title: Characteristics of the Colombian armed conflict and the mental health of civilians living in active conflict zones.
abstract: BACKGROUND
  Despite the fact that the Colombian armed conflict has continued for almost five decades there is still very little information on how it affects the mental health of civilians. Although it is well established in post-conflict populations that experience of organised violence has a negative impact on mental health, little research has been done on those living in active conflict zones. Médecins Sans Frontières provides mental health services in areas of active conflict in Colombia and using data from these services we aimed to establish which characteristics of the conflict are most associated with specific symptoms of mental ill health.
  
  
  METHODS
  An analysis of clinical data from patients (N = 6,353), 16 years and over, from 2010-2011, who consulted in the Colombian departments (equivalent to states) of Nariño, Cauca, Putumayo and Caquetá. Risk factors were grouped using a hierarchical cluster analysis and the clusters were included with demographic information as predictors in logistic regressions to discern which risk factor clusters best predicted specific symptoms.
  
  
  RESULTS
  Three clear risk factor clusters emerged which were interpreted as 'direct conflict related violence', 'personal violence not directly conflict-related' and 'general hardship'. The regression analyses indicated that conflict related violence was more highly related to anxiety-related psychopathology than other risk factor groupings while non-conflict violence was more related to aggression and substance abuse, which was more common in males. Depression and suicide risk were represented equally across risk factor clusters.
  
  
  CONCLUSIONS
  As the largest study of its kind in Colombia it demonstrates a clear impact of the conflict on mental health. Among those who consulted with mental health professionals, specific conflict characteristics could predict symptom profiles. However, some of the highest risk outcomes, like depression, suicide risk and aggression, were more related to factors indirectly related to the conflict. This suggests a need to focus on the systemic affects of armed conflict and not solely on direct exposure to fighting.
authors.affiliation: Médicos sin Fronteras España, Misión Colombia, Bogotá, Colombia. msfe-bogota-cg@barcelona.msf.org.
authors.forename: Vaughan
authors.initials: V
authors.lastname: Bell
authors.forename: Fernanda
authors.initials: F
authors.lastname: Méndez
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.forename: Pedro Pablo
authors.initials: PP
authors.lastname: Palma
authors.forename: Marc
authors.initials: M
authors.lastname: Bosch