Highlight: Identifying barriers to mental healthcare for civilians affected by protracted armed conflict in Colombia
Lead Research Organisation:
UNIVERSITY COLLEGE LONDON
Department Name: Clinical Health and Educational Psych
Abstract
Colombia has endured a brutal and extensive armed conflict with 9 million registered victims. A national cost-free mental health programme for people with conflict-related mental health needs is being under-used by the most affected and it's unclear why, amplifying conflict-related inequalities. To overcome this, we need to understand barriers facing the invisible victims of conflict - who have conflict-related mental health problems but never access services and who have been hard to research for this reason - and barriers affecting treatment delay and quality of care in those that do access services.
This will be the first project to identify invisible victims using innovative data-linkage between i) a nationally representative psychiatric epidemiological study (N=12k+) that used active case ascertainment in the general population, and; ii) data from the national mental health programme (N=1 million+), and the first to examine quality of care at the population level.
We will use robust statistical analysis to identify:
1) social, health, and demographic drivers of being an invisible victim of conflict - who has conflict-related mental health needs but who never accesses services
2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related mental health needs who successfully access services
3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment access / outcome in women and girls
All 3 aims address urgent national policy issues. Aim 3 was suggested, and most prioritised by, our panel of people with lived experience of the armed conflict who will continue to co-produce this project.
Given the large-scale longitudinal data and robust statistical methods, this project will provide high-quality evidence on barriers to equality of access and quality of care. These will translate directly into on-the-ground policy changes and community engagement, while providing an evidence base for Colombia and other conflict-affected countries in Latin America.
Access to this data is unique to our research group and no such analysis has been completed or proposed before. This project could only be possible through collaboration between our unique team of international collaborators.
The project is led by a team of Colombian and UK academics specialising in the Colombian armed conflict and mental health. Fundación Santa Fé de Bogotá will work in collaboration with the UCL Centre for Outcomes Research and Effectiveness, UCL Clinical Psychology, and UCL Epidemiology and Applied Clinical Research - world-leading centres in data science of mental health and social inequalities.
This project is timely. The results of this study will be directly communicated to the new government in Colombia, for whom addressing conflict-related mental health inequalities is central to their 'total peace' policy. We will engage national and international NGOs and women's organisations who have underlined the need for this information to reach the most marginalised communities and inform their programmes.
Using a grassroots community involvement programme, led by our panel of lived experience collaborators, we will engage communities most affected by the conflict in the results of the study to directly inform our interpretation, framing and recommendations.
This project will develop capacity in Colombia through a planned programme of training and supervision of our Colombian ECR collaborators to facilitate their involvement and through immersion in equal partnership with three world-leading research groups in the UK. They will be trained in advanced epidemiological analysis, policy engagement, and open science methods. In addition, we will publish open access code repositories that will leave a permanent legacy to facilitate future analysis of these datasets by other Colombian researchers.
This will be the first project to identify invisible victims using innovative data-linkage between i) a nationally representative psychiatric epidemiological study (N=12k+) that used active case ascertainment in the general population, and; ii) data from the national mental health programme (N=1 million+), and the first to examine quality of care at the population level.
We will use robust statistical analysis to identify:
1) social, health, and demographic drivers of being an invisible victim of conflict - who has conflict-related mental health needs but who never accesses services
2) social, health, and demographic drivers of treatment delay, quality of care, and outcome in people with conflict-related mental health needs who successfully access services
3) the extent to which gender-based and sexual violence mediates conflict-related mental health needs and poor treatment access / outcome in women and girls
All 3 aims address urgent national policy issues. Aim 3 was suggested, and most prioritised by, our panel of people with lived experience of the armed conflict who will continue to co-produce this project.
Given the large-scale longitudinal data and robust statistical methods, this project will provide high-quality evidence on barriers to equality of access and quality of care. These will translate directly into on-the-ground policy changes and community engagement, while providing an evidence base for Colombia and other conflict-affected countries in Latin America.
Access to this data is unique to our research group and no such analysis has been completed or proposed before. This project could only be possible through collaboration between our unique team of international collaborators.
The project is led by a team of Colombian and UK academics specialising in the Colombian armed conflict and mental health. Fundación Santa Fé de Bogotá will work in collaboration with the UCL Centre for Outcomes Research and Effectiveness, UCL Clinical Psychology, and UCL Epidemiology and Applied Clinical Research - world-leading centres in data science of mental health and social inequalities.
