Herbert Elvis Ainamani

Worldwide, suicide remains a major public health challenge, with a disproportionate burden in low- and middle-income countries. Despite growing evidence on suicidal behavior in Uganda, little is known about how community stakeholders perceive its burden, drivers and opportunities for prevention in rural settings. We aimed to explore stakeholders’ perspectives on suicidal behavior, its perceived drivers and opportunities for suicide prevention in Ntungamo District, southwestern Uganda. We conducted a qualitative study involving 19 face-to-face in-depth interviews and three focus group discussions with purposively selected stakeholders. Interviews were audio-recorded, transcribed verbatim and analyzed using rapid qualitative thematic analysis. Three themes emerged: (1) suicidal behavior was perceived as an increasingly visible community and public health concern; (2) participants identified interacting drivers of suicidal behavior, including access to lethal means, socioeconomic adversity, demographic vulnerabilities, and harmful alcohol and substance use; (3) participants identified community-informed opportunities for suicide prevention and to promote awareness, reduce stigma and encourage early help-seeking. Stakeholders perceived suicidal behavior as a significant community concern driven by interacting social, economic, demographic and environmental influences. Community-informed suicide prevention strategies that strengthen existing community structures and trusted local actors could inform policy and practice in Uganda and similar rural settings across sub-Saharan Africa.

Learning to regulate one's emotions is a key feature of socio‐emotional development. The still‐face experiment—which measures how infants respond to a sudden change in maternal responsiveness—has long been considered a reliable indicator of infant reactivity and regulation. However, as a paradigm established to fit Western, middle‐class industrialized contexts, its robustness in other cultural contexts, has been questioned. Differences in responses to the still‐face experiment are likely shaped by variation in infant‐caregiver interactions and practices. To expand the literature and address sampling biases, we conducted the still‐face experiment with 10‐month‐old infants ( N = 138, 68 female) across three sites, in rural and urban Uganda and urban UK. Across sites, we found the expected patterns of decreased infant positive affect and gaze toward their caregiver in the still‐face phase. However, while infants in urban Uganda and the UK exhibited increased negative affect when their mother ceased interacting, infants from rural Uganda did not. Our findings highlight important variation across socio‐cultural contexts in infant emotional reactivity and interaction style, suggesting that infants' responses to the still‐face paradigm may be shaped by the broader caregiving environments in which they develop.

Despite the growing global burden of mental health conditions, nationally representative data in low- and middle-income countries remain limited. Using data from the 2024 Uganda National Population and Housing Census, this study examined the prevalence and distribution of probable mental health conditions among persons aged 10 years and older in Uganda, while assessing variations by sex, place of residence and sub-region. We conducted a descriptive secondary analysis of publicly available census tabulations (2024 Volume I, Section 6.5). The analytic population comprised 31,389,721 individuals aged 10 years and older. Mental health outcomes were based on self-reported symptoms synthesised by the Uganda Bureau of Statistics into six indicators of probable mental health conditions, such as general psychological distress, depression, anxiety, bipolar disorder, psychosis and suicidality, rather than clinical diagnoses. Among persons aged 10 years and older, 3,773,915 (12.0%) reported probable general psychological distress. Probable depressive condition affected 2,444,272 (7.8%), followed by probable bipolar condition 1,262,088 (4.0%) and probable anxiety condition 1,201,182 (3.8%). Higher prevalence was observed among females and rural residents. Substantial sub-regional variation was observed across all outcomes, with the prevalence of general psychological distress ranging from ~8% in Madi, Sebei and Ankole to over 16% in Teso. The 2024 census suggests a substantial and uneven distribution of probable mental health conditions in Uganda and underscores the need for geographically targeted, equity-oriented mental health strategies, as well as stronger integration of mental health into primary healthcare systems.

Suicide is a leading cause of death among young people globally. Although suicidality has been studied in various populations, limited research has focused on refugee youth in low and middle-income countries. This study aimed to assess the prevalence of suicidal ideation, suicide attempts, and methods of attempted suicide among refugee children and adolescents in southwestern Uganda. We also examined risk factors associated with suicidal ideation in this population. We conducted a cross-sectional study of 325 refugee children and adolescents selected through simple random sampling in Nakivale Refugee Settlement, southwestern Uganda. Suicidal behavior and post-traumatic stress disorder (PTSD) were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents, version 7.02 (MINI-KID). Additional variables—including war-related trauma and post-migration experiences were measured using structured checklists administered through KoboCollect. The data were then exported to STATA 17 for analysis. Descriptive statistics were used to calculate the prevalence of suicidal ideation, attempts, and means, while bivariate and multivariate logistic regression analyses were conducted to identify factors associated with suicidal ideation. Of 325 participants, 129 (40%) reported suicidal ideation, and among these, 70 (54%) had formulated a suicide plan. Of those with a plan, 13 (19%; (4.3% of the total sample)) had attempted suicide. The most common method of attempted suicide was self-poisoning (4/13, 31%), followed by hanging or drowning (3/13, 23%), self-stabbing (2/13, 15%), and self-imposed accidents (1/13, 8%). In multivariate analyses, suicidal ideation was significantly associated with exposure to war-related trauma (OR = 2.30, 95% CI: 1.35–3.94, p = 0.002), PTSD (OR = 5.47, 95% CI: 2.15–13.94, p < 0.001), and being an unaccompanied minor (OR = 6.14, 95% CI: 2.13–17.68, p = 0.001). Suicidal ideation is highly prevalent among refugee children and adolescents in Nakivale Refugee Settlement. Prevention efforts should prioritize trauma-related factors, PTSD, and the specific needs of unaccompanied minors. Not applicable.

