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Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes. [ABSTRACT FROM AUTHOR]

Young people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help)seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes. [ABSTRACT FROM AUTHOR]

This paper discusses the complexity of contemporary struggles for collective health in Colombia, by analysing the efforts of different actors to inscribe abortion as a matter of public health and as a human right. In 2006 the Colombian Constitutional Court (Sentence C 355 of 2006) partially decriminalised abortion in specific circumstances. Such a change in regulation was the result of the strategic coordination of international organisations, researchers and women's social movements. These groups produced a powerful network of international regulation and epidemiological data about abortion's mortality and burden of disease in order to move the discussion from the moral field to public health and international law. Despite the significance of the sentence in terms of civil rights, ten years after the regulation there is no clarity about its impact. Conservative sectors within the government have limited the operation of the regulation, through eliciting convoluted rules for hospitals and care providers. On the other hand, data about safe abortions are weak and precarious. Recently groups opposed of abortion have exploited such weakness to undermine the impact of the decriminalisation and to criticise the justification of legalising abortion as a matter of public health. [ABSTRACT FROM AUTHOR]

The neoliberal reforms of the early 1990s in Colombia, mainly labour and social security reforms, transformed capital-labour relations and contributed to the erosion of working conditions and health protection at work, with devastating impacts on workers' health. In the context of these dramatic changes, Colombian workers mobilised around collective identities that have shaped new forms of workers' struggle and resistance. Since 2006, associations of workers suffering work-related illnesses have been active in Colombia. The associated workers engaged in collective actions have demanded from employers, the Ministry of Work, occupational risk administrators, disability rating boards and the judicial system the recognition of certain diseases as being of occupational origin and that these entities guarantee corresponding labour, economic and social security rights. This paper describes and analyses the dynamics of the struggle for the right to health at work undertaken by these associations in Colombia, adopting an analytical perspective inspired by collective action theory. [ABSTRACT FROM AUTHOR]

ABSTRACTYoung people in Colombia present high rates of mental health problems, to which the country’s history of armed internal conflict contributes in complex ways. Mental health services in Colombia are fragmented, inadequate, and difficult to access for many. Young people’s help-seeking is often hindered by mental health stigma and/or poor experiences with services. This paper presents a thematic analysis of qualitative data from a mixed-methods study aimed at developing and testing a mental health intervention for Colombian youths. We draw upon theoretical lenses from scholarly work on stigma and Sen’s ‘capabilities approach’ to inform our analysis of interviews and group discussions with staff and young people involved in the state-funded human capital building programme ‘Jovenes en Acción’ (JeA). By illustrating how study participants talked about stigma, vulnerability, mental health services organisation, and the challenges of discussing mental health topics in a learning environment, we illuminate aspects of mental health support and anti-stigma interventions that might need enhancing. In particular, we suggest that more emphasis on ‘community competencies’ as complementary to and interrelated with individual competencies would strengthen young people’s individual and collective resources for mental wellbeing while being in line with the sociocritical principles of existing human capital-enhancing programmes.

Mental health is a key issue for populations affected by conflict. The evidence base on the mental health of internally displaced Colombians is undefined, as well as protective strategies utilised by this group. This systematic literature review aims to identify and assess the evidence base on the mental health of Colombian internally displaced persons (IDPs). Specific objectives are to examine (1) prevalence and incidence rates of common mental disorders (CMDs) amongst adult Colombian IDPs, (2) risk factors associated with CMDs amongst this group, and (3) coping strategies used by these displaced persons. A database search was conducted in May 2021. Included studies reported quantitative and/or qualitative mental health outcomes of CMDs, and/or coping strategies, among Colombian IDPs. The search yielded 34 articles. Study quality ranged from adequate to poor, with several containing serious shortcomings. PTSD prevalence ranged from 1.2%-97.3%, anxiety from 0.0%-60.0%, depression from 5.1%-100%, and problematic alcohol use from 8.0%-33.5%. Factors significantly associated with CMDs were inconsistent. Seeking social support and problem-solving strategies were the two most-commonly reported coping strategies. Associations between mental health and coping were largely unreported. As the evidence base is weak, there is a clear need for better quality research in this area. [ABSTRACT FROM AUTHOR]

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

Addressing mental health needs is a central focus of the Colombian Government's framework for socio-political reconstruction following over 60 years of conflict. Informed by WHO standards, country efforts utilise biopsychosocial models that prioritise individual psychological and psychiatric conditions. However, increasing scrutiny of the deployment of Western approaches to mental health and recovery in the global south suggests a need to explore the best route to improving mental health outcomes. Our research contributes to these debates through a qualitative study of local understandings of mental health recovery related concepts among internally displaced persons in Colombia. Analysis of focus groups with 40 internally displaced men and women established definitions for emotional distress and recovery as parallel processes linked to the fracture and rebuilding of social worlds and family life. Definitions were shaped heavily by cultural, political, economic and legal contexts of everyday survival, often linked to experiences of structural and symbolic forms of violence. We conclude that a locally informed mental health recovery model that stretches beyond individual experiences of mental ill-health to promote ideas of collective social change would be best suited to addressing mental health needs of internally displaced groups in Colombia. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Women displaced by conflict are often exposed to many factors associated with a risk of intimate partner violence (IPV) such as high levels of community violence and the breakdown of social support systems. Previous research found that Colombian women perceived IPV to increase after displacement. This study explored how the experience of displacement altered gendered roles in ways that influenced the risk of IPV. Thirty-three qualitative interviews were conducted with displaced partnered Colombian women. Women disclosed that couples often held patriarchal gender norms; however, the roles of each partner necessitated by conditions of displacement were often in conflict with these norms. Men's underemployment and women's employment outside the home were viewed as gender transgressive within some partnerships and increased relationship conflict. Economic resources intended to empower displaced women, notably women's earnings and home ownership, had unintended negative consequences for women's agency. These consequences included a corresponding decrease in partner financial contributions and reduced mobility. Women's ability to obtain support or leave violent relationships was hindered by interpersonal, social and structural barriers. For women to have agency to leave violent relationships, power relationships at all levels from the interpersonal to societal must be recognised and addressed. [ABSTRACT FROM AUTHOR]

The demobilisation of guerrillas and paramilitaries in Colombia, also known as irregular armed groups, has raised the question among mental health professionals as to whether ex-combatants who have had repeated exposure to stressful events might meet the requirements for posttraumatic stress disorder (PTSD). Upon arrival at a psychiatric clinic in Bogota, 76 patients were evaluated by a group of mental health professionals with experience in this diagnosis. Contrary to clinicians' expectations, there was a conspicuous lack of PTSD among this population. Subsequently, the clinical team administered the Clinician Administered PTSD Scale with 21 of these patients; PTSD was found in 57% of the men. The authors consider various arguments that might explain this discrepancy. Differences between the clinical presentation of PTSD among the ex-combatants and the classic descriptions contained in the DSM-IV-TR may be explained by organisational characteristics of the irregular armed groups. Further research is necessary which focuses on the mental health of populations in the context of political violence, such as those encountered in Colombia. [ABSTRACT FROM AUTHOR]