A pilot study of a stepped-care brief intervention to help psychologically-distressed women displaced by conflict in Bogotá, Colombia

Abstract

Background Colombia's 6.5 million internally displaced persons (IDPs) have been exposed to trauma, loss, and hardships. Common mental disorders (CMDs) are prevalent in this group, yet there are few evidence-based psychosocial interventions for this population. We assessed the feasibility and acceptability of a stepped-care intervention for women IDPs in Bogota, Colombia. Methods Feasibility to recruit participants for an intervention trial, to screen for CMDs and displacement-related traumas, to refer high-risk cases to professional consultation, to implement evidence-based interpersonal counseling (IPC) for women with diagnosed CMDs, to retain participants in the intervention, and to conduct follow-up assessments was assessed. Assessment instruments were validated. The intervention was delivered by trained outreach personnel. Intervention acceptability was assessed by monitoring session attendance, dropout rates, and satisfaction. Potential efficacy was evaluated with pre- and post-intervention measures of CMDs. Results We recruited 279 women IDPs into the intervention. On screening, 177 (63.4%) had symptom levels suggesting a CMD. Participants endorsed a wide range of displacement-related exposures. Most participants receiving IPC decreased their symptom levels at follow-up. Many participants did not complete the recommended number of IPC sessions; loss to follow-up was 30%. The performance of the outreach personnel improved after the initial intervention team was replaced with community members trained to deliver the intervention. The Bogotá health system was unable to reliably accommodate emergency psychiatric referrals. Conclusions The IPC intervention shows promise, but significant challenges remain for improving reach, adherence, and participant retention. We identified strategies and partnerships to redress some of the main study limitations.

Venezuelan migrants in Colombia: COVID-19 and mental health

“…Exposure to trauma, loss, and life changing events throughout all phases of migration increases the risk of developing psychiatric disorders. 3 , 4 , 5 We discuss these risks while describing the migration journey ( appendix 2 ).…”

“…Second, the departure from an individual's country of origin involves profound loss. 3 , 4 Many migrants will never return. Loss of home and all tangible resources is compounded by devastating social losses.…”

“… 5 In common with Colombia's own 5·5 million IDPs, Venezuelans living in Colombia are at risk for major depression, generalised anxiety, post-traumatic stress disorder (PTSD), and substance use disorders. 3 , 4 , 5 A study that assessed depression, generalised anxiety, and PTSD in Colombian women IDPs in Bogotá found that 63·4% of the women had symptomatology suggestive of at least one of these conditions. 4 A study of Venezuelan migrants in Bogotá, found that 21% had probable PTSD.…”

“… 3 , 4 , 5 A study that assessed depression, generalised anxiety, and PTSD in Colombian women IDPs in Bogotá found that 63·4% of the women had symptomatology suggestive of at least one of these conditions. 4 A study of Venezuelan migrants in Bogotá, found that 21% had probable PTSD. 9…”

“…Fifth, the unprecedented COVID-19 pandemic is the latest in a succession of life-changing events that predispose Venezuelan migrants to psychopathology. 1 , 3 , 4 Migrants are at increased of having COVID-19 because they are exposed to high population densities, poor sanitation, and cannot effectively socially distance or wash hands. Preventative isolation measures impose disproportionate hardships for migrants.…”