More than 700 000 people lose their life to suicide every year. A core foundation of suicide prevention is the timely registration and regular monitoring of suicide and self-harm. Surveillance data can be used to show important progress towards reaching global targets, such as reducing the suicide rate by one third by 2030 as articulated in the UN SDGs and in the WHO Mental Health Action Plan 2013-2030.

Following the trauma of the Shoah, many survivors took to writing their experiences in memoir. The trauma  memoir, a term defined in the body of this thesis, became a significant space to share real world experiences of a genocide that shocked the world. Trauma is continuous, it lives on through the repetitive behaviours of the survivor, a concept that Sigmund Freud conceptualizes as the “compulsion to repeat” (XVII 1920–1922 19).

Background: Conflict in the Democratic Republic of Congo has led to large numbers of refugees fleeing to Uganda and Rwanda. Refugees experience elevated levels of adverse events and daily stressors, which are associated with common mental health difficulties such as depression. The current cluster randomised controlled trial aims to investigate whether an adapted form of Community-based Sociotherapy (aCBS) is effective and cost-effective in reducing depressive symptomatology experienced by Congolese refugees in Uganda and Rwanda.

The aim of the current dissertation is three-fold. First, we aimed to provide insight with regard to the alterations of traumatized youths’ neurobiological stress systems (PART I). We investigated sympathetic, parasympathetic, and HPA axis parameters among traumatized adolescents in residential care and a nontraumatized comparison sample. Both basal activity during rest and reactivity to acute social stress were evaluated. The outcomes of this study are described in Chapter 2.