Understanding post-conflict mental health needs and co-producing a community-based mental health intervention for older adults in Colombia: a research protocol

Abstract

Background Older adults in Colombia have seen a number of stressful life events – including the Colombian armed conflict, forced misplacement and recently COVID-19. These events likely have had and are having a substantial impact on people’s mental health and well-being, whilst mental health care provision in Colombia is not sufficient and often access is limited and unaffordable. Therefore, the aim of this study is to understand the impact of stressful life events on the mental health of older adults living in Colombia, and co-produce, pilot, and evaluate a community-based mental health intervention in Turbo. Methods This 3-year international mixed-methods study comprises of three phases: Phase I will explore the impact of stressful life events on the mental health of older adults living in Colombia, and their mental health needs, via quantitative needs assessments and qualitative interviews and focus groups; Phase II will involve synthesising the findings from Phase I as well as conducting a systematic review and qualitative interviews with experts into implementing mental health interventions in LMICs to co-produce a community-based mental health intervention with older adults and local community group leaders and care providers; Phase III will involve the piloting and evaluation of the mental health intervention via quantitative and qualitative assessments. Co-production and public involvement underpin each element of this project. Discussion Appropriate mental health care is as important as physical health care, but this study also looks at how we might integrate these findings into community-level public health initiatives for application both within Colombia and more widely in both LMICs and more developed countries. This study protocol will act as a guide for the development and adaptation of psychosocial mental health interventions in different cultures and contexts.

Mental health services implementation in Colombia – a systematic review

“…In line with Flores et al, (134) and Giebel et al, (135) there is scarce literature on older people and mental health in Colombia and only a few studies have explored this field. For instance, Flores et al, (134) used quantitative data which associated higher levels of depression in older adults with earlier armed-conflict situations such as sexual abuse and displacement.…”

“…symptoms, or violent and hostile behaviours) that are also linked to socio-demographic factors, mentioned before (e.g., race, age, nationality).Finally, although age is an influence that might lead to discrimination or stereotyping selected(43), studies did not consider it a relevant factor for their interventions. Only Barrios-Acosta et al,(77) highlighted how suicide in older adults is frequently associated with structural conditions, but this is not deepened in the study, which is focused on young university students.In line with Flores et al,(134) and Giebel et al,(135) there is scarce literature on older people and mental health in Colombia and only a few studies have explored this field. For instance, Flores et al,(134) used quantitative data which associated higher levels of…”

“…However, multiple studies, independent reports and civil complaints spell out the decay of mental health services and how they are failing to satisfy mental health care needs (27)(28)(29)(30)(31)(32)(33), demonstrating that this supportive policy environment does not automatically translate into effective and accessible services in practice.…”

Experiencias adversas en la infancia asociadas con trastornos neuropsiquiátricos en la adultez: una revisión sistemática

“…Quienes hoy son las personas mayores del país, han debido seguir adelante con su vida, pero con la complejidad que implica haber crecido con experiencias traumáticas y negligencia infantil. Lo anterior tiene un impacto significativo en la salud mental y el bienestar de las personas, pero la atención de salud mental en Colombia está desatendida y el acceso es limitado e inasequible (Giebel et al, 2022).…”

Few interventions support the affected other on their own: A systematic review of individual level psychosocial interventions to support those harmed by others’ alcohol drinking

“…Fourth, the diversity of outcomes and behavioral targets in interventions is of concern; international and synthesized qualitative work may help to prioritize targets for intervention; however, it must be cautious to cultural diversity in international works. Co-designed approaches to interventions may support the acceptability and uptake in future trials (Giebel et al, 2022). Finally, the target population may also need to be diversi ed, non-white, and nonfemale populations are under-represented, yet still experience harm from others' alcohol.…”