Eventos violentos anteriores y resultados de salud mental en Guatemala

Objetivos. Analizamos una muestra probabilística de los guatemaltecos para determinar si existe una relación entre eventos violentos anteriores y el desarrollo de resultados de salud mental en diversos grupos sociodemográficos, así como durante la guerra civil guatemalteca y después ella. Métodos. Usamos el modelado de regresión, una prueba de interacciones y complejos ajustes del diseño de encuestas para hacer una estimación de la prevalencia y examinar las posibles relaciones entre los eventos violentos anteriores y la salud mental. Resultados. Muchos de los participantes (20,6%) habían presenciado o sufrido anteriormente al menos un evento violento grave. Ser testigo de cómo alguien fue herido gravemente o asesinado fue el evento más frecuente. El 4,2% de los participantes presentaron depresión; 6,5%, ansiedad; 6,4%, un trastorno relacionado con el alcohol; y 1,9% un trastorno de estrés postraumático (TEPT). Las personas que presenciaron o fueron víctimas de la violencia durante la guerra tenían una probabilidad ajustada 4,3 veces mayor de presentar trastornos relacionados con el alcohol (P <0,05) y una probabilidad ajustada 4,0 veces mayor de TEPT (P < 0,05) en comparación con el periodo de posguerra. Las mujeres, los indígenas mayas y los habitantes de zonas urbanas tenían mayor probabilidad de presentar resultados de salud mental posteriores a la violencia. Conclusiones. La violencia que empezó durante la guerra civil y que actualmente se mantiene tiene un efecto importante en la salud mental de los guatemaltecos. Sin embargo, los resultados de salud mental como resultado de eventos violentos disminuyeron en el periodo de posguerra, lo que hace pensar que la nación se está recuperando.

Objectives. We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. Methods. We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. Results. Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. Conclusions. Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery.

Previous violent events and mental health outcomes in Guatemala.

OBJECTIVES: We analyzed a probability sample of Guatemalans to determine if a relationship exists between previous violent events and development of mental health outcomes in various sociodemographic groups, as well as during and after the Guatemalan Civil War. METHODS: We used regression modeling, an interaction test, and complex survey design adjustments to estimate prevalences and test potential relationships between previous violent events and mental health. RESULTS: Many (20.6%) participants experienced at least 1 previous serious violent event. Witnessing someone severely injured or killed was the most common event. Depression was experienced by 4.2% of participants, with 6.5% experiencing anxiety, 6.4% an alcohol-related disorder, and 1.9% posttraumatic stress disorder (PTSD). Persons who experienced violence during the war had 4.3 times the adjusted odds of alcohol-related disorders (P < .05) and 4.0 times the adjusted odds of PTSD (P < .05) compared with the postwar period. Women, indigenous Maya, and urban dwellers had greater odds of experiencing postviolence mental health outcomes. CONCLUSIONS: Violence that began during the civil war and continues today has had a significant effect on the mental health of Guatemalans. However, mental health outcomes resulting from violent events decreased in the postwar period, suggesting a nation in recovery.

An exploration of violence, mental health and substance abuse in post-conflict Guatemala.

Guatemala's 36-year civil war officially ended in December 1996 after some 200,000 deaths and one million refugees. Despite the ceasefire, Guatemala continues to be a violent country with one of the highest homicide rates in the world. We investigated potential associations between violence, mental health, and substance abuse in post-conflict Guatemala using a community-based survey of 86 respondents living in urban and rural Guatemala. Overall, 17.4% of our respondents had at least one, direct violent experience during the civil war. In the post-conflict period, 90.7% of respondents reported being afraid that they might be hurt by violence, 40.7% screened positive for depression, 50.0% screened positive for PTSD, and 23.3% screened positive for alcohol dependence. Potential associations between prior violent experiences during the war and indicators of PTSD and aspects of alcohol dependence were found in regression-adjusted models (p < 0.05). Certain associations between prior civil war experiences, aspects of PTSD and alcohol dependence in this cohort are remarkable, raising concerns for the health and safety of the largely indigenous populations we studied. Higher than expected rates of depression, PTSD, and substance abuse in our cohort may be related to the ongoing violence, injury and fear that have persisted since the end of the civil war. These, in turn, have implications for the growing medical and surgical resources needed to address the continuing traumatic and post-traumatic complications in the post-conflict era. Limitations of the current study are discussed. These findings are useful in beginning to understand the downstream effects of the Guatemalan civil war, although a much larger, randomly sampled survey is now needed.