BackgroundExposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors.Methods and findingsA referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12–14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList–Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d = 0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city.ConclusionsThis trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors.Trial registrationClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/...
Correspondence to: Carlos A. Ordóñez, carlosordonez@telecom.com.co.
Due to the limited supply of mental health services for Afro-Colombian victims of violence, a Common Elements Treatment Approach (CETA) intervention has been implemented in the Colombian Pacific. Given the importance of improvement in mental health interventions for this population, it is necessary to characterize this process. This article seeks to describe the implementation of CETA for Afro-Colombian victims of violence in Buenaventura and Quibdó, Colombia through case studieswith individual in-depth interviews with Lay Psychosocial Community Workers (LPCW), supervisors, and coordinators responsible for implementing CETA. From this six core categories were obtained: 1. Effect of armed conflict and poverty 2. Trauma severity 3. Perceived changes with CETA 4. Characteristics and LPCW’s performance 5. Afro-Colombian culturalapproach and 6. Strategies to promote users’ well-being.Colombian Pacific’s scenario implies several factors, such as the active armed conflict, economic crisis, and lack of mental health care resources, affecting the implementation process and the intervention effects. This implies the need to establish and strengthen partnerships between institutions in order to administer necessary mental health care for victims of violence in the Colombian Pacific.
Since 2002, the Institute for Peace Promotion and Injury/Violence Prevention (CISALVA) at the Universidad del Valle, Cali, Colombia and the Colombia Program at Georgetown University have developed and implemented 21 epidemiologically based municipal crime observatories in intermediate-sized municipalities in Colombia. These crime observatories serve as monitoring centres that provide low cost, geo-referenced methods of data collection and analysis, which allow cities to develop more responsive policies and prevention programmes and enhance governance. This article focuses on the methodology employed and lessons learned that may be applicable to similar settings. Worth noting within the results was a significant decrease in homicides after the first year of the programme. Whether or not such results could be attributed to the method or to the nature of the interventions and policy initiatives stemming from it remains open to conjecture.
Background: Emergency care information systems in trauma are essential to improve the decision making and identify potential areas of intervention. Objective: To describe the first year of experience of trauma registry in two reference trauma centers of the southwestern Colombia. Methods: A study conducted in two reference trauma centers of Cali city. There were included those patients with any injury from external causes or trauma occurred between January 1st and December 31st of 2012. Information related with demographics, injury mechanism, severity injury (ISS) and mortality were collected. We presented a descriptive analysis. Results: There were registered 17,431 patients whereof 67.8% were male with a mean of 30 (±20) years old. Workplace injuries were the 28.2% cause of emergency consultation, and falls were the most prevalent trauma mechanism. Majority of patients with a ISS ≥15 were in a range age of 18-35 years (6.4%). The 28% of patients with gunshot wounds had a ISS ≥15. An overall of 2.5% of included patients died and those who had a ISS ≥15 and gunshot wounds showed a mortality of 54%. Conclusion: Upon the implementation of the trauma registry in two main hospitals of Cali city, we identify that falls and workplace injuries were the leading cause of admission to the emergency room. Severely compromised patients are in the range age of 18-35 years old. Mortality was higher for those patients who suffered gunshot wounds.
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