The study populations
In the displaced community, 211 families (845 individuals) were interviewed and in the non-displaced population 181 families (732 individuals), showing four persons per family in both groups. The direct respondents to the interview were in both communities mainly women at the age of 30 to 50 years, almost all of them with school education. However, in the displaced community, 9.6% (81) did not comply with the definition of displacement (i.e. were not registered with RUV) and in the non-displaced community, 12.4% (91) of families were in fact displaced according to the registration with RUV (Central Colombian Register for Victims).
The demographic characteristics of both communities were similar: slight excess of females (female to male ratio 1.04 in the displaced community and 1.1 in the non-displaced) and slight excess of young adults among the displaced compared to the non-displaced (38.7% of all ages versus 31.6%, p= 0.018). The proportion of children <15 years old was higher among the displaced compared to the non-displaced. With respect to ethnicity, in both groups the mestizo-population (ethnic mixture) was predominant (53.3% of all families) while the afro-descendants and indigenous people had suffered more frequently from displacement: 28.0% afro-descendants among the displaced families and 20.4% among the non-displaced, 5.7% of indigenous people among the displaced and 2.2% among non-displaced (p= 0.052). The educational level of persons above 12 years of age including qualified technicians was clearly higher in the non-displaced group (35.6% of all educational levels) compared to the displaced group (only 15.7% of all; p=0.000).
History of displacement
The peak of the violence in Colombia occurred from 2002 to 2004, which means about 18 years before our survey when our mostly female respondents were about 20 years old. Therefore 55.5% of the displaced families reported that the event of displacement has happened between 16 to 20 years ago. Only a smaller proportion (19.0%) had been displaced 11 to 15 years ago and only 9.5% during the preceding 10 years. However, the in-depth interviews showed that the traumatic experience of displacement and victimization had still a profound emotional effect on the displaced in present times (tears, profound breathing, lifting the voice) and that the fear of going back and receiving bad News from their place of origin kept the memory of those days of life.
Peoples` perception of the current situation (qualitative study)
In the displaced community, the government subsidizes the apartments and the inhabitants did not have to pay a rent. However, there was a continuous feeling of insecurity -as mentioned by most respondents- due to the open access to the premises, and the existence of gangs of young adults as well as of drug users. The interviewers could witness this; particularly when they arrived in the late afternoon, they saw groups of youngsters and perceived the smell of marihuana. Another problem was the noise which was always present, either loud music or intra-familiar fights or aggression between families. The elected community leaders did not seem to have much authority, as they did not want to accompany the interviewers (mostly females) or introduce them to the families. Taxi drivers could hardly be convinced to enter the compound and bring the interviewers to the buildings because of the bad access road and the feeling of insecurity. In general, families were happy to answer the interview questions.
In the adjacent buildings of the non-displaced community, the situation was different. The flats were partially subsidized by the government, but the residents had to pay a rent. The residential area was closed for outsiders by a fence and a special permission was required to enter. There was an administrator of the compound who looked over the security and order and controlled entering unknown people. However, the risk of leaving the compound and being attacked on the street was also mentioned. Although the families belonged to the second lowest socio-economic stratum, they felt superior to the adjacent displaced community. Some of them did not want to answer the interview questions due to mistrust.
Experience with violence
When asked for their exposure to violence, significantly more displaced families had experienced such events (n= 64.0%) compared to non-displaced families (n= 25.4%; p=0.000) (Fig. 2, table 2). The responses show that in all categories (intended murder, theft, threat, murder of a family member, kidnapping and sexual violence) the displaced families had to suffer much more frequently than the non-displaced ones. Also, the non-displaced had suffered, although to a less extent, particularly of theft and to less extent of intended murder. Once a violent event has happened, both groups suffered equally of emotional disturbance.
