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Linking coping strategies to locally-perceived aetiologies of mental distress in northern Rwanda
  1. Teisi Tamming1,2,
  2. Yuko Otake3
  1. 1Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  2. 2Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
  3. 3School of Anthropology and Museum Ethnography, University of Oxford, Oxford, Oxfordshire, United Kingdom
  1. Correspondence to Teisi Tamming; teisitamming{at}


Introduction How and why people in a particular setting turn to a specific coping strategy for their distress is pivotal for strengthening mental healthcare and this needs to be understood from a local point of view. Prior research in northern Rwanda documented common local concepts of distress for the population that cannot receive assistance despite severe adversities; however, the locally-perceived causes, manifestation and coping strategies and their associations are still unclear.

Methods The qualitative study in the Musanze district, northern Rwanda, was informed by Interpretative Phenomenological Analysis. In-depth interviews were conducted with people with lived experience and those in close contact with people with lived experience of distress. Ethnographic observation was conducted and the analyses were complimented by an earlier ethnography in the same village.

Results Study participants (n=15) included community members with lived experience of mental distress and/or those with close friends or family with lived experience. The perceived manifestations of the mental distresses were diverse and the causal attributions shifted from more social, concrete and explainable (eg, loss) towards magical, more abstract and unexplainable (eg, poisoning). Finally, participants sought coping strategies in accordance with their causal attribution in ways that made sense to them.

Conclusion The coping strategies were chosen according to the perceived aetiology of the symptoms and they were perceived to be effective for their distress. Local coping strategies that match people’s help-seeking patterns should therefore be supported in policy and programmes. In Rwanda this requires a mutual training of medical professionals and traditional healers and establishing co-treatment within two parallel systems. This also requires the support for programmes and initiatives that strengthen positive interactions and change in circumstances.

  • mental health & psychiatry
  • public health
  • qualitative study

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  • Handling editor Kerry Scott

  • Contributors TT is the guarantor of the research and accepts full responsibility. TT and YO designed the study. TT collected the data. TT and YO both analysed the data and contributed to the manuscript writing. Both have read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval The study gained ethical approval from the London School of Hygiene and Tropical Medicine and the National Council for Science and Technology (NCSCT) in Rwanda.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. It is not viable nor ethical to make the data openly available due to confidentiality and sensitivity of the information and the agreement signed by the participants.

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