Assessing mental health outcomes of political violence and civil unrest in Peru.

BACKGROUND: Sustained political violence (SPV) may have long-term effects. AIMS: To assess mental and residual effects of exposure to SPV. To validate a post-traumatic stress disorder (PTSD) assessment tool in Quechua-speaking Peru. METHOD: Survey of 373 individuals aged 15 and over using the General Health Questionnaire (GHQ-12), Hopkins Symptom Checklist (HSCL-25) and a Trauma Questionnaire (TQ), derived from the Harvard Trauma Questionnaire. Sociodemographics were recorded. Reliability was assessed. Data reduction used factor analysis and modelling multiple regressions. RESULTS: A quarter of the sample had symptoms compatible with PTSD. Questionnaire reliability ranged from 0.81 to 0.89. Factor analysis confirmed high construct validity for TQ and HSCL-25. Modelling showed a strong association of PTSD-related symptoms and expressions of distress with the degree of exposure to SPV, especially among returnees. CONCLUSIONS: Long-term consequences of exposure to SPV take the form of PTSD, anxiety and depressive disorders, and culturally formulated expressions of distress. Some implications for clinicians are discussed.

The sequelae of political violence: assessing trauma, suffering and dislocation in the Peruvian highlands.

In this article, we begin with a qualitative mapping of the multiple ways indigenous peoples in the Peruvian highlands construct their emotions, symptoms and specific disorders when confronted with an adverse environment of sustained political violence, multiple stressors and massive exposure to traumatic experiences. Second, we address the issue of magnitude (point prevalence) and distribution of mental health problems such as depression and anxiety, and sequelae of exposure to violence-related stressors as reported in the selected populations, by reviewing the quantitative results of a cross-sectional survey. Third, we examine the pathways and linkages between the social context (drawn from ethnography and secondary sources) and the collective experience, such as massive exodus, forced displacement, resilience and accommodation strategies for coping and survival. When assessing the overall mental health impact of exposure to protracted forms of extreme violence in civilian populations, we argue for the need to move beyond the limited notion of post-traumatic stress disorder, which is a useful but restrictive medical category failing to encompass the myriad of signals of distress, suffering and affliction, as well as other culture bound trauma-related disorders and long-term sequelae of traumatic experiences. Lastly, following the concluding remarks, we discuss some implications the results of the study may have at various levels, not only for the victims and survivors of massive exposure to traumatic events, but also their families and communities, as well as for interventions carried out by humanitarian and emergency relief organizations, and specialised agencies engaged in the promotion of social justice, prevention of human rights abuses, and mental health rehabilitation programs at both national and international levels.