Characteristics of the Colombian armed conflict and the mental health of civilians living in active conflict zones.
Characteristics of the Colombian armed conflict and the mental health of civilians living in active conflict zones.
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DOI：
10.1186/1752-1505-6-10
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发表时间：
2012-11-21
影响因子：
3.6
通讯作者：
Bosch M
中科院分区：
文献类型：
--
作者：
Bell V;Méndez F;Martínez C;Palma PP;Bosch M
尽管哥伦比亚武装冲突已经持续了近五十年，但关于它如何影响平民心理健康的信息仍然很少。尽管在冲突后人群中，有组织暴力的经历对心理健康有负面影响这一点已得到充分证实，但对生活在活跃冲突地区的人群的研究却很少。无国界医生组织在哥伦比亚冲突地区提供心理健康服务，并利用这些服务的数据，我们旨在确定冲突的哪些特征与精神疾病的具体症状最相关。对 2010 年至 2011 年期间在哥伦比亚纳里尼奥省（相当于各州）、考卡省、普图马约省和卡克塔省就诊的 16 岁及以上患者 (N = 6,353) 的临床数据进行了分析。使用分层聚类分析对风险因素进行分组，并将这些聚类包含在人口统计信息中作为逻辑回归的预测因子，以辨别哪些风险因素聚类最能预测特定症状。出现了三个明确的风险因素群，它们被解释为“与冲突直接相关的暴力”、“与冲突不直接相关的个人暴力”和“普遍困难”。回归分析表明，与其他危险因素组相比，冲突相关暴力与焦虑相关精神病理学的相关性更高，而非冲突暴力与攻击性和药物滥用的相关性更高，而这在男性中更为常见。抑郁症和自杀风险在危险因素群中的表现相同。作为哥伦比亚同类研究中规模最大的一项，它证明了冲突对心理健康的明显影响。在咨询过心理健康专业人士的人中，特定的冲突特征可以预测症状特征。然而，一些最高风险的结果，如抑郁、自杀风险和攻击性，更多地与与冲突间接相关的因素有关。这表明需要关注武装冲突的系统性影响，而不仅仅是直接接触战斗。
Despite the fact that the Colombian armed conflict has continued for almost five decades there is still very little information on how it affects the mental health of civilians. Although it is well established in post-conflict populations that experience of organised violence has a negative impact on mental health, little research has been done on those living in active conflict zones. Médecins Sans Frontières provides mental health services in areas of active conflict in Colombia and using data from these services we aimed to establish which characteristics of the conflict are most associated with specific symptoms of mental ill health. An analysis of clinical data from patients (N = 6,353), 16 years and over, from 2010–2011, who consulted in the Colombian departments (equivalent to states) of Nariño, Cauca, Putumayo and Caquetá. Risk factors were grouped using a hierarchical cluster analysis and the clusters were included with demographic information as predictors in logistic regressions to discern which risk factor clusters best predicted specific symptoms. Three clear risk factor clusters emerged which were interpreted as ‘direct conflict related violence’, ‘personal violence not directly conflict-related’ and ‘general hardship’. The regression analyses indicated that conflict related violence was more highly related to anxiety-related psychopathology than other risk factor groupings while non-conflict violence was more related to aggression and substance abuse, which was more common in males. Depression and suicide risk were represented equally across risk factor clusters. As the largest study of its kind in Colombia it demonstrates a clear impact of the conflict on mental health. Among those who consulted with mental health professionals, specific conflict characteristics could predict symptom profiles. However, some of the highest risk outcomes, like depression, suicide risk and aggression, were more related to factors indirectly related to the conflict. This suggests a need to focus on the systemic affects of armed conflict and not solely on direct exposure to fighting.