After the violence

FEATURES OF AFFECTIVE SYMPTOMS IN COMBATANTS WITH NON-PSYCHOTIC MENTAL DISORDERS THAT HAVE SUFFERED FROM COVID-19

OBJECTIVE

The aim: To establish the level of anxiety and depressive disorders and the impact of covid-19 on affective pathology in combatants with non-psychotic mental disorders who have suffered from COVID-19 in a comparative aspect.

PATIENTS AND METHODS

Materials and methods: 252 male combatants with non-psychotic mental disorders who suffered from COVID-19 were clinically examined using HRDS and HARS scales.

RESULTS

Results: A lower prevalence of anxiety or fear was found in combatants who did not have COVID-19: 70.5% vs. 80.8%; low mood - 55.3% vs. 66.7%; emotional lability - 44.7% vs. 58.3%; irritability - 40.9% vs. 55.0%; emotional sensitivity - 53.0% vs. 71.7%; dulling of emotions - 6.8% vs. 6.7%; anhedonia - 77.3% vs. 83.3% of patients, rapid fatigue - 51.5% vs. 65.8%, feelings of guilt, futility, anxiety or fear - 78.0% vs. 87.5%, dissomnia - 47.0% vs. 61.7%; inability to concentrate and make decisions - 25.8% vs. 43.3%; thoughts of death or suicide - 25.0% vs. 35.8% pessimism - 21.2% vs. 31.7%, low self-esteem - 21.2% vs. 31.7%, unstable appetite and weight loss-17.4% vs. 24.2%. The overall HDRS depression score in combatants with non-psychotic mental disorders who did not have COVID-19 was also significantly lower: 15.29±4.16 points vs. 18.05±4.29 points. Similar patterns were found for indicators of anxiety on the HARS scale: 20.52±7.14 points vs. 24.53±6.69 points.

CONCLUSION

Conclusions: Combatants with non-psychotic mental disorders are characterized by high levels of depressive and anxiety disorders. COVID-19 disease aggravates the course of affective pathology in combatants with non-psychotic mental disorders and increases the incidence of their depressive and anxiety symptoms.

Meaningful Work and Satisfaction with Life: A Case Study from a Supported Employment Program-Colombia

Work helps to satisfy instrumental and transcendental needs. For people affected by armed conflict, work has an additional value because it helps them overcome the social disadvantage they suffer; however, topics such as meaningful work—MW—have been poorly studied in this type of population. Based on the above, we propose to analyze the relationship between meaningful work and satisfaction with life in one of the largest private supported employment programs for people involved in the armed conflict in Colombia. To this end, a nonexperimental, quantitative case study was conducted with 62 employees of that employment program. To collect the data, a survey with two measurement scales was administered: Work as Meaning Inventory and Satisfaction with Life Scale. Sociodemographic variables were also obtained. The results demonstrate that meaningful work has a significant effect on satisfaction with life (R2 = 0.28, p < 0.00). We conclude that having meaningful work that provides a sense of belonging, interpersonal connection, and attachment generates greater satisfaction with life in the workers involved in the analyzed program. We also discuss the implications of this research for companies and public policy in Colombia.

The Dynamics of Implicit Intergroup Biases of Victims and Ex-combatants in Post-conflict Scenarios

Strong group identities arise in intergroup conflict scenarios and perpetuate sectarian violence even in post-conflict scenarios. In particular, out-group negative implicit associations are predictors of decreased intergroup forgiveness, as well as increased distrust and aggression against the out-group. Thus, the presence of implicit intergroup (i.e., ex-combatants and victims) biases seems to be a relevant factor in post-conflict scenarios. Here, we aimed to explore whether negative biases toward the out-group are boosted by (a) previous exposure to conflict violence or (b) identification with an armed violent group. One hundred and twenty-eight participants, 65 ex-combatants from Colombian guerrillas and 63 victims of the armed conflict, were assessed with a modified version of the implicit association test (IAT). Our results revealed that the victim group showed a significant negative bias against ex-combatants. However, no bias toward the out-group (i.e., victims) or in-group favoritism was observed in the ex-combatant group. Similarly, we found that IAT scores were not associated with sociodemographical variables (i.e., sex, years of education, or type of dwelling), the levels of combat exposure, victimization armed-conflict-related experiences, or child abuse antecedents. Our results showed an unexpected lack of in-group bias in ex-combatants, potentially triggered by the effect of current demobilization and reintegration processes. Thus, negative associations with the out-group will persist in the framework of societal condemnation of the out-group. In contrast, these negative biases will tend to be abolished when entering in conflict with larger societal reintegration processes. The results reinforce the idea that reintegration may benefit from interventions at the societal level, including all actors of the conflict. In addition, our findings highlight the importance of implementing victim interventions aimed at reducing stigma and revengeful actions in spaces of collective disarmament.

Disarming Ex-Combatants' Minds: Toward Situated Reintegration Process in Post-conflict Colombia

Collective violence in the context of armed conflict impacts the economy, health systems, and social stability of affected countries. This is considered a complex phenomenon with interwoven biological, psychological, social, cultural, and political factors. However, most of the research on this topic still lacks suitable established integrative approaches to assess multilevel perspectives. Social, cognitive and affective mental processes (SCAMP) are critical factors that should be considered in multilevel approaches. In this article, we critically discuss some of the classically isolated approaches used in violence research, the absence of successful interventions for ex-combatants reintegration, and the specific neglect of SCAMP in these interventions. We present the case of post-conflict Colombia as a unique opportunity to study the different roots of collective violence, and we call for a more robust and situated approach to understanding of and intervention in this multifaceted phenomenon. In addition, we suggest a two-stage approach for addressing ex-combatants’ reintegration programs, which considers the situated nature of post-conflict scenarios and the urgent need for evidence-based interventions. This approach focuses on the comprehensive scientific assessment of specific factors involved in violence exposure and the subsequent design of successful interventions. The implementation of this approach will contribute to the effective reintegration of individuals who have been exposed to extreme violence for more than 50 years.

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

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.