RESEARCH ARTICLE Traumatic Grief and Traumatic Stress in Survivors 12 Years after the Genocide in Rwanda Jean Mutabaruka 1 , Nathalène Séjourné 1 , Eric Bui 2,3 , Philippe Birmes 2 * † & Henri Chabrol 1 1 Centre d'Etudes et de Recherches en Psychopathologie, Université de Toulouse, Toulouse, France 2 Université de Toulouse ; UPS ; Laboratoire du Stress Traumatique (LST – EA 4560) ; CHU de Toulouse, France 3 Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA Abstract The relationship between exposure to traumatic events and traumatic grief and the role of mediating and moder- ating variables [peritraumatic distress, post traumatic stress disorder (PTSD) symptoms and symptoms of depres- sion] were studied in survivors of the genocide of Batutsi in Rwanda in 1994. One hundred and two survivors (70 women, mean age 45 Æ 7.53 years) participated in this retrospective study. All of them had lost a member of their family. The severity of traumatic exposure (Comprehensive Trauma Inventory), peritraumatic distress (Peritrau- matic Distress Inventory), current PTSD symptoms (PTSD Checklist), depressive symptoms (Beck Depression In- ventory) and traumatic grief symptoms (Inventory of Traumatic Grief) was evaluated. A hierarchical multiple regression analysis was then conducted to examine the relative contribution of each variable to the symptoms of traumatic grief. The severity of traumatic exposure was related to traumatic grief symptoms (B = 0.06, R = 0.6, R 2 = 0.36 and ß = 0.6, t = 7.54, p = 0.00). The Baron and Kenny procedure (1986) (including three separate regres- sions), along with the Sobel test, was used to test mediation effects. Peritraumatic distress and PTSD symptoms may be mediating variables between traumatic exposure and traumatic grief. Traumatic grief is a complex but assessable entity, where previous distress and suffering result from both psychological trauma and the loss of a loved one. Copyright © 2011 John Wiley & Sons, Ltd. Received 6 October 2010; Accepted 31 August 2011; Revised 25 July 2011 Keywords complicated grief; PTSD; trauma *Correspondence Philippe Birmes, Université de Toulouse ; UPS ; Laboratoire du Stress Traumatique (LST – EA 4560) ; CHU de Toulouse, Hôpital Casselardit, 170 av. de Casselardit, TSA 40031, 31059 Toulouse Cedex 9, France. † Email: birmes.p@chu-toulouse.fr Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/smi.1429 Introduction Genocide is defined by acts committed with the intention to destroy in part or entirely, a national, ethnic, racial or religious group such as murder of members of the group; causing serious, mental or physical injury to members of the group; deliberately inflicting living conditions on the group leading to its partial or complete physical destruc- tion; imposing birth control measures within the group; and transferring children by force from the group to another group (Chalk & Jonassonhn, 1990; Fein, 1990). A historical survey demonstrates that, even from the beginning of antiquity, psychological responses to mass violence have always been the source of scientific interest (Ben-Ezra, 2004; Ben-Ezra, 2010 in press; Birmes, Hatton, Brunet & Schmitt, 2003; Birmes, Bui, Klein, Billard, Schmitt & Allenou, 2010). Mass violence is the cause of severe psychological traumatic disorders (Roth, Ekblad & Agren, 2006). The survivors of the genocide of Batutsi in Rwanda in 1994 lived through extremely traumatic events, and many lost members of their family; they were exposed to the death. The United Nations and the Red Cross estimated the number of deaths at around 1 million (Dyregrov et al., 2000). Dyregrov, Gupta, Gjestad and Mukanoheri (2000) reported the results of a study on Rwandan children aged 8–19 years, 13 months after the genocide, revealing an extreme level of exposure to traumatic events. Approximately 10 years after the genocide, Schaal and Elbert (2006) carried out a study on 68 Rwandan adolescent orphaned survivors. All individuals had been exposed to high levels of violence: 41% had witnessed the murder of their mother or father, and 44% had significant symptoms of PTSD. The authors suggested that the daily memory of the death of their parent(s) could have contributed to the persistence of PTSD symptoms. Thus, in the context of genocide, Stress Health (2011)© 2011 John Wiley & Sons, Ltd.