Objective: The prevalence of post-traumatic stress disorder (PTSD) and its risk factors among adult refugees in the context of war-related forced migration is well established. However, reliable data are lacking on war-related trauma among refugee children and adolescents residing in refugee settlements. This study estimated the magnitude of PTSD and its associated factors among children and adolescents in Nakivale refugee settlement, south-western Uganda.Method: We conducted a cross-sectional quantitative study among 325 adolescent (10-19-year-old) refugees, who were selected using a simple random sampling approach. The presence of PTSD was assessed by the Mini-International Neuropsychiatric Interview for Children and Adolescents. The main predictor variables were assessed by structured checklists for war trauma and post-migration using Kobol collect software. Data were exported to Stata 23 for analysis. The prevalence of PTSD was computed using descriptive statistics. Bivariate and multivariate logistic regression analyses were used to determine factors associated with PTSD.Results: The prevalence of PTSD in our study was 83% (269/325, 95% CI 0.782-0.867). Factors associated with PTSD included post-migration difficulties (OR = 4.11, 95% CI 2.52-8.43, p < .001) and exposure to war-related trauma (OR = 2.23, 95% CI 1.16-4.261, p = .016).Conclusion: The high prevalence of PTSD in our sample of refugee children and adolescents is associated with both war trauma and post-migration difficulties. This information is important for the psychological assessment and treatment of the children and adolescents living in the refugee settlement. Identification of potentially modifiable factors in post-migration conditions and acknowledgement of the effects of conflicts on health are of high priority from both societal and global perspectives.

Gaze following in infancy allows triadic social interactions and a comprehension of other individuals and their surroundings. Despite its importance for early development, its ontology is debated, with theories suggesting that gaze following is either a universal core capacity or an experience-dependent learned behavior. A critical test of these theories among 809 nine-month-olds from Africa (Uganda and Zimbabwe), Europe (Sweden), and Asia (Bhutan) demonstrated that infants follow gaze to a similar degree regardless of environmental factors such as culture, maternal well-being (postpartum depression, well-being), or traumatic family events (related to war and/or climate change). These findings suggest that gaze following may be a universal, experience-expectant process that is resilient to adversity and similar across a wide range of human experiences—a core foundation for social development.

Background: Prolonged conflicts in the Democratic Republic of Congo (DRC) have caused widespread psychological trauma among civilians leading to maladaptive coping strategies across generations. Despite this occurrence, empirical studies on the prevalence of trauma and its impact on attitudes towards revenge and forgiveness, particularly among the youth, are scarce. This study aims to clarify the relationship between Post Traumatic Stress Disorder (PTSD) symptom severity and the desires for forgiveness and revenge among Congolese adolescents residing in Uganda.Methods: We analysed data from 269 adolescent refugees from the DRC living in the Nakivale refugee settlement in Southwestern Uganda. The assessment included exposure to war-related traumatic events and the MINI-KID for DSM-V PTSD symptom severity. The Heartland Forgiveness and Vengeance Scales measured willingness to forgive and feelings of vengeance.Results: Exposure to war-related traumatic events was notably high in our sample, with severe deprivation of food (260 [97%]), exposure to armed combat (249 [93%]), witnessing bombing, burning, or destruction of houses (245 [91%]), disappearance of family members (239 [89%]), and seeing dead bodies (236 [88%]). PTSD symptom severity was negatively associated with willingness to forgive (b = -0.48; 95% CI -0.71--0.25; p < .001) and positively associated with vengeance (b = 0.18; 95% CI 0.04-0.32; p = .011).Conclusion: PTSD symptom severity reduces the willingness to forgive and increases the desire for vengeance among adolescent refugees. Mental health clinicians and policymakers should consider addressing maladaptive coping behaviours related to feelings of revenge and unwillingness to forgive in their support strategies for refugees.