Understanding and addressing the impact of stressful live events on the mental health of older adults in Colombia

自20世纪50年代以来，哥伦比亚一直遭受政治暴力，特别是最近的贩毒集团和移民流动。这些都严重影响了公民。哥伦比亚人现在正受到全球新冠肺炎疫情的影响。目前尚不清楚这些事件如何影响居民的心理健康和福祉，特别是老年人的心理健康和福祉。预计到2050年，哥伦比亚老年人的比例将从10%翻一番，达到20%。这种增长对哥伦比亚人的影响越来越大，特别是在安蒂奥基亚省的乌拉巴等地区，这些地区在其历史上由于国家的不重视和长期政治冲突的持续存在而遭受不平等和缺乏发展的痛苦，这加深了这些结构性不平等。60岁以上的人目睹了该国的暴力历史，作为受害者或肇事者(对于那些属于武装团体的人)。这些人对冲突有一种复杂的理解，并使他们成为和平的倡导者，因为他们目睹了战争的可怕后果--他们遭受了战争的痛苦，并幸存了下来。从这个意义上说，哥伦比亚的老年人编织了冲突的一生记忆，但也遭受了后果。我们的研究中心是特博市，这是这些地区和人口的典型。在过去60年里，乌拉巴·安提奥昆托一直是受哥伦比亚武装冲突影响最大的地区之一。它被认为是安蒂奥基亚省因武装冲突或暴力原因而被驱逐人数最多的地区之一，但同时也是太平洋区域和大西洋沿岸乔科受害者以及寻求进入美国的非洲和拉丁美洲外国人的移民过境的主要接收区之一。2020年，413,397名居民(占区域总人口525,685人的78.6%)登记为武装冲突受害者。在Turbo，这一比例为64.5%(83993名受害者)。在该地区，9.7%(n=14,425)被归类为老年人，生活在城市、农村、郊区和分散的农村地区。我们的建议将联合制作与公共和专业顾问贯穿始终。我们已经与当地老年居民和专业人士进行了磋商，以确定方法和设计项目。这项建议将收集和结合关键的现有数据集，并使用精神健康调查和个人访谈和焦点小组收集的新信息，以绘制老年人的心理健康状况和压力，他们遭受数十年的冲突，现在是COVID19。这些调查结果将结合对支持中低收入国家老年人心理健康的干预措施的系统审查，特别侧重于冲突幸存者，并结合对国际学术专家的深入访谈。证据摘要，结合Turbo的定量和定性数据，将用于共同设计和测试以社区为基础的心理社会护理战略，并与Turbo老年居民一起进行干预，以减少和管理心理健康问题。它将解决Turbo研究阶段在家庭和社区一级确定的情况，并与不同的区域卫生和福利系统和数据集联系起来。然后，将评估其成本效益、对精神健康的影响和其他关键因素以及专业人员和服务使用者的接受程度，作为试点。调查结果将被用于在更广泛的人群中提供更大规模的正式试验赠款申请；以及指导如何更广泛地实施这一办法，以支持哥伦比亚和其他低收入国家内的其他人口以及从英格兰开始的高收入国家，重点解决经历过冲突的移民的心理健康需求。

Colombia has suffered political violence since the 1950s notably la violencia, more recently drug cartel and migrant flows linked. These severely impact citizens. Colombians are now being affected by the global COVID-19 pandemic. It remains unclear how these events are affecting residents' mental health and wellbeing, particularly older adults. The proportion of Colombian older adults is expected to double from 10% to 20% by 2050. This rise increasingly impacting upon Colombians, particularly in regions like Urabá in the Department of Antioquia, that have suffered throughout their history from inequality and lack of development due to inattention from the state and the constant presence of prolonged political conflict that deepens these structural inequalities. Those over 60 years of age have witnessed the history of violence in the country, as victims or perpetrators (for those who were part of armed groups). These account for a complex understanding of the conflict and turn them into the advocates for peace, as they have witnessed the dire consequences of war -they have suffered and survived them. In this sense, the elderly in Colombia are the ones who weave the life-story memories of the conflict, but suffer consequences.Our research centres on the municipality of Turbo, typical of such regions and populations. Uraba Antioqueno has been one of the territories most affected by the Colombian armed conflict in the last six decades. It is considered one of the regions of the Department of Antioquia with the highest numbers of expulsion of people for reasons related to the armed conflict or violence, though at the same time it is one of the main receiving areas for victims from Choco in the Pacific region and the Atlantic coast, as well as the migratory transit of foreigners from Africa and Latin America who seek reaching the United States. In 2020 413,397 inhabitants (78.6% of the total regional population of 525,685) were registered as victims of the armed conflict. In Turbo, the proportion is 64.5% (83,993 victims). In the region, 9.7% (n=14,425) are classed as older adults, living in urban, rural, peri-urban and dispersed rural areas.Our proposal embeds co-production with public and professional advisors throughout. We have already been undertaking consultations with local older residents and professionals in determining the approach and designing the project.This proposal will collect and combine key existing datasets added to new information collected using mental health surveys and both individual interviews and focus groups to map the mental health condition and pressures on older adults, suffering from decades of conflict and now COVID19. These findings will link with a systematic review of interventions to support the mental health of older adults in lower and middle income countries (LMICs), with a particular focus on conflict survivors, linked to in-depth interviews with international academic experts. The evidence summary, combined with quantitative and qualitative data from Turbo will be used to co-design and test a community-based psychosocial care strategy and intervention with, and for, Turbo older residents to reduce and manage mental health problems. It will address the situations identified at family and community levels in the Turbo research phases, linking with different regional health and welfare systems and datasets. This will then be evaluated as a pilot for its cost effectiveness, impact on mental health and other key factors as well as acceptability to professionals and service users. The findings will be used to inform a larger formal trial grant application across wider populations; as well as guides to implementing the approach more widely to support its application across other populations, within Colombia and other LMICs; as well as higher income countries, starting with England, with a focus on addressing the mental health needs of migrants who have experienced conflict.