Abstract
Guatemala's 36-year civil war officially ended in December 1996 after some 200,000 deaths and one million refugees. Despite the ceