The invisible wounds of five decades of armed conflict: inequalities in mental health and their determinants in Colombia
We analyzed the relation between exposure to the armed conflict and violence with mental health disorders in Colombia and assessed the extent and determinants of socioeconomic inequalities in mental health related to differential exposure to the conflict and violence.
Regression and decomposition analyses were used in combination with the 2015 nationally representative Mental Health Survey (N = 10,853). Mental health disorders were assessed using the Self-Reporting Questionnaire (SRQ 20), and socioeconomic status by a Multidimensional Poverty Index.
3% of adults have been victim of a violent crime and 13% victim of the armed conflict. Victims of the armed conflict have 1.74 times higher odds (p < .05) of suffering mental health disorders compared to non-victims. Differential exposure to the armed conflict among lower socioeconomic groups explains 86% of total inequality in mental health disorders.
Interventions that increase quality and access of mental health treatments among victims of the conflict will not only lead to improvements in mental health among victims but also significantly reduce inequalities in mental health in Colombia.
KeywordsColombia Conflict Inequality Mental health Violence
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Alarcón RD (2003) Mental health and mental health care in Latin America. World Psychiatry 2:54–56Google Scholar
- Beusenberg M, Orley JH, World Health Organization DoMH (1994) A User’s guide to the self reporting questionnaire (SRQ). World Health Organization, GenevaGoogle Scholar
- Ekblad, S, Blight KS, Lindencrona K (2004) Employment focused interventions in post-conflict societies. In: Mollica RF, Guerra R, Bhasin R, Lavelle J (eds) Book of best practices: trauma and the role of mental health in post-conflict recovery. Harvard Programme in Refugee Trauma, Boston, pp. 326–348Google Scholar
- Gillin J (2015) Understanding the causes of Colombia’s conflict: inequality. https://colombiareports.com/understanding-colombias-conflict-inequality/. Accessed 20 April 2019
- Gómez-Restrepo C, de Santacruz C, Rodriguez MN et al. (2016) Encuesta Nacional de Salud Mental Colombia 2015. Protocolo del estudio Revista Colombiana de Psiquiatría 45Google Scholar
- Hurtado DA, Hessel P, Avendano M (2016) The hidden costs of informal work: lack of social protection and subjective well-being in Colombia. Int J Public Health 62:1–10Google Scholar
- Ibáñez AM, Moya A (2010) Do conflicts create poverty traps? Asset losses and recovery for displaced households in Colombia. In: Di Tella R, Edwards S, Schargrodsky E (eds) The economics of crime: lessons for and from Latin America. University of Chicago Press, pp. 137–172Google Scholar
- Kohn R, Saxena S, Levav I et al (2004) The treatment gap in mental health care. Bull World Health Organ 82:858–866Google Scholar
- Mejía D, Ortega D, Ortiz K (2015) Un análisis de la criminalidad urbana en Colombia. http://scioteca.caf.com/handle/123456789/810. Accessed 20 April 2019
- Murthy RS, Lakshminarayana R (2006) Mental health consequences of war: a brief review of research findings. World Psychiatry 5:25Google Scholar
- Muscat RJ (2011) Mental health disabilities and post-conflict economic and social recovery textbook of global mental health: trauma and recovery, A companion guide for field and clinical care of traumatized people worldwide, 403Google Scholar
- Norwegian Refugee Council (NRC) (2017) New wave of violence threatens Colombia’s peace prospects. https://www.nrc.no/news/2017/august/new-wave-of-violence-threatens-colombias-peace-prospects/. Accessed November 22 2017
- Organization for Economic Co-Operation and Development (OECD) (2015) Colombia: policy priorities for inclusive development. OECD, ParisGoogle Scholar
- Oxford Poverty & Human Development Institute (OPHI) (2011) Colombia’s Multidimensional Poverty Index. http://www.ophi.org.uk/policy/national-policy/colombia-mpi/. Accessed 20 Apr 2019
- Patel V, Kleinman A (2003) Poverty and common mental disorders in developing countries. Bull World Health Organ 81:609–615Google Scholar
- Presidency of the Republic of Colombian (2016) Summary of Colombia’s agreement to end conflict and build peace. Presidencia de la Républica, BogotáGoogle Scholar
- United Nations Office on Drugs and Crime (UNODC) (2006) Violence, crime and illegal arms trafficking in Colombia. UNODC, BogotáGoogle Scholar
- Wagstaff A, O’Donnell O, Van Doorslaer E et al (2007) Analyzing health equity using household survey data: a guide to techniques and their implementation. World Bank Publications, Washington, DCGoogle Scholar