Efficacy of a primary care mental health program for victims of the armed conflict in Colombia.

Abstract

In Colombia, there are more than 8,000,000 victims of the armed conflict, some of whom suffer physical and mental health problems or family, work, or social life issues—or both. Although some programs have been devised to treat these psychosocial problems, it still is necessary to evaluate their efficacy so that they may replicated. Accordingly, the purpose of this study was to (1) assess the efficacy of a rurally based primary care mental health program that deals with the psychological problems of children, adolescents, and adults who have been victims of the armed conflict and (2) identify the relationships between stress, resilience, and coping skills in these adolescents and adults. The method used was a quasi-experimental design with separated samples and pre- and postintervention measures. By means of a multistage purposive-random sampling, 127 children, 162 adolescents, and 677 adults were selected for the preintervention sample and 126 children, 162 adolescents, and 676 adults for the postintervention sample. The application of a set of questionnaires allowed identifying some psychological problems at the pre- and poststage of the intervention program. A comparative analysis of the pre and post scores conducted through a Mann–Whitney test revealed a significant decrease in most of the psychological problem scores of children and adults, who changed from the clinical to the normal range. Adolescents who were in a normal preintervention range remained in that range. Both adolescents and adults reduced the use of negative coping skills. Resilience scores remained high after the intervention program. A structural equation modeling confirmed the relationships among stress, resilience, and coping skills, which were the same in adolescents at both the pre and post samples, as well as in adults at the pre and post samples.

Psychosocial rehabilitation experiences of women victims of armed conflict in Montes de María, Colombia

“…In order to grant an integral reparation, it is important to reinforce the evaluation on the effectiveness of VL’s psychosocial and mental health care programs. The lack of evaluation processes is affecting the restoration of their rights [ 24 ].…”

“…In response to this necessity, in December 2019, was granted the extension of the VL until 2030 through the Constitutional Court Sentence C-588/19 for the continuation of the reparation process [ 2 ]. Furthermore, as interventions in Colombia which are mainly focused on psychosocial support programs lack of continuity due to the armed conflict, results and effectiveness of these programs have not been evaluated, neglecting victims’ reparation towards well-being and quality of life [ 24 ]. Therefore, in this Law’s extension context, it becomes relevant to understand women victim’s experiences on PR to contribute to more pertinent and transformative social policy interventions in Colombia.…”

“…However, there are challenges of PR implementation related with integral reparation and non-repetition rights since the armed conflict has not ceased [ 50 ], showing a high complexity due to neoliberal conditions of the Colombian State that prevail [ 51 – 53 ]. Victims encounter difficulties for the materialization of fundamental rights in a human rights vulnerability framework; characterized by extreme poverty, lack of access to the guarantee of their basic needs and systematic social leaders homicides; as Colombian State’s historical and structural violence is perpetuated throughout ineffective public policies that do not limit the escalation of social inequality and marginalization with a differential impact on women [ 24 , 27 , 34 , 44 , 47 , 50 – 54 ]. Furthermore, despite the fact that the VL is a ground-breaking social policy and includes a vast amount of measures that the Colombian State has committed to, remains a gap between the rights it aims to grant and the articulated, institutional and intersectoral actions it assists [ 26 , 35 ].…”

Psychosocial Rehabilitation Experiences of Women Victims of Armed Conflict in Colombia.

“…This, as a need to generate changes at the structural level regarding the patriarchal order, the recognition of women victim's needs and the symbolic repercussions of feminine and masculine roles [27,38,46]. PR is relevant in reparation processes as it has been proven in different countries, its repercussions on lessening symptoms at the individual-clinical and psychosocial levels by sharing experiences and agency, improving the way in which women victims relate to their community [24,47]. It also allows the strengthening of skills and knowledge through workshops and training that serve as tools for empowering women in their contexts [15,47].…”

“…Furthermore, as interventions in Colombia which are mainly focused on psychosocial support programs lack of continuity due to the armed conflict, results and effectiveness of these programs have not been evaluated, neglecting victims' reparation towards well-being and quality of life [24]. Therefore, in this Law's extension context, it becomes relevant to understand women victim's experiences on PR to contribute to more pertinent and transformative social policy intervention in Colombia.…”