Depression is common in Rwanda among teenage and young adult orphans who are primary caregivers for younger children, according to a recent survey reported in The New York Times. Tulane University researchers, working with Rwanda’s national school of public health, surveyed 539 orphans ages 12 to 24 who care for others and found that 53 percent of them met the criteria for depression.

Rwanda, a country devastated by tribal genocide in 1994 and the AIDS epidemic, is believed to have the world’s highest percentage of orphans. In many African countries, orphans have relatives or neighbors who take care of them. However, young people without parents or close adult relatives in Rwanda are left on the streets to fend for themselves. According to the survey, nearly 40 percent said life was meaningless or that they had lost faith in God since their parents died.

The survey was featured in the August issue of “The Archives of Pediatrics and Adolescent Medicine”—part of The Journal of the American Medical Association—and its authors suggested that large-scale interventions would be necessary “if the next generation of youth is to thrive.”