Browsing by Autor "Oscar Bernal"

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A Light of Hope? Inequalities in Mental Health and The Peace Agreement in Colombia: A Decomposition Analysis
(2020) Sebastián León-Giraldo; Germán Casas; Juan Sebastián Cuervo-Sánchez; Catalina González-Uribe; Antonio Olmos; Noémi Kreif; Marc Suhrcke; Oscar Bernal; Rodrigo Moreno‐Serra
<title>Abstract</title> <bold>Background: </bold>The present<bold> </bold>study seeks to evaluate the evolution of mental health inequalities in the department of Meta after the signing of Colombia's Peace Agreement in 2016 with the FARC guerrilla group. Using a validated survey instrument composed of 20 questions (‘SRQ-20’), we measure changes in mental health inequalities from 2014, before the signing of the agreement, to 2018, after the signing of the agreement. We then decompose the changes in inequalities to establish which socioeconomic factors explain differences over time.<bold>Methods: </bold>Our study uses information from the <italic>Conflicto, Salud y Paz </italic>(CONPAS) survey<bold> </bold>conducted in the department of Meta, Colombia, in 1,309 households in 2018, with retrospective information for 2014. To measure inequalities, we calculate the concentration indices for both years. Through the Oaxaca change decomposition method, we disaggregate changes in mental health inequalities into its underlying factors. This method allows us to explain the relationship between changes in mental health inequalities and reduced inequality in several sociodemographic factors. It also identifies the extent to which these factors help explain the changes in mental health inequalities. <bold>Results: </bold>Mental health inequalities in Meta were reduced almost by half from 2014 to 2018. In 2018, the population at the lower and middle socioeconomic levels had fewer chances of experiencing mental health disorders in comparison to 2014. The reduction in mental health differences is mostly attributed to reductions in the influence of certain sociodemographic variables, such as residence in rural zones and conflict-affected territories, working in the informal sector, or experiencing internal displacement. However, even though mental health inequalities have diminished, overall mental health outcomes have worsened in these years. <bold>Conclusions: </bold>The reduction in the contribution of conflict-related variables for explaining mental health inequalities could mean that the negative consequences of conflict on mental health have started to diminish in the short run after the peace agreement. Nevertheless, conflict and the presence of other socioeconomic inequalities still contribute to persistent adverse mental health outcomes in the overall population. Thus, public policy should be oriented towards improving mental health care services in these territories, given the post-accord context.
Mental Health and Catastrophic Health Expenditures in Conflict-Affected Regions of Colombia before and during COVID-19: An Inequalities Perspective
(2025) Sebastián León-Giraldo; Nicolas Jater-Maldonado; Javier García-Estévez; Oscar Bernal
<title>Abstract</title> The objective of this study is to analyze the changes in catastrophic health expenditures (CHE) and out-of-pocket expenditures (OOP) before and during the COVID-19 pandemic, as well as to examine their determinants in Meta, Colombia, a region affected by armed conflict. We used data from the Conflicto, Paz y Salud (CONPAS) survey and applied mixed-effects logistic regression models. The analysis places particular emphasis on mental health as a key determinant, comparing the odds of incurring OOP and CHE between individuals with and without a tendency to present mental health disorders (SRQ + versus SRQ-). The results show that the odds of incurring CHE increased in 2020 compared to 2018, while the odds of incurring OOP decreased during the same period. Individuals living in less wealthy households (quintiles 1, 2, and 3 of the Household Wealth Index) have more odds of incurring CHE than those in the wealthiest group (quintile 5). Similarly, individuals aged 45 to 60 years or over 60 years and have more odds of incurring CHE than younger individuals (18 to 44 years). Those who fell sick or were hospitalized also have more odds of incurring CHE compared to those who did not. Additionally, we found that individuals with SRQ + have significantly higher odds of incurring OOP and marginally significantly higher odds of incurring CHE compared to SRQ- individuals. Additionally, those who have been displaced due to the conflict have higher odds of incurring OOP compared to those who have not. This study underscores the heightened vulnerability of regions impacted by violence; a situation further exacerbated by the COVID-19 pandemic. It emphasizes the need for targeted financial safeguards and comprehensive mental health programs to support marginalized communities, enhance economic resilience, and advance progress toward the Sustainable Development Goals (SDGs), particularly SDG 3, which aims to promote good health and well-being. The findings shed light on health disparities in violence-affected areas, highlighting the urgency of policies designed to improve financial security and healthcare access for individuals with mental health conditions.