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Mental Health and Psychosocial Problems
and Needs of Violence Survivors in the Colombian
Pacific Coast: A Qualitative Study in Buenaventura
and Quibdó
Julián Santaella-Tenorio, MSc;
1,2
Francisco J. Bonilla-Escobar, MSc;
2
Luis Nieto-Gil, MSc;
3
Andrés Fandiño-Losada, PhD;
2
María I. Gutiérrez-Martínez, PhD;
2
Judy Bass, PhD;
4
Paul Bolton, MB BS
5
1. Epidemiology Department, Mailman
School of Public Health, Columbia
University, New York, New York USA
2. Instituto Cisalva, Universidad del Valle,
Cali, Colombia
3. Secretaría de Educación de Cali, Colombia
4. Department of Mental Health, Bloomberg
School of Public Health, Johns Hopkins
University, Baltimore, Maryland USA
5. Departments of International Health and
Mental Health, Bloomberg School of
Public Health, Johns Hopkins University,
Baltimore, Maryland USA
Correspondence:
Julian Santaella-Tenorio, MSc
Epidemiology Department
Mailman School of Public Health
Columbia University
722 W 168
th
St.
New York, New York 10032 USA
E-mail: js4222@cumc.columbia.edu
Abstract
Introduction/Problem: For more than 60 years, Colombia experienced an armed conflict
involving government forces, guerrillas, and other illegal armed groups. Violence, including
torture and massacres, has caused displacement of entire rural communities to urban areas.
Lack of information on the problems displaced communities face and on their perceptions
on potential solutions to these problems may prevent programs from delivering appropriate
services to these communities. This study explores the problems of Afro-Colombian sur-
vivors from two major cities in Colombia; the activities they do to take care of themselves,
their families, and their community; and possible solutions to these problems.
Methods: This was a qualitative, interview-based study conducted in Quibdó and Bue-
naventura (Colombia). Free-list interviews and focus groups explored the problems of
survivors and the activities they do to take care of themselves, their families, and their
community. Key-informant interviews explored details of the identified mental health
problems and possible solutions.
Results: In Buenaventura, 24 free-list interviews, one focus group, and 17 key-informant
interviews were completed. In Quibdó, 29 free-list interviews, one focus group, and 15 key-
informant interviews were completed. Mental health problems identified included: (1) pro-
blems related to exposure to torture/violent events; (2) problems with adaptation to the new
social context; and (3) problems related to current poverty, lack of employment, and ongoing
violence. These problems were similar to trauma symptoms and features of depression and
anxiety, as described in other populations. Solutions included psychological help, talking to
friends/family, relying on God’s help, and getting trained in different task or jobs.
Conclusion: Afro-Colombian survivors of torture and violence described mental health
problems similar to those of other trauma-affected populations. These results suggest that
existing interventions that address trauma-related symptoms and current ongoing stressors
may be appropriate for improving the mental health of survivors in this population.
Santaella-Tenorio J, Bonilla-Escobar FJ, Nieto-Gil L, Fandiño-Losada A, Gutiérrez-
Martínez MI, Bass J, Bolton P. Mental health and psychosocial problems and needs of
violence survivors in the Colombian Pacific Coast: a qualitative study in Buenaventura
and Quibdó.
Introduction
Colombia experienced an armed conflict lasting over 60 years. This conflict began with
armed confrontations between government forces and left-wing guerrillas and has expan-
ded in the last three decades to include drug cartels, paramilitary, and other criminal
Conflict of interest/funding: This study was
made possible by the generous support of the
American people through the United States
Agency for International Development
(USAID; Washington, DC USA) Victims of
Torture Fund, contract number AID-OAA-
A-10-00046. The contents are the
responsibility of the Cisalva Institute of
Universidad del Valle (Colombia), Heartland
Alliance International (Chicago, Illinois USA),
and Johns Hopkins University (Baltimore,
Maryland USA) and do not necessarily reflect
the views of USAID or the United States
Government. The funder did not take part of
the design and conduct of the study; collection,
management, analysis, and interpretation of
the data; and preparation, review, or approval
of the manuscript. The authors declare no
conflicts of interest.
Keywords: displacement; psychology social; qua-
litative research; torture; violence
Abbreviation:
AFRODES: National Association of Displaced
Afro Colombians
Received: October 8, 2017
Revised: January 7, 2018
Accepted: February 3, 2018
doi:10.1017/S1049023X18000523
ORIGINAL RESEARCH
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groups.
