[How does collective violence shape the health status of its victims? Conceptual model and design of the ISAVIC study]. / ¿Cómo influye la violencia colectiva en la salud? Modelo conceptual y diseño del estudio ISAVIC.

OBJECTIVES: Epidemiologic research on collective violence (violence exerted by and within groups in pursuit of political, social or economic goals) is very scarce despite its growing recognition as a major public health issue. This paper describes the conceptual model and design of one of the first research studies conducted in Spain aiming to assess the impact of collective violence in the health status of its victims (study known as ISAVIC, based on its Spanish title Impacto en la SAlud de la VIolencia Colectiva). METHODS: Starting with a comprehensive but non-systematic review of the literature, the authors describe the sequelae likely produced by collective violence and propose a conceptual model to explain the nature of the relationships between collective violence and health status. The conceptual model informed the ISAVIC study design and its measurement instruments. RESULTS: The possible sequelae of collective violence, in the physical, emotional and social dimensions of health, are described. Also, the review distinguishes the likely impact in primary and secondary victims, as well as the interplay with the social environment. The mixed methodological design of the ISAVIC study supports the coherence of the conceptual model described. CONCLUSIONS: The ISAVIC study suggests that collective violence may affect the main dimensions of the health status of its victims, in intimate relation to the societal factors where it operates. It is necessary to validate these results with new studies.

Secuelas de la violencia colectiva: hablan las víctimas del estudio ISAVIC / Sequelae of collective violence: victims’ voices in the ISAVIC study

Objetivo: A pesar de la importancia de la violencia colectiva en la salud, aún quedan muchas lagunas sobre la naturaleza de las lesiones que produce y su relación con el bienestar y la calidad de vida de susvíctimas. Durante los años 2005-2008 se realizó en el País Vasco el estudio ISAVIC para estimar los efectosde este tipo de violencia en la salud. El estudio intentó comprender las características de las secuelas dela violencia colectiva en la salud de las víctimas a partir de sus percepciones. Métodos: Se seleccionó una muestra intencional de 36 víctimas primarias, a través de redes de contactosy mediadores. Se realizaron entrevistas en profundidad semiestructuradas, analizadas en función delmodelo conceptual del estudio.Resultados: Los testimonios sugieren que las víctimas han experimentado un proceso traumático de gran intensidad que no han superado en su totalidad y que es causa de una importante pérdida de calidad devida. Se describen las principales limitaciones funcionales observadas en términos físicos, emocionales y sociales.Conclusiones: Los resultados cualitativos son coherentes con los obtenidos mediante instrumentos estandarizados,a los que dotan de mayor sentido al explicar la naturaleza de las limitaciones de la salud.También permiten intuir algunas de las relaciones entre las diferentes limitaciones funcionales y su impacto en la calidad de vida. Conviene verificar los resultados con muestras más amplias de víctimas y profundizar en el estudio de la relación entre violencia y salud, incluyendo el impacto del contexto social (AU)

Objective: Despite the significant influence of collective violence on the health status of its victims,there are still many gaps in our understanding of the nature of the functional limitations this violenceproduces and its impact on victims’ wellbeing and quality of life. The ISAVIC study was carried out in the autonomous region of the Basque Country from 2005-2008 to estimate the effects of collective violenceon health. The assessment included victims’ perceptions of these sequelae and their impact on health. Methods: A purposive sample of 36 primary victims was selected through contact networks and mediators.The victims’ perceptions were collected through semi-structured in-depth interviews, which were later analyzed according to the study’s conceptual framework.Results: The victims’ testimony suggests that they were profoundly traumatized by the collective violence experienced, which was often not yet completely overcome and significantly impaired their qualityof life. The main functional, physical, emotional and social limitations described by the victims were identified.Conclusions: The qualitative results of this study are coherent with those obtained through the parametric phase of the ISAVIC study and provide a more complete overview of the nature of the sequelae of collective violence and its impact on quality of life. These results should be verified in larger studies and the influence of the social context on the relationship between collective violence and health should beanalyzed in greater depth (AU)

[Sequelae of collective violence: victims' voices in the ISAVIC study]. / Secuelas de la violencia colectiva: hablan las víctimas del estudio ISAVIC.

OBJECTIVE: Despite the significant influence of collective violence on the health status of its victims, there are still many gaps in our understanding of the nature of the functional limitations this violence produces and its impact on victims' wellbeing and quality of life. The ISAVIC study was carried out in the autonomous region of the Basque Country from 2005-2008 to estimate the effects of collective violence on health. The assessment included victims' perceptions of these sequelae and their impact on health. METHODS: A purposive sample of 36 primary victims was selected through contact networks and mediators. The victims' perceptions were collected through semi-structured in-depth interviews, which were later analyzed according to the study's conceptual framework. RESULTS: The victims' testimony suggests that they were profoundly traumatized by the collective violence experienced, which was often not yet completely overcome and significantly impaired their quality of life. The main functional, physical, emotional and social limitations described by the victims were identified. CONCLUSIONS: The qualitative results of this study are coherent with those obtained through the parametric phase of the ISAVIC study and provide a more complete overview of the nature of the sequelae of collective violence and its impact on quality of life. These results should be verified in larger studies and the influence of the social context on the relationship between collective violence and health should be analyzed in greater depth.