Mental health among displaced and non-displaced populations in Valledupar, Colombia: Why do inequities continue?

Abstract

Background: During the long-lasting civil war in Colombia involving several armed groups, the year 2002 marked a peak of violent activities displacing thousands of people mainly from rural to urban areas, causing social disruption and prolonged poverty. In 2015, the Colombian national survey on mental health provided a first overview of mental health problems of victimized families and individuals (macro level). The here presented study aimed at analysing ongoing inequalities regarding displaced and non-displaced populations in Cesar State (micro level), one of the most affected areas by the armed conflict.Methods: An interview survey was conducted among 211 displaced families and 181 non-displaced families in 2 adjacent compounds with several five-storey buildings in the outskirts of Valledupar, the capital of Cesar State in Colombia. The questionnaires were developed together with and applied by staff of the health and social services of the departmental secretary of health. The 15 interviewers conducted additionally in-depth interviews and participant observations.Results: The peak of internal displacement occurred around the year 2002, affecting disproportionally more the afro-descendent and indigenous populations. However, the marginalization of previously displaced persons is still ongoing. The living conditions in the neighbourhood of the displaced community were quite precarious in terms of lack of security, continuous noise, drug trafficking and poor connection with public transport. Consequently, psycho-emotional problems were more frequent among the displaced compared to the non-displaced neighbourhood. The displaced had experienced more violent acts (intended murder, threat, murder of a family member and kidnapping) and had subsequently a larger number of emotional symptoms (fright, headache, nervousness, depression, sleeplessness). Other stress factors like economic problems, severe disease or death of family members and unemployment prevailed in the community of displaced persons compared to the non-displaced. Non-displaced lived in a more protected environment and were less exposed to violence and stress, although belonging to a similarly low socio-economic stratum.