1
Aggressions against rural communities include torture,
massacres, rape, forced displacement, and kidnaping
1-3
to gain
control of vast areas of land for their natural resources and to
provide routes for trafficking illegal substances.
1,3
Historically, the Colombian Pacific Coast region (comprising
the departments of Chocó, Valle del Cauca, Cauca, and Nariño)
has suffered from social exclusion, violence, and poverty. For
decades, communities living in this region have been exposed to
the horror of the armed conflict in the absence of governmental
presence and support. Here, the conflict has included massacres
and displacements such as those that occurred in Naya in 2001 (37
killed and more than 500 displaced) and in Bojayá in 2002 (119
killed and around 6,000 displaced).
4-6
Over 150,000 individuals
from minority populations, mostly Afro-Colombians, have been
displaced to Buenaventura (Valle del Cauca) and Quibdó (the
capital of Chocó), the two largest cities in the Pacific Coast.
7
These cities are also two of the poorest and most violent cities in
Colombia, among municipalities over 100,000 inhabitants. Both
cities have few mental health treatment facilities or psychosocial
programs for victims of violence and torture, despite the fact that
Colombian legislation mandates appropriate psychosocial treatment
for victims.
8,9
Although the Colombian government has promoted
the generation of psychosocial treatment programs for victims of the
internal armed conflict in recent years, there has been little pro-
gress.
10
Only two studies have explored the psychological symptoms
in these communities. One study described the symptoms of survi-
vors of the Bojayá massacre
11
whiletheotherinvestigatedsurvivors
from different parts from the west-southern region, including some
Afro-Colombians from the Pacific Coast.
12
These studies describe
the presence of posttraumatic stress syndrome and major depression
symptoms, as well as anxiety and suicidal thoughts among indivi-
duals exposed to the armed conflict.
11,12
However, they provide
limited information on how displaced Afro-Colombians survivors
view the problems resulting from torture and violence.
The purpose of this study was to describe, from their own
perspective, the psychosocial problems and mental health needs of
the Afro-Colombian victims of torture living in Buenaventura and
Quibdó. This included their understanding of the causes of these
problems, along with what people currently do and what they
think should be done to address these problems.
The data from this study were later used to develop locally
adapted instruments to assess psychosocial and mental health con-
structs
13-18
and locally adapted interventions to address those pro-
blems. These formed the basis of a subsequent trial
19
(manuscript in
preparation) to screen individuals with reported mental health symp-
toms and to evaluate the effectiveness of the designed intervention.
Methods
This qualitative study was conducted based on methods previously
used with vulnerable populations.
15,17,18
The study was conducted
from February through March of 2011 and was approved by the
Human Ethical Committee Board (CIREH) Universidad del Valle,
Colombia (approval number: 014-011). The study was conducted in
collaboration with the National Association of Displaced Afro
Colombians (AFRODES), a local nongovernmental organization
that works for Afro-Colombia’s displaced individuals’rights, and
Heartland Alliance International (Chicago, Illinois USA).
Three qualitative interviewing methods were used: free-list inter-
views, key-informant interviews, and focus group discussions. In each
city, 12 staff from AFRODES were trained and supervised in the
conduct of the free-list and the key-informant interviews. The training
included research ethics, including confidentiality. Training and data
collection were done in Buenaventura, and a week later in Quibdo.
Interviewers worked in pairs, one person leading the interview
and the other as primary recorder. Interviewer pairs could swap
roles between (but not during) interviews.
Three supervisors from AFRODES each supervised and sup-
ported two pairs of interviewers. Supervisors knew the neighbor-
hoods and the locations in which interviewees could be found and
were known to community leaders. Supervisors were in direct con-
tact with the research leader and were responsible for interview
schedules, correct technique, and the safety of interviewees, inter-
viewers, or supervisors. Supervisors collected and reviewed interview
transcripts after each interview, sometimes sending interviewers back
to the respondent for any missing information. All interviews were
conducted in Spanish, the native language of these communities. All
participants provided written informed consent.
Free-List Interviews
A convenience sample of respondents, individuals recognized by the
community to be knowledgeable about the problems of those who
had experienced or witnessed torture, was selected to generate free
lists. Most respondents were torture or violence survivors, balanced by
gender. Each free-list respondent generated four free lists: (1) What
are all the problems of persons who have been affected by torture or
violence? (2) What are the tasks and activities that people do to take
care of themselves? (3) What are the tasks and activities that people
do to take care of their families? and (4) What are the tasks and
activities that people do to contribute to their communities?
