در جستجوی ارتباط بین سرمایه اجتماعی، بهداشت روانی و اجتماع درمانی: مطالعه طولی در رواندا

To date, reviews show inconclusive results on the association between social capital and mental health. Evidence that social capital can intentionally be promoted is also scarce. Promotion of social capital may impact post-conflict recovery through both increased social cohesion and better mental health. However, studies on community interventions and social capital have mostly relied on cross-sectional study designs. We present a longitudinal study in Rwanda on the effect on social capital and mental health of sociotherapy, a community-based psychosocial group intervention consisting of fifteen weekly group sessions. We hypothesized that the intervention would impact social capital and, as a result of that, mental health. We used a quasi-experimental study design with measurement points pre- and post-intervention and at eight months follow-up (2007–2008). Considering sex and living situation, we selected 100 adults for our experimental group. We formed a control group of 100 respondents with similar symptom score distribution, age, and sex from a random community sample in the same region. Mental health was assessed by use of the Self Reporting Questionnaire, and social capital through a locally adapted version of the short Adapted Social Capital Assessment Tool. It measures three elements of social capital: cognitive social capital, support, and civic participation. Latent growth models were used to examine whether effects of sociotherapy on mental health and social capital were related. Civic participation increased with 7% in the intervention group versus 2% in controls; mental health improved with 10% versus 5% (both: p < 0.001). Linear changes over time were not significantly correlated. Support and cognitive social capital did not show consistent changes. These findings hint at the possibility to foster social capital and simultaneously impact mental health. Further identification of pathways of influence may contribute to the designing of psychosocial interventions that effectively promote recovery in war-affected populations.

Traumatized survivors of war or political violence often have complex mental health problems, with anxiety, depressive and cognitive disturbances (De Jong et al., 2003 and Rodin and van Ommeren, 2009). Most patients also suffer from feelings like shame, guilt, distrust and alienation. Such feelings complicate social functioning and interpersonal contacts in communities where social structures and cohesion have already been damaged by human violence (Ager, 2002 and Hobfoll et al., 2007). Psychological and behavioral problems hamper daily functioning and the engagement in relations. Learning how to cope with such difficulties may not only counter individual suffering, it may also help to prevent additional damage in social relations caused by ongoing behavioral disturbances, and to rebuild meaningful social structures in which people can re-find and practice (self)respect. Social capital is potentially a key resource supporting post-conflict recovery. Promotion of social capital may impact post-conflict recovery both through increased social cohesion and through better mental health (Scholte and Ager, 2014). This study explores the possible effects of an intervention called sociotherapy on social capital and mental health in post-genocide Rwanda. We hypothesized that this intervention would impact social capital and, as a result of that, mental health.

This study addresses the potential of community based sociotherapy to promote recovery in a war-affected population. Evaluating the intervention's delivery is complicated by the method's openness to contextual determinants, such as the different backgrounds, living situations and wishes of group participants and leaders. Further identification of effective elements requires close monitoring of practices per group and per session. Also, application in strongly differing populations may reveal to what degree the method's effectiveness is impacted by cultural and contextual factors like religion and history. The study hints at the possibility to foster one element of social capital, i.e. civic participation, and to simultaneously impact mental health. However, further research is needed. The sensitivity of the Short A-SCAT as a measure of social capital in complex sociocultural settings like Rwanda needs to be confirmed. In particular, the validity of items addressing structural social capital and support needs attention (Verduin et al., 2010). Future studies also need to determine which specific elements of sociotherapy are effective, which particular elements of social capital can intentionally be promoted in different settings, and what are possible pathways of influence on mental health. Further elaboration is highly relevant as post-conflict recovery of a population is best served by an increase of both societal cohesion and mental health. It may lead the way to community based psychosocial interventions that effectively promote wellbeing in war-effected populations.