Social Determinants of Mental Health in Armed Conflict-affected Municipalities

Background: Armed conflicts affect mental health. In Colombia, many communities have been victims of armed conflict and multiple social inequalities and injustices for more than six decades. Our research explored the social determinants of mental health in fifteen municipalities affected by the armed conflict in Montes de María, Colombia. Method: A convergent parallel mixed methods design was conducted. In the quantitative component, we assessed mental health (PHQ-4 and DASS-21), social support (Medical Outcomes Study Social Support Survey - MOS), and sense of community (Brief Sense of Community Scale - BSCS) in a sample of 134 leaders and community members. In the qualitative component, we conducted 35 focus groups and held two regional meetings with 167 leaders to further explore the social determinants of mental health in the region. Quantitative and qualitative analyses were conducted concurrently, and methodological triangulation was applied to integrate both data types and thus enhance the comprehensiveness and rigor of the findings. Results: The network analysis (23 nodes, sparsity = 0.708) evidenced strong conditional associations linking mental health (depression, stress, anxiety) with sense of community and perceived social support. Sociodemographic variables showed minimal integration. Psychosocial care showed moderate centrality indicating relevant but secondary associations with mental health compared to more central nodes. Qualitative data showed that armed conflict, state abandonment, economic issues, lack of opportunities, and barriers to access mental health services are SDH that have impacted the current mental health of the community. In this context, social capital and communitarian resistance strategies promote mental health in Montes de María. Conclusions: The results suggest that social determinants of health related to social support and sense of community positively impact the mental health of conflict-affected communities. Both quantitative and qualitative findings highlight the region's challenges, their capacity for resilience, and the urgent need for more effective psychosocial interventions for this population, focusing on psychosocial care that builds on the existing social and community support strengths identified in Montes de María.