Interviewers probed for as many responses as possible. These
were entered onto a separate free-list recording form for each
question, along with a brief description of each response provided
by the respondent.
After completing the free lists, each respondent was asked to
identify people in their community knowledgeable about the
mental health problems mentioned in the lists. The respondents
were also asked to provide contact information so they could be
contacted later as potential key informants.
Analysis of free-list interviews was carried out by the AFRODES
interviewers and supervisors, under the direction of local researchers.
The problem lists were analyzed first by combining all problems
mentioned in all interviews into a singlesummarylist,includinghow
many respondents mentioned each problem. Similarly, all the
responses from the three function free lists were condensed into a single
list. Then, the supervisors reviewed all summary lists (problems and
function) for responses that used different wording but had the same
meaning. Where found, responses and the number of respondents who
gave them were combined, keeping the wording that was clearest.
The free-list analysis was used to identify potential mental
health problems for the more in-depth key-informant interviews.
Selection criteria were:
1. The problem wasrelated to thoughts, feelings, or relationships;
2. The problem could likely be addressed by an existing
evidence-based intervention provided by community mem-
bers using available resources;
3. Many respondents mentioned the problem; and
4. The apparent severity of the problem, based on the brief
descriptions and what is currently known about it.
Focus Groups
Following the free-list interviews, a focus group session on func-
tioning was conducted in each city. Focus group sessions were led
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by a supervisor from the local research team. Participants were
selected in the same way as respondents from the free-list inter-
views with none of the free-list respondents participating. The
focus groups were asked the same three function questions as the
free-list respondents to expand on the free-list data. The analysis
of the focus group was done in the same way as the free-list data.
Key-Informant Interviews
The potential mental health problems selected from the free-list
data were the subjects of the key-informant interviews. Causes,
effects, symptoms, and solution to the selected problems were
explored in more detail in these interviews. Key informants were
individuals from the community said by free-list respondents to be
particularly knowledgeable about these problems and who were
willing and able to talk at length. Health practitioners and com-
munity workers, and other professionals who might respond on
the basis of their training, were excluded as the goal was to capture
the community perspective.
The same teams of two interviewers from the free-list inter-
views conducted the key-informant interviews with one person
interviewing and the other writing down the responses.
Key informants were asked to tell all they know about each of
the selected problems. For each problem, interviewers were
instructed to probe to obtain as much information as possible on:
1. The nature of each problem, including a description of
symptoms and effects;
2. The causes of each problem;
3. What people currently do about each problem; and
4. What people think could/should be done about each
problem.
Key informants were intended to be interviewed at least twice
because a single interview is often not sufficient in time (they
normally lasted one hour) for them to cover all information, and
because informants often think of new information after the first
interview. However, both in Buenaventura and Quibdó, several
key informants only agreed to be interviewed once because they
had to travel to other areas during interview days, or because they
had to work during daytime hours (the only period in which
interviewers were allowed to visit the neighborhoods, as suggested
by the AFRODES team, due to security reasons).
For the analysis, interviewers worked in four teams (one for
each mental health problem the key informants were asked about),
reviewing each interview to abstract relevant information and
classifying responses according to the nature (eg, symptoms),
causes and effects of problems, and what people currently do about
it and what should be done. Each team produced a table with a list
of these responses and how many key informants gave each
response. As in the free-list analysis, when two or more responses
had the same meaning, the team selected the wording that was the
clearest and combined the total number of participants providing
that response.
All results from the three qualitative methods were translated into
English by the local institution researchers in order to discuss the
results with non-Spanish speaking members of the research team.
Results
Free-List Interviews
Twenty-four (12 men; 12 women) free-list interviews were
completed in Buenaventura. In Quibdó, 29 free list interviews
(15 men; 14 women) were completed. The focus group in Bue-
naventura included four women and three men, and the focus
group in Quibdo included three women and two men. In both
cities, respondents’ages ranged from 20-70 years. A review of the
data separately by city did not find much variation, therefore
researchers decided to combine the data from both.
The mental health and psychosocial problems identified during
the free-lists interviews were grouped in the following categories
(fragments from interviewees’responses are presented below):
1. Mental health problems, referred to as problems of the soul
and the heart:
a. Excessive rumination over the past traumatic events and
their effects on their lives; and
b. Features of depression and anxiety including sadness, fear,
anger, resentment, and hopelessness) resulting from the
perceived impact of those events on their lives, particularly
reduced function and poverty.