This project is timely. The results of this study will be directly communicated to the new government in Colombia, for whom addressing conflict-related mental health inequalities is central to their 'total peace' policy. We will engage national and international NGOs and women's organisations who have underlined the need for this information to reach the most marginalised communities and inform their programmes.
Using a grassroots community involvement programme, led by our panel of lived experience collaborators, we will engage communities most affected by the conflict in the results of the study to directly inform our interpretation, framing and recommendations.
This project will develop capacity in Colombia through a planned programme of training and supervision of our Colombian ECR collaborators to facilitate their involvement and through immersion in equal partnership with three world-leading research groups in the UK. They will be trained in advanced epidemiological analysis, policy engagement, and open science methods. In addition, we will publish open access code repositories that will leave a permanent legacy to facilitate future analysis of these datasets by other Colombian researchers.
Publications
Constable Fernandez C
(2025)
Armed conflict exposure types are not equally associated with access to psychosocial support: A study of over 8 million victims of the Colombian armed conflict.
in The International journal of social psychiatry
Fernandez C
(2026)
Intervention provision and engagement in Colombia's PAPSIVI - a national psychosocial support service for over half a million victims of armed conflict
in Conflict and Health
RamÃrez Bermúdez J
(2026)
Towards a Latin American neuropsychiatry: challenges and opportunities.
in Lancet regional health. Americas
| Description | This research generated new knowledge about how large-scale psychosocial support systems operate for victims of armed conflict, using Colombia as a case study. The findings are relevant both to national policymakers and to international organisations seeking to support civilian populations affected by violence and conflict. 1. The first population-scale evaluation of access to psychosocial support for conflict victims. The research analysed anonymised national administrative data covering more than 8 million registered victims of the Colombian armed conflict, linked to records of participation in the national psychosocial support programme PAPSIVI (Program for Psychosocial Care and Comprehensive Health for Victims). This represents the largest analysis to date of access to psychosocial support services for conflict-affected populations. The study showed that the programme successfully reaches many priority groups, including women, ethnic minorities, older people, and people with disabilities, as well as victims exposed to severe forms of violence such as sexual violence, torture, and forced disappearance. 2. Identification of important gaps in service access. Despite these successes, the research identified groups who were less likely to receive support. Victims affected by confinement, homicide of relatives, and child recruitment into armed groups showed lower levels of access to services. In addition, among some already marginalised groups, experiences such as displacement and sexual violence were associated with reduced access. These findings highlight areas where barriers to care may persist and where policy improvements could strengthen equitable service provision. 3. New evidence on how large-scale psychosocial interventions are delivered and sustained. The project analysed service provision among more than 500,000 individuals who attended PAPSIVI interventions, providing the first national-level assessment of how psychosocial interventions are delivered at this scale. The findings indicate that interventions are generally delivered in line with programme guidelines, with more intensive support provided to individuals with severe conflict exposures or existing mental health needs. However, approximately 29% of people attending individual sessions received only one session, suggesting potential early disengagement or mismatches between services and participants' needs. 4. New insights into the spatial and temporal dynamics of conflict-related sexual violence. Using advanced statistical modelling of national datasets spanning the entire conflict period (1964-2024), the research showed that incidents of sexual violence cluster geographically but have become more dispersed in recent years. Importantly, there was little evidence that incidents trigger further incidents in the short term, suggesting that prevention strategies should prioritise addressing long-term structural drivers of violence. Together, these findings provide rare large-scale evidence on how governments can design, deliver, and evaluate psychosocial support systems for conflict-affected populations. The insights are relevant for policymakers, humanitarian organisations, and researchers working in conflict and post-conflict settings worldwide. |
| Exploitation Route | Our research outcomes will be taken forward through both academic and non-academic channels. Academically, we will continue to engage with academic journals, building on the current revision of our submitted paper. We plan to disseminate our findings at conferences and workshops, encouraging further exploration of the barriers to accessing psychosocial support for marginalised populations. Collaborations with other researchers in the field of conflict-related trauma and healthcare access will be sought to refine the research and extend its reach. In terms of non-academic impact, we have presented the results directly to the Colombian government departments responsible for the PAPSIVI psychosocial support service. Our publications are freely available and will be presented to NGOs involved in post-conflict rehabilitation and mental health. These stakeholders are vital for translating our findings into practical interventions, especially for underserved communities. Policymakers, particularly those focused on healthcare and social inclusion, will also benefit from our insights to enhance policy and practice. By engaging with grassroots organisations who advocate for victims of the armed conflict globally, we hope to influence the design and delivery of psychosocial support services, ensuring more inclusive and equitable access for all affected by the conflict. |
