of research in the Global South by understanding how social, cultural and structural factors shape pathways to harm and recovery from self-harm.
Involving parents too, as a major part of the social context, was really important to us, to extend our knowledge of parents' experiences and needs."
The team found five key themes emerging to explain how study participants understood and made sense of youth self-harm (see Figure 1 above).
Participants described multiple triggers for self-harm, from mental illness and drug abuse to more complex, inter-related factors such as family conflict, abuse, poverty, school challenges, and peer relationships.
Young people also talked about a ‘build-up’ of distressing emotions and responses, leading to overwhelm. Healthcare providers noted that self-harm was used by young people to regulate emotions and communicate distress but indicated a concerning lack of awareness about its long-term impacts, emphasising the need for better education.
When exploring community perceptions, researchers found that young people often faced stigma, silence and harmful judgement. However, in cases where community leaders and neighbours reacted supportively, this could be lifesaving.
“Our findings show that young people's self-harm is deeply relational and context-sensitive, with community responses playing a dual role that can either increase risk through stigma and shame, or protect young people through care and connection.”
Self-harm in Rwanda is evidently not solely a mental health issue, but is intertwined with factors like education, economic development, violence or abuse, adolescent pregnancy and substance use.
“This highlights the need for prevention and therapeutic approaches that extend beyond clinical services to include families, schools and communities,” says Dr Martin.
By making use of more culturally sensitive, multi-sector approaches, policymakers, parents, and clinicians could help to design effective interventions and make better-informed decisions to support young people in distress.
Dr Martin comments on her next steps, “We’ve just started to translate these findings into community-informed interventions for not just young people and their families, but also communities and healthcare providers. We are excited to continue to develop this work, whilst also taking steps towards carrying out formal trials of our interventions.”
See the full study here >>
This article discusses suicide and/or self-harm, so please read the content with care. If you are feeling suicidal, know that help is available. Contact the Samaritans on 116 123 if you need emotional support. If you feel you are in immediate danger to yourself, call 999.