“...la persona no podía moverse, de noche los veía haciendo cosas,
y mantenía como viendo lo que estaba haciendo con su mucha-
cho”(...the person could not move, during the night she would
see them doing things, she kept seeing what they were doing to
her boy).
“No salíamos porque tenía miedo... yo me acompleje muy feo”
(we would not go out because I was scared…I became terribly
withdrawn).
2. Problems with adaptation to new social context:
a. Adaptation difficulties to the new social context, intoler-
ance, and lack of communication with neighbors; and
b. Fear due to insecurity and violence in new environment.
“Sobrevivir en una ciudad donde uno no conoce a nadie, ni tiene
uno los medios de trabajá, es muy difícil, a mi si me dio muy
difícil”(Surviving in a city where nobody knows you, or where
one does not have the ways to work, is very difficult, it has been
very very difficult).
“Llego a mi barrio a mi casa, leo el periódico, salgo, me cuentan o
veo las noticias y otra vez se me vuelve a caer el mundo, entonces
creo que es complejo porque la situación de violencia y de conflicto
en Buenaventura es permanente”(I get to my neighborhood, my
house, I read the newspaper, go out, people tell me or I see the
news and once again my world falls apart, then I see it is
complex because the violent and conflict situation in Buena-
ventura is a permanent one).
3. Problems related to the current situation:
a. Lack of assistance from government; and
b. Unemployment and poverty.
“Tienen todas las necesidades básicas insatisfechas, hoy están
aquí, mañana en otra parte”(they all have unmet basics needs,
one day they are here, tomorrow they are somewhere else).
The four most frequently reported problems in each city were
selected for key-informant interviews. In Buenaventura, the four
problems included: Fear (in Spanish: Miedo), Psychological
Trauma (Trauma), Sadness (Tristeza), and Violence (Violencia).
The team of researchers decided to include Violence as one of the
problems given the fact that it was frequently reported and because
of the interest in further exploring participants’thoughts on how it
was related to mental health problems. In Quibdó, the four
Prehospital and Disaster Medicine
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Frequency
Symptoms Suffering
Psychological
Trauma Fear Violence Sadness Resentment Total
Fear/being afraid 4 9 10 23
Suffering of “nervios”/“nervios”become altered/
being anxious
32724 18
Becoming violent/aggressive 3 5 4 5 17
Crying 2 3 7 12
Being sad 7 5 12
Not being social/desire to be alone 2 8 10
Maltreatment 2 2 5 9
Having headaches 5 3 8
Being traumatized 3 2 2 7
Death/desire for being death 2 5 7
Hate/feelings of revenge 7 7
Lack of concentration 6 6
Personality changes 6 6
Getting upset (acongojarse) 5 5
Hearing noises or voices 2 3 5
Loneliness 5 5
Stop eating/lack of appetite 2 3 5
Low self-esteem 3 3
Intolerance 4 4
Feelings of being threatened 4 4
Twitching (tembladera) 4 4
Feeling being followed 3 3
Feeling of being locked 3 3
Lack of strength 3 3
Pain 2 2
Being defensive 2 2
Being quiet all the time 2 2
Hide from others 2 2
Desperate 2 2
Lack of sleep 2
Being untruthful 2 2
Santaella-Tenorio © 2018 Prehospital and Disaster Medicine
Table 1. Symptoms and Signs of Problems Affecting People Suffering from Selected Problems (n =32)
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problems were: Fear (Miedo), Psychological Trauma (Trauma),
Suffering (Sufrimiento), and Resentment (Resentimiento). The
results of the analysis of the function activities from the free list
and focus groups are available from the authors upon request.
Key-Informant Interviews
In Buenaventura, a total of 17 key informants (14 women; three
men) were interviewed. Approximately one-half (n =9) were
interviewed only once; seven were interviewed twice and one was
interviewed three times. In Quibdó, a total of 15 key informants
(seven women; eight men) were interviewed. Less than one-half
(n =6) were interviewed only once; eight were interviewed twice
and one was interviewed three times. The results are presented
separately for each problem.
Fear/Being Afraid (Miedo) was characterized as a problem
associated with continuous feelings of anxiety (with diverse phy-
sical manifestations), desire for being alone/isolation, and in
Quibdó, with feelings of being followed, trapped, or threatened.
