Establishing Context to Build Capacity: A Qualitative Study to Determine the Feasibility, Utility, and Acceptability of a Complex Trauma Training for Psychologists Working in Urban Migrant Communities in Northern Peru.

Across Latin America, increasing access to mental health care has become a priority. Management of common mental disorders is shifting to primary care, and community mental health centers (CMHCs) are being established to treat severe needs. In urban migrant communities on the outskirts of Trujillo, Peru, five new CMHCs have been built to treat complex mental health concerns, partially in response to high rates of domestic violence and child maltreatment. However, psychologists have no training in the treatment of interpersonal trauma. This study sought to determine the utility of such a training and identify areas for cultural adaptation. Six focus groups were conducted with CMHC psychologists. Findings revealed that, while a culturally-adapted training in trauma-focused treatment is desired, sociocultural barriers to ensuring the physical and psychological safety of the service user must be considered, as well as provider barriers including short treatment packages, insufficient physical infrastructure, and unstable work conditions.

[Domestic violence as a threat to maternal and child well-being in an urban migrant community in Peru].

OBJECTIVE: To examine the impact that domestic violence (DV) has on hindering the success of urban migrants in Peru and any association with maternal depression, impaired parenting, social capital, and child development. METHODS: This was a cross-sectional study consisting of structured interviews with 97 mothers and their school-aged children in El Porvenir, a predominantly migrant area of the city of Trujillo, Peru. Data collection occurred in February-June 2011. Proven tools previously validated for use in Spanish were used to assess the following variables: maternal depression, social capital, domestic violence, parenting behaviors, child socioemotional development, and child cognitive development. Correlational, multiple regression, tests of interaction, and indirect/mediator models were used for analysis. RESULTS: Sixty-five percent of women reported currently experiencing DV. DV strongly predicted depression (P < 0.001). Women who reported DV were less likely to be employed (P < 0.05), had lower cognitive social capital (P < 0.01), engaged in fewer caregiving activities (P < 0.05), had less maternal energy (P < 0.05), and were less warm (P < 0.05). DV was associated with internalizing behaviors in children (P < 0.01), with impaired parenting partially mediating this relationship. CONCLUSIONS: DV compromises women's mental health and parenting ability. High rates of DV among urban migrants affect the whole community by hindering employment potential and reducing trust among community members. Interventions targeting DV-related variables (e.g., substance abuse and limited job opportunities for men) could reduce the deleterious effects of DV on urban migrant communities across Latin America.

Domestic violence as a threat to maternal and child well-being in an urban migrant community in Peru / La violencia doméstica como una amenaza para el bienestar maternoinfantil en una comunidad urbana de migrantes del Perú

OBJECTIVE: To examine the impact that domestic violence (DV) has on hindering the success of urban migrants in Peru and any association with maternal depression, impaired parenting, social capital, and child development. METHODS: This was a cross-sectional study consisting of structured interviews with 97 mothers and their school-aged children in El Porvenir, a predominantly migrant area of the city of Trujillo, Peru. Data collection occurred in February-June 2011. Proven tools previously validated for use in Spanish were used to assess the following variables: maternal depression, social capital, domestic violence, parenting behaviors, child socioemotional development, and child cognitive development. Correlational, multiple regression, tests of interaction, and indirect/mediator models were used for analysis. RESULTS: Sixty-five percent of women reported currently experiencing DV. DV strongly predicted depression (P < 0.001). Women who reported DV were less likely to be employed (P < 0.05), had lower cognitive social capital (P < 0.01), engaged in fewer caregiving activities (P < 0.05), had less maternal energy (P < 0.05), and were less warm (P < 0.05). DV was associated with internalizing behaviors in children (P < 0.01), with impaired parenting partially mediating this relationship. CONCLUSIONS: DV compromises women's mental health and parenting ability. High rates of DV among urban migrants affect the whole community by hindering employment potential and reducing trust among community members. Interventions targeting DV-related variables (e.g., substance abuse and limited job opportunities for men) could reduce the deleterious effects of DV on urban migrant communities across Latin America.

OBJETIVO: Analizar la repercusión de la violencia doméstica como obstáculo para el éxito de los migrantes urbanos del Perú, y su asociación con la depresión materna, el deterioro de la crianza, el capital social y el desarrollo infantil. MÉTODOS: Se realizó un estudio transversal que constaba de entrevistas estructuradas dirigidas a 97 madres y sus hijos en edad escolar residentes en El Porvenir, una zona predominantemente migratoria de la ciudad de Trujillo (Perú). Se recopilaron datos de febrero a junio del 2011. Se emplearon instrumentos comprobados, validados anteriormente para su uso en español, con objeto de evaluar las siguientes variables: la depresión materna, el capital social, la violencia doméstica, los comportamientos de crianza, y el desarrollo socioemocional y cognoscitivo de los niños. Para el análisis se utilizaron diseños correlacionales y de regresión múltiple, pruebas de interacción y modelos indirectos o de mediadores. RESULTADOS: El 65% de las mujeres notificaron que eran víctimas de algún tipo de violencia doméstica en aquel momento, y esta predijo intensamente la depresión (P < 0,001). Las mujeres que notificaron violencia doméstica tenían menores probabilidades de tener un empleo (P < 0,05), poseían un capital social cognoscitivo inferior (P < 0,01), realizaban menos actividades de cuidado de otras personas (P < 0,05), tenían menos energía para la crianza (P < 0,05), y eran menos afectuosas (P < 0,05). La violencia doméstica se asoció con comportamientos de internalización en niños (P < 0,01), y el deterioro de la crianza mediaba parcialmente esta relación. CONCLUSIONES: La violencia doméstica compromete la salud mental y la capacidad de crianza de las mujeres. Las tasas elevadas de esta entre los migrantes urbanos afectan a toda la comunidad al entorpecer su potencial para lograr un empleo y reducir la confianza entre los miembros de la comunidad. Las intervenciones que actúen sobre las variables relacionadas con la violencia doméstica (por ejemplo, el consumo de sustancias psicoactivas y las limitadas oportunidades de trabajo para los hombres) podrían reducir los efectos nocivos de la violencia doméstica en las comunidades de migrantes urbanos en América Latina.