Violence during the civil war in Guatemala from 1960 to 1996 led to significant mental health problems and conditions for the county’s people, according to a new multi-institution study co-led by Dr. Victor D. Puac-Polanco, a post-doctoral researcher in the Department of Epidemiology at the Mailman School of Public Health and Dr. Charles C. Branas, at the University of Pennsylvania’s Perelman School of Medicine. People who experienced or witnessed violence were four times more likely to suffer from alcohol-related disorders and post-traumatic stress disorder (PTSD). The study is the first national random sample of the mental health of Guatemalans in their home country. Findings are published online in the American Journal of Public Health.
The study conducted with researchers at the University of San Carlos in Guatemala and Brown University also show that mental health consequences resulting from violent events decreased in the postwar period. Of note, 40 percent of Guatemalans continue to have no mental health services.
In a countrywide representative sample, the study assessed almost 1,500 Guatemalans, men and women between 18 and 65 years old. One-in-five of these Guatemalans had witnessed or experienced at least one prior serious violent event (26.1 percent of males and 19.3 percent of females). Witnessing someone severely injured or killed was the most common event.
Overall, 4.2 percent of the randomly selected Guatemalans in the study had experienced depression, 6.5 percent anxiety, 6.4 percent an alcohol-related disorder, and 1.9 percent post-traumatic stress disorder. Women, indigenous Maya, and urban dwellers had greater odds of experiencing post-violence mental health problems. These were troubling disparities for a developing nation like Guatemala, the authors said.
“This is the first advanced epidemiological analysis of the Guatemalan National Mental Health Survey,” said lead author Puac-Polanco. “The linkage between violence and mental health problems remains significant in Guatemala and our study will hopefully raise awareness of this linkage and the need for greater investment in mental health resources in Guatemala and other nations affected by persistent violence.”
Of the 338 survey participants who experienced any previous violence, 61.1 percent reported witnessing or experiencing one violent event; 24.8 percent witnessed or experienced two violent events; 9.8 percent witnessed or experienced three violent events; and 4.4 percent witnessed or experienced four or more violent events in their lifetime. A further analysis of the 338 survey participants found that 31.8 percent were exposed to their most serious violent event during the civil war and 65.4 percent after.
“Our findings show that witnessing or experiencing a violent event, which is quite common in civil wars around the world, does indeed take a serious toll on many people,” said Branas. “We are concerned for survivors of violence in these conflicts, and are hopeful that public health problems related to violence, such as mental illness, will continue to improve as the Guatemalan people further emerge from the toxic conditions created by the war.”
Nearly three quarters of the people in the world’s poorest societies have recently been through a civil war or are still in one. Similar findings of higher rates of mental health problems during periods of war, as opposed to postwar periods, have been reported in other nations.
The study was funded by the National Institutes of Health’s Fogarty International Center and the Trauma and Global Health Program of the Global Health Research Initiative (D43TW008317 and D43TW008972).