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Alarcón Garavito GA, Burgess R, Dedios Sanguinetti MC, Peters LER, Vera San Juan N. Mental health services implementation in Colombia-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001565. [PMID: 38055705 DOI: 10.1371/journal.pgph.0001565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
Colombia's mental health services have a complex history shaped by 60 years of armed conflict, a predominantly clinical approach to mental health, and social factors such as inequities and stigma. The 1990 Caracas declaration proposed a shift towards decentralised community mental health services and interventions based on the recovery approach and emphasis on social determinants of mental health in the Americas. Colombia has adopted these approaches in its legal and practical framework in recent years, but implementation has been uneven. This systematic review aims to contribute to mental health services understanding in Colombia by examining the barriers and facilitators to the implementation of mental health services in Colombia. A search was conducted to explore available peer-reviewed studies on Colombian mental health services across five databases (Medline, PubMed, Scopus, Scielo and BVS) on quantitative and qualitative research papers published in the last ten years and without language restrictions. The Consolidated Framework for Implementation Research (CFIR) was used to structure the analysis and identify barriers and facilitators during the implementation of mental health services. We adapted the CFIR to attend to gender, race and age informed by the Socio-Political Economy of Global Mental Health framework, given the importance of these factors to the Colombian health landscape. Finally, narrative synthesis was used to summarise the data. 1 530 records were identified, and 12 articles met all inclusion criteria and were included in the analysis. 8 papers described substance use disorders services, 11 involved multidisciplinary healthcare professionals, and 7 were implemented at a local scale. The primary barriers to implementation were the lack of coordination, high workloads, and low funding. Facilitators included the use of protocols, and the involvement of communities, stakeholders, users, and external champions. Findings suggest the continued importance of community and recovery approaches and efforts to improve coordination between multi-sector actors involved in the mental health spaces (e.g., public, and private organisations, users and their families).
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Affiliation(s)
- Germán Andrés Alarcón Garavito
- Institute for Global Health-University College London, London, United Kingdom
- School of Government-Universidad de los Andes, Bogotá, Colombia
| | - Rochelle Burgess
- Institute for Global Health-University College London, London, United Kingdom
| | | | - Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, United Kingdom
- College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, United States of America
| | - Norha Vera San Juan
- Institute for Global Health-University College London, London, United Kingdom
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Giebel C, Saldarriaga-Ruiz G, Gabbay M, Zea S, Martínez Morales D, Castano-Pineda Y, Montoya EM, Lizcano D, Zuluaga-Callejas MI. Coping in the Face of Violence - a Qualitative Study on the Impacts of Stressful Life Events on the Mental Health of Older Adults in Colombia. Clin Gerontol 2023:1-11. [PMID: 37921425 DOI: 10.1080/07317115.2023.2274055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Many older adults in Colombia have lived through violent and stressful life events, particularly in areas of poverty. The aim of this qualitative study was to understand the impact of stressful life events on the mental health and wellbeing of older Colombians living in areas of relative poverty. METHODS Older adults (aged 60+) living in the Turbo region in Colombia were interviewed face-to-face between August and December 2021. Transcripts were coded in Spanish and English by at least two researchers, using inductive thematic analysis. RESULTS Twenty-six older adults participated in the study. Four overarching themes were generated: Living in violent and dangerous communities; Disturbing gender violence and gender roles; Lack of mental health awareness; Coping mechanisms. Older adults experienced a long narrative of stressful life events. Younger generations appeared to disrespect older members of Society. Without any mental health support, older adults coped by accepting the extreme situations or seeking solace in their faith. CONCLUSIONS The health system and Government need to build up trust and generate an awareness of mental health, as older Colombians will not approach psychological support otherwise. Intergenerational community-based interventions may provide a first avenue of mental health support.