Key informants described characteristics of Psychological
Trauma (Trauma) to include symptoms related to significant
distress, changes in behaviors/attitudes such as not eating or
sleeping, being confused and becoming violent/aggressive, and
signs of alteration of thought process and content (delusions:
hearing voices or noises). Informants described these symptoms as
the results of experiencing traumatic events.
Symptoms of Sadness (Tristeza) were described as emotional
alterations that included crying continuously, being upset, wanting
to be alone, a depressive mood, anxiety, and suicidal thoughts.
Informants reported that sadness was a common feeling associated
with remembrances of the places they used to live and things they
used to do before being displaced.
Suffering (Sufrimiento) was described as having characteristics
in common with sadness, including emotional difficulties such as
depressive mood, anxiety, low self-esteem, and suicidal thoughts.
Resentment/Bitterness (Resentimiento) was a problem char-
acterized by feelings of hate and anger, rooted in social injustice
and exclusion from society.
Violence (Violencia), characterized by delinquency and lack of
opportunities, was commonly reported as a current problem.
Violence was described as a continuous cause of distress and was
associated with feelings of isolation, marginalization, insecurity,
and emotional distress.
Respondents in both cities frequently mentioned that people
seemed to be ashamed of having these problems and were usually
Frequency
Activities Suffering
Psychological
Trauma Fear Violence Sadness Resentment TOTAL
Look for professional/ psychological help 5 9 11 2 4 31
Talk to friends/somebody 1 8 3 3 15
Leave things in God’s hands 2 2 2 2 8
Ask for help (family or friends) 1 4 1 6
Go to the doctor 3 2 5
Keep moving forward 2 2 1 5
Get training 4 4
Look for remedies (pharmaceutical or natural,
eg, plants)
33
Work 2 1 3
Rely on your strength 2 2
Find solutions 2 2
Look for help from governmental institutions 1 1 2
Learn how to live 2 2
Get isolated 2 2
Planton (peaceful protests in streets) 2 2
Meet with the community 2 2
Walk to get distracted 2 2
Accept and forget your resentment 2 2
Santaella-Tenorio © 2018 Prehospital and Disaster Medicine
Table 2. What People Can Do to Cope with Torture/Violence related Problems (n =32)
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afraid to talk to other people about their feelings and difficulties
apparently due to social stigma. Respondents also talked about
people avoiding talking about their problems, as they feared that
members of illegal groups present in neighborhoods might hear
about this and decide to attack or extort them. The problems that
were selected to be the focus of the key-informant interviews were
also often reported as symptoms, effects, or causes of other pro-
blems. The related symptoms for each of the problems explored in
the key-informant interviews are presented in Table 1.
Causes of these problems were described in similar ways in
both cities. Respondents blamed many of the problems on vio-
lence and insecurity represented by displacement, death, abuse, life
threats, and drug trafficking. They also described other causes
based on social injustice represented by poverty, unemployment,
and lack of opportunities. Respondents often mentioned that
individuals had a hard time keeping up with their daily normal life,
given that they were unable to forget past traumatic experiences.
The most common solutions were finding professional/psy-
chological help, talking to friends and family, and relying on God’s
help. Others solutions included working, joining workshops in
which people are trained in different task or jobs, and being part of
community activities that promote socialization and strengthen
community networks. A list of coping activities and solutions
offered by the study respondents are included in Tables 2 and 3.
Discussion
This study aimed to describe common problems of victims of
torture and violence from the perspective of those living in the two
major urban areas in the Pacific Coast region. This included local
descriptions of these problems, their symptoms, effects and causes
of these problems, as well as coping activities and alternative
solutions. This study used a qualitative methodology previously
used in other cultures.
13-18
In the free-list interviews, the most common reported pro-
blems were Fear and Psychological Trauma. Both were char-
acterized by trauma symptoms and features of depression and
anxiety, as previously described for western and non-western
civilian populations,
13-18
including political violence survivors in
Colombia.
