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.
Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA.
Charles C
CC
Branas
Department of Internal Medicine & Global Health Equities, University of Pennsylvania, Philadelphia, USA.
Andrew R
AR
Dinardo
School of Medicine, Universidad de San Carlos de Guatemala, Guatemala City, Guatemala; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
Victor D
VD
Puac Polanco
Hospitalito Atitlan, Santiago Atitlan, Guatemala; Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, USA.
Michael J
MJ
Harvey
Section of General Internal Medicine, VA Boston Healthcare System, Boston, USA; Division of General Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA.
Jason L
JL
Vassy
Department of Family Medicine & Community Health, University of Pennsylvania, Philadelphia, USA.
Kent
K
Bream
Civil Conflict; Latin America; Trauma; Violence