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Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | | | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Santiago Zea
- National School of Public Health, Universidad de Antioquia, Medellin, Colombia
| | | | | | - Erika Maria Montoya
- National School of Public Health, Universidad de Antioquia, Medellin, Colombia
| | - Douglas Lizcano
- National School of Public Health, Universidad de Antioquia, Medellin, Colombia
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Burgess R, Dedios Sanguineti MC, Maldonado-Carrizosa D, Fonseca L, Vera San Juan N, Lucumí D, González-Gort M, Melgar MC, Gaviria MF, Tovar DF, Jovchelovitch S. Using participatory action research to reimagine community mental health services in Colombia: a mixed-method study protocol. BMJ Open 2022; 12:e069329. [PMID: 36549743 PMCID: PMC9772630 DOI: 10.1136/bmjopen-2022-069329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Mental healthcare systems are challenged by how they hear and respond to what marginalised communities experience as drivers of mental distress. In Colombia, this challenge intersects with wider challenges facing post-conflict reconstruction. Our pilot study will explore the feasibility and acceptability of a participatory approach to developing community-led participatory interventions for community mental health systems strengthening and mental health improvement, in two sites in Caquetá, Colombia. METHODS AND ANALYSIS The project is divided into three distinct phases aligned with community participatory action research cycles: diagnostic, intervention and evaluation. This allows us to use a participatory approach to design a community-led, bottom-up intervention for mental health systems strengthening and the promotion of mental health and well-being.The diagnostic phase explores local understandings of mental health, mental distress and access to mental health services from community members and health providers. The intervention stage will be guided by a participatory Theory of Change process. Community priorities will inform the development of a participatory, learning and action (PLA) informed group intervention, with a community linkage forum. The pilot of the PLA intervention will be evaluated using MRC process evaluation guidelines. ETHICS AND DISSEMINATION This project has received ethical approval from two sources. Universidad de Los Andes (2021-1393) and the University College London (16127/005). Dissemination of findings will include academic publications, community forums, policy briefs and visual media (cartoons, pod casts and short films).
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Affiliation(s)
| | | | | | - Laura Fonseca
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
| | - Norha Vera San Juan
- UCL Institute for Global Health, London, UK
- Rapid Research Appraisal and Evaluation Lab, University College London, London, UK
| | - Diego Lucumí
- School of Government, Universidad de los Andes, Bogota, Colombia
| | | | | | | | - Diego Ferney Tovar
- Cooperativa Multiactiva Para El Buen Vivir Y La Paz Del Caquetá, Florencia, Colombia
| | - Sandra Jovchelovitch
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, London, UK
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Rasheed OS, López-Rodríguez L, Navas M. Withstanding psychological distress among internally displaced Yazidis in Iraq: 6 years after attack by the Islamic State of Iraq and the Levant. BMC Psychol 2022; 10:262. [DOI: 10.1186/s40359-022-00973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Insurgents of the Islamic State of Iraq and the Levant created a crisis that has had immediate and long-term consequences for the population in Iraq. Yazidis are among the most affected ethnos religious groups in the region. The current study focuses on investigating the level of psychological distress and its association with subjective resilience among the Yazidi minority 6 years after the attack by the Islamic State of Iraq and the Levant.
Methods
The present study recruited four hundred and twenty-two Yazidi individuals (50.8% female) residing in two camps in the Iraqi Kurdistan region. In face-to-face interviews, each participant replied to different scales to measure psychological distress (i.e., depression, anxiety, and stress), perceived stress, and subjective resilience. In addition, they were asked questions about mental health and psychosocial service acquisition.
Results
The results indicate that levels of psychological distress were high among the target population; around 65% of respondents reported having some level of psychological distress. Moreover, women showed not only higher level of psychological distress but also revealed slightly lower subjective resilience as compared to male participants. Hierarchical regressions showed that subjective resilience significantly contributed to the predictive model of distress beyond demographics and having received or not mental health and psychosocial support. Subjective resilience was significantly associated to less anxiety (R2adj = .157, ΔR2 = .022, p = .010) and stress (R2adj = .083, ΔR2 = .026, p = .008) in Mam-Rashan camp; and to less depression (R2adj = .184, ΔR2 = .095, p < .001), anxiety (R2adj = .140, ΔR2 = .024, p = .034), stress (R2adj = .046, ΔR2 = .047, p = .005), and perceived stress (R2adj = .024, ΔR2 = .032, p = .022) in Shekhan camp.
Conclusions
Conflict and displacement contribute to high level of psychological distress. Resilience, however, seem to have a negative association with psychological distress. Additionally, living conditions and sex also played an important role in both psychological distress and resilience. Consequently, Yazidi community residing in camps are in need of further support to alleviate the consequences of displacement. We critically discuss the differences in the results among participants per camp and by sex, and its implications.
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