Highlight: Identifying barriers to mental healthcare for civilians affected by protracted armed conflict in Colombia

哥伦比亚经历了一场残酷和广泛的武装冲突，登记在册的受害者达900万人。受影响最严重的人没有充分利用一项针对有冲突相关心理健康需求的人的国家免费心理健康方案，其原因尚不清楚，从而加剧了与冲突相关的不平等。为了克服这一点，我们需要了解无形的冲突受害者面临的障碍——他们有与冲突有关的心理健康问题，但从未获得服务，因此很难对他们进行研究——以及影响那些获得服务的人的治疗延误和护理质量的障碍。这将是第一个使用创新数据来识别隐形受害者的项目，i)在普通人群中使用主动病例确定的全国代表性精神病学研究（N=12k+）；二)来自国家精神卫生方案的数据（N= 100多万），这是第一个在人口层面检查护理质量的数据。我们将使用强有力的统计分析来确定：1)成为隐形冲突受害者的社会、健康和人口驱动因素——那些有与冲突相关的心理健康需求但从未获得服务的人；2)导致治疗延误、护理质量、3)基于性别的暴力和性暴力在多大程度上调解了妇女和女孩与冲突有关的心理健康需求和治疗机会/结果不佳的问题。所有这三个目标都涉及紧迫的国家政策问题。目标3是由我们的有武装冲突生活经验的小组提出的，并且是最优先考虑的，他们将继续共同制作这个项目。考虑到大规模的纵向数据和可靠的统计方法，该项目将提供高质量的证据，说明平等获取和保健质量的障碍。这些成果将直接转化为实地政策变化和社区参与，同时为哥伦比亚和拉丁美洲其他受冲突影响的国家提供证据基础。访问这些数据是我们研究小组所独有的，以前没有完成或提出过这样的分析。这个项目只有通过我们独特的国际合作者团队的合作才能实现。该项目由哥伦比亚和英国的一个专门研究哥伦比亚武装冲突和心理健康的学者团队领导。Fundación Santa f<e:1> de bogot<e:1>将与伦敦大学学院成果研究和有效性中心、伦敦大学学院临床心理学中心和伦敦大学学院流行病学和应用临床研究中心合作，这些中心是世界领先的心理健康和社会不平等数据科学中心。这个项目很及时。这项研究的结果将直接传达给哥伦比亚新政府，对他们来说，解决与冲突有关的心理健康不平等是其“全面和平”政策的核心。我们将与国内和国际非政府组织和妇女组织合作，这些组织强调需要将这些信息传达给最边缘化的社区，并为其方案提供信息。在我们的生活经验合作者小组的领导下，我们将利用基层社区参与计划，让受冲突影响最大的社区参与到研究结果中，直接为我们的解释、框架和建议提供信息。该项目将通过计划中的培训和监督哥伦比亚ECR合作者的方案来发展哥伦比亚的能力，以促进他们的参与，并通过与英国的三个世界领先的研究小组建立平等的伙伴关系。他们将接受高级流行病学分析、政策参与和开放科学方法方面的培训。此外，我们将发布开放获取代码库，这将留下永久的遗产，以促进其他哥伦比亚研究人员未来对这些数据集的分析。

Colombia has endured a brutal and extensive armed conflict with 9 million registered victims. A national cost-free mental health programme for people with conflict-related mental health needs is being under-used by the most affected and it's unclear why, amplifying conflict-related inequalities. To overcome this, we need to understand barriers facing the invisible victims of conflict - who have conflict-related mental health problems but never access services and who have been hard to research for this reason - and barriers affecting treatment delay and quality of care in those that do access services.This will be the first project to identify invisible victims using innovative data-linkage between i) a nationally representative psychiatric epidemiological study (N=12k+) that used active case ascertainment in the general population, and; ii) data from the national mental health programme (N=1 million+), and the first to examine quality of care at the population level.We will use robust statistical analysis to identify:1) social, health, and demographic drivers of being an invisible victim of conflict - who has conflict-related mental health needs but who never accesses services2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related mental health needs who successfully access services3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment access / outcome in women and girlsAll 3 aims address urgent national policy issues. Aim 3 was suggested, and most prioritised by, our panel of people with lived experience of the armed conflict who will continue to co-produce this project.Given the large-scale longitudinal data and robust statistical methods, this project will provide high-quality evidence on barriers to equality of access and quality of care. These will translate directly into on-the-ground policy changes and community engagement, while providing an evidence base for Colombia and other conflict-affected countries in Latin America.Access to this data is unique to our research group and no such analysis has been completed or proposed before. This project could only be possible through collaboration between our unique team of international collaborators.The project is led by a team of Colombian and UK academics specialising in the Colombian armed conflict and mental health. Fundación Santa Fé de Bogotá will work in collaboration with the UCL Centre for Outcomes Research and Effectiveness, UCL Clinical Psychology, and UCL Epidemiology and Applied Clinical Research - world-leading centres in data science of mental health and social inequalities.This project is timely. The results of this study will be directly communicated to the new government in Colombia, for whom addressing conflict-related mental health inequalities is central to their 'total peace' policy. We will engage national and international NGOs and women's organisations who have underlined the need for this information to reach the most marginalised communities and inform their programmes.Using a grassroots community involvement programme, led by our panel of lived experience collaborators, we will engage communities most affected by the conflict in the results of the study to directly inform our interpretation, framing and recommendations.This project will develop capacity in Colombia through a planned programme of training and supervision of our Colombian ECR collaborators to facilitate their involvement and through immersion in equal partnership with three world-leading research groups in the UK. They will be trained in advanced epidemiological analysis, policy engagement, and open science methods. In addition, we will publish open access code repositories that will leave a permanent legacy to facilitate future analysis of these datasets by other Colombian researchers.