11,12,20
The problems that were explored were highly
inter-related. Fear was linked with intrusive thoughts and con-
tinuously being alert, which could also be part of re-experiencing
traumatic experiences, but may also reflect the current situation
Frequency
Activities Suffering
Psychological
Trauma Fear Violence Sadness Resentment TOTAL
Look for professional/ psychological help 4 10 7 3 3 2 29
Ask for help (family or friends) 10 2 12
Leave things in God’s hands/ask God for
help
423 1 10
Get training (workshops/job activities) 5 4 1 10
Work/job opportunities 2 6 1 1 10
Help others 6 2 8
Talk/dialogue with friends/somebody 2 3 2 7
To provide advice 2 3 1 6
Give all you have 2 2
Rely on your strength 2 2
Find solutions 2 2
Economic support 2 2
Confront fear 2 2
Provide opportunities to go to school 2 2
Provide justice 2 2
To provide guidelines to end maltreatment 2 2
To prosecute those who harm others 1 1
Recuperate family values 1 1
Get organized 1 1
Santaella-Tenorio © 2018 Prehospital and Disaster Medicine
Table 3. Things that Could be Done to Assist Torture/Violence Survivors with related Problems (n =32)
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in both cities where insecurity and violence remain common.
Two other problems, Sadness and Suffering, have overlapping
characteristics with features of trauma symptoms and features of
depression, anxiety, and grief. Being sad was reported as a
symptom of Suffering, suggesting how close related these two
constructs are in both cities. Additional symptoms in Suffering,
not shared with Sadness, included anger, pain, untruthfulness,
and being traumatized, which may be related to a phase of sor-
row after experiencing traumatic experiences and may be specific
to this problem. These problems identified in both cities were
similar to those described in a study with survivors of the armed
conflict in the area of Bojayá, Chocó, in which trauma-related
symptoms and features of depression were frequently observed
among victims.
11
Resentment was a problem identified in Quibdó. Resentment
towards society was characterized by anger and a profound sense of
injustice due to discrimination and lack of opportunities and
unemployment. Resentment, as explained by the interviewees, is
related to affective difficulties that may turn into aggressions
toward society, neighbors, and also against the person. A similar
characterization of Resentment has been described among torture
survivors in other regions.
16
In addition, one major concern for
treatment of traumatic experiences of torture survivors in Buena-
ventura is the previous and current exposure to violence in
neighborhoods. Violence was the fourth most frequent problem
reported in this city. It is likely that torture victims are exposed to
new traumatic experiences and that symptoms reported are the
results of past and recent events. Studies on therapeutic strategies
should take into account the continuous re-exposure to traumatic
experiences and stressors that likely influence all possible inter-
vention outcomes.
Coping activities and solutions suggested by interviewees were
based on psychological treatment, indicating that individuals
acknowledge psychological therapy as a potentially acceptable
solution for torture and violence survivors. Other coping activities
included leaving things in God’s hands. The spiritual experience,
which could work as a form of cognitive optimism,
21
may improve
growth and recovery among victims through the acceptance and
assimilation of traumatic experiences. In addition, other activities
included asking for help and getting trained in different activities,
indicating the importance of social support and of engagement in
activities that could be both a source of distraction and a relief to
economic hardship.
The data from this study served to adapt western mental health
instruments to better reflect mental health problems and symp-
toms according to local cultural constructs and language. The
results also suggested a need for an intervention that would cover
the overlapping characteristics of the reported disorders; specifi-
cally, a transdiagnostic intervention such as the Common Element
Treatment Approach (CETA).
22
This approach may include
components aiming at improving mental health conditions of
individuals by: (1) encouraging them to face feared and avoided
memories through gradual exposure; (2) promoting cognitive
reprocessing, cognitive coping, and behavioral activation; and (3)
providing safety skills and techniques for relaxation.
Limitations
A potential limitation of this study is that the sample size prevents
exploration of the data separately by city. However, similarities in
the problems identified, how people understand these problems,
and suggested solutions were observed in both settings. This study
also focused on problems of survivors living in the two major urban
areas of the Colombian Pacific Coast. It is uncertain whether these
findings apply to other populations of Afro-Colombians survivors
(eg, those living in rural areas).
Conclusions
This qualitative study provided rich information about the mental
health problems of Afro-Colombian victims of violence in two
communities located in the Colombian Pacific Coast region.
Symptoms and effects of the problems selected were found to be
similar to trauma symptoms and features of depression and anxiety
frequently found in populations of torture survivors and victims of
violence in different western and non-western cultures. The bat-
tery of symptoms was used to adapt western instruments that were
used to screen participants into a psychosocial intervention
designed with and implemented by a local nongovernmental
organization under the supervision of the research team. The
descriptions of problems and potential solutions for them, which
were also obtained in this qualitative study, were used to define the
intervention components that seemed most likely to be effective in
reducing the symptoms among torture survivors in this region.
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