In addition, the intra-familiar violence was clearly more frequent in the displaced community (victims of insults, physical aggression, and armed attacks) compared to the non-displaced community (p=0.001, 0.035, and 0.001, respectively; Fig. 3, table 3). Other causes of human suffering were important life or vital events such as economic problems (affecting 72.5% of the displaced families compared to 43.1% of the non-displaced; p=0.000). Also severe disease or death of a family member as well as unemployment and severe health problems were more frequent among the displaced families compared to the non-displaced ones (Fig. 4, table 4).
Current psycho-emotional status of displaced and non-displaced respondents (Self Reporting Questionnaire, SRQ)
There were 22 different emotional symptoms mentioned: frequent headaches, loss of appetite, sleeplessness, fright, trembling of hands, tension/nervousness, mal-digestion, lack of clear thinking, sadness, does not enjoy daily activities, difficulty to take decisions, difficulty to work, incapable of doing something useful, loss of interest, feels to be useless, suicidal thoughts, feels tired all the time, has unpleasant feelings in the stomach, gets easily tired, feels that somebody has tried to wound her, feels that she is more important than other people think.
46.4% of the displaced interviewees and only 20.4% of the non-displaced suffered seven or more symptoms (p=0.000). Only 6.6% of the displaced had no symptom at all while among the non-displaced interviewees this was 20.4% (p=0.000, Fig. 5, table 5).
More than half of the 211 displaced respondents felt symptoms like “get easily frightened” (62.1%) and “frequent headache” (59.7%), “feels nervous or tense” (54.0%), all of them being much rarer than among the 181 non-displaced respondents (35.9%, 43.6% and 30.4% respectively; p=0.000, 0.001 and 0.000 respectively). Other frequent emotional disorders among the displaced interviewees was “feels depressed” (47.9%), “cannot sleep” (43.6%) or “cannot think well” (40.8%) in contrast to the non-displaced participants (28.2%, 22.1% and 32.0% respectively; p= 0.000, 0.000 and 0.074 respectively). There were three additional questions on psychotic symptoms (“hears strange voices”, “has strange interferences in her thoughts”, “has epileptic seizures”) but these were rare in both groups although marginally more frequent among the displaced respondents.
Current psycho-emotional status of displaced respondents living in the non-displaced community
This analysis was done to better understand if the emotional problems among displaced respondents are more due to the displacement or due to the current living conditions, 40.9% of the 91 respondents belonging to the “displaced living among the non-displaced” reported more than seven symptoms in the SRQ and showed a pattern of emotional distress similar to the displaced group rather than to the non-displaced suggesting that the traumatic experience of the armed conflict with displacement and victimization long ago still impacts on the emotional status of displaced individuals and their families.
Use of mental health services
Mental health services in local hospitals and ambulatory care were equally available for the displaced and non-displaced persons. However, they were rarely used during the preceding 12 months, both by displaced families (16.6%) and even less by non-displaced families (6.1%; p=0.000). Hospitalizations for mental health problems “once in their lives” were rare exceptions (4.7% among the displaced and 0.6% among the non-displaced; p=0.012) keeping in mind that the relative frequency of mental health issues was higher among the displaced compared to the non-displaced populations. The main reason for not using mental health services during the last 12 months were “was not necessary” (39.1% among the displaced and 71.6% among the non-displaced; p=0.000). Other major reasons for not attending mental health services particularly among the displaced families were, service far away, no time, no money, unawareness of my rights, bureaucratic hurdles, distrust.
Most patients attending mental health services went there 3 times or less (12.3% among displaced persons and 5.0% among non-displaced; p=0.001). Patients in both groups went for treatment mainly to hospitals or clinics (56.3% both groups), but some of them to pharmacies (mainly the non-displaced) or to friends and family members including alternative medicine. Additional consultations for mental health problems were mainly sought by non-displaced patients (28.9%) and less by the displaced (17.8%; p=0.157). The treatment costs for displaced patients were mainly borne by the subsidized insurance companies for the displaced patients (48.9%) while the treatment of non-displaced patients was mainly financed by the pre-paid insurance companies (21.1%) and often through out-of-pocket payment.