| Sectors | Communities and Social Services/Policy Healthcare Government Democracy and Justice |
| Description | Dissemination and engagement with Colombian government |
| Geographic Reach | South America |
| Policy Influence Type | Participation in a guidance/advisory committee |
| Impact | The results we presented broadly reported that PAPSIVI is effective in reaching key population groups affected by the armed conflict but highlighted several areas of under-access for key exposures to the armed conflict (e.g. lower levels of access after exposure to sexual violence for LGBT individuals and those on subsidised healthcare) which have led these departments to focus on making their services more accessible to key groups. Given the recency of the meeting, this are still in the planning stage. |
| Description | Barriers to mental healthcare for civilians affected by armed conflict in Colombia project working group |
| Organisation | Autonomous University of Bucaramanga |
| Country | Colombia |
| Sector | Academic/University |
| PI Contribution | The project working group was convened by me to develop the grant application and has been chaired by me since the project began. My role has been to co-ordinate across all members of the team and ensure that all members, from senior members to early career researchers, are involved in project decisions and the research process, through regular project team meetings. I have also led on the UCL-side ethics application, data analysis implementation, and supervised the post-doctoral researcher, Dr Constable-Fernandez, in the development of her analysis in R, which she was previously not familiar with, including on statistical models, visualisation, and the open science archive, which formed part of the first submitted study from the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá), has been provided with an honorary UCL contract and access to the UCL Data Safe Haven, the secure analysis platform, where the project data is stored and analysed, to ensure transparency and partnership with regard to the analysis of the data. Two early career researchers, María Camila Garcia Duran and Charlotte Constable Fernandez have access formal research methods training, as part of a costed training support for early career researchers. I have trained the post-doctoral researcher on the context of Colombia and the ongoing armed conflict. |
| Collaborator Contribution | Co-I Prof Fabio Idrobo facilitated the material transfer agreement with Fundación Santa Fe de Bogotá to establish the transfer of data to UCL. He also led the Colombia-side ethics application for the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá) has been essential to consulting with the Colombian healthcare services from where the data originated to clarify the nature and parameters of the data. Co-I Prof Fabio Idrobo also hosted an in-person project meeting in Bogotá (Aug, 2024), attended by Co-I Prof Fabio Idrobo, PI Prof Vaughan Bell, and early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo, to talk through initial findings, future direction, and provide in-person support and training for the early career researchers. Early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo have contributed to decision-making, analytic suggestions, interpretation and write-up throughout. |
| Impact | None yet |
| Start Year | 2024 |
| Description | Barriers to mental healthcare for civilians affected by armed conflict in Colombia project working group |
| Organisation | Cooperative University of Colombia |
| Country | Colombia |
| Sector | Academic/University |
| PI Contribution | The project working group was convened by me to develop the grant application and has been chaired by me since the project began. My role has been to co-ordinate across all members of the team and ensure that all members, from senior members to early career researchers, are involved in project decisions and the research process, through regular project team meetings. I have also led on the UCL-side ethics application, data analysis implementation, and supervised the post-doctoral researcher, Dr Constable-Fernandez, in the development of her analysis in R, which she was previously not familiar with, including on statistical models, visualisation, and the open science archive, which formed part of the first submitted study from the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá), has been provided with an honorary UCL contract and access to the UCL Data Safe Haven, the secure analysis platform, where the project data is stored and analysed, to ensure transparency and partnership with regard to the analysis of the data. Two early career researchers, María Camila Garcia Duran and Charlotte Constable Fernandez have access formal research methods training, as part of a costed training support for early career researchers. I have trained the post-doctoral researcher on the context of Colombia and the ongoing armed conflict. |
| Collaborator Contribution | Co-I Prof Fabio Idrobo facilitated the material transfer agreement with Fundación Santa Fe de Bogotá to establish the transfer of data to UCL. He also led the Colombia-side ethics application for the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá) has been essential to consulting with the Colombian healthcare services from where the data originated to clarify the nature and parameters of the data. Co-I Prof Fabio Idrobo also hosted an in-person project meeting in Bogotá (Aug, 2024), attended by Co-I Prof Fabio Idrobo, PI Prof Vaughan Bell, and early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo, to talk through initial findings, future direction, and provide in-person support and training for the early career researchers. Early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo have contributed to decision-making, analytic suggestions, interpretation and write-up throughout. |
| Impact | None yet |
| Start Year | 2024 |
| Description | Barriers to mental healthcare for civilians affected by armed conflict in Colombia project working group |
| Organisation | Fundación Santa Fe de Bogotá |
| Country | Colombia |
| Sector | Charity/Non Profit |
| PI Contribution | The project working group was convened by me to develop the grant application and has been chaired by me since the project began. My role has been to co-ordinate across all members of the team and ensure that all members, from senior members to early career researchers, are involved in project decisions and the research process, through regular project team meetings. I have also led on the UCL-side ethics application, data analysis implementation, and supervised the post-doctoral researcher, Dr Constable-Fernandez, in the development of her analysis in R, which she was previously not familiar with, including on statistical models, visualisation, and the open science archive, which formed part of the first submitted study from the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá), has been provided with an honorary UCL contract and access to the UCL Data Safe Haven, the secure analysis platform, where the project data is stored and analysed, to ensure transparency and partnership with regard to the analysis of the data. Two early career researchers, María Camila Garcia Duran and Charlotte Constable Fernandez have access formal research methods training, as part of a costed training support for early career researchers. I have trained the post-doctoral researcher on the context of Colombia and the ongoing armed conflict. |
| Collaborator Contribution | Co-I Prof Fabio Idrobo facilitated the material transfer agreement with Fundación Santa Fe de Bogotá to establish the transfer of data to UCL. He also led the Colombia-side ethics application for the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá) has been essential to consulting with the Colombian healthcare services from where the data originated to clarify the nature and parameters of the data. Co-I Prof Fabio Idrobo also hosted an in-person project meeting in Bogotá (Aug, 2024), attended by Co-I Prof Fabio Idrobo, PI Prof Vaughan Bell, and early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo, to talk through initial findings, future direction, and provide in-person support and training for the early career researchers. Early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo have contributed to decision-making, analytic suggestions, interpretation and write-up throughout. |
| Impact | None yet |
| Start Year | 2024 |
| Description | Barriers to mental healthcare for civilians affected by armed conflict in Colombia project working group |
| Organisation | King's College London |
| Country | United Kingdom |
| Sector | Academic/University |
| PI Contribution | The project working group was convened by me to develop the grant application and has been chaired by me since the project began. My role has been to co-ordinate across all members of the team and ensure that all members, from senior members to early career researchers, are involved in project decisions and the research process, through regular project team meetings. I have also led on the UCL-side ethics application, data analysis implementation, and supervised the post-doctoral researcher, Dr Constable-Fernandez, in the development of her analysis in R, which she was previously not familiar with, including on statistical models, visualisation, and the open science archive, which formed part of the first submitted study from the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá), has been provided with an honorary UCL contract and access to the UCL Data Safe Haven, the secure analysis platform, where the project data is stored and analysed, to ensure transparency and partnership with regard to the analysis of the data. Two early career researchers, María Camila Garcia Duran and Charlotte Constable Fernandez have access formal research methods training, as part of a costed training support for early career researchers. I have trained the post-doctoral researcher on the context of Colombia and the ongoing armed conflict. |
| Collaborator Contribution | Co-I Prof Fabio Idrobo facilitated the material transfer agreement with Fundación Santa Fe de Bogotá to establish the transfer of data to UCL. He also led the Colombia-side ethics application for the project. Co-I Prof Fabio Idrobo (Fundación Santa Fe de Bogotá) has been essential to consulting with the Colombian healthcare services from where the data originated to clarify the nature and parameters of the data. Co-I Prof Fabio Idrobo also hosted an in-person project meeting in Bogotá (Aug, 2024), attended by Co-I Prof Fabio Idrobo, PI Prof Vaughan Bell, and early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo, to talk through initial findings, future direction, and provide in-person support and training for the early career researchers. Early career researchers María Camila Garcia Duran, Dr Alida M Acosta Ortiz and William Tamayo have contributed to decision-making, analytic suggestions, interpretation and write-up throughout. |
| Impact | None yet |
| Start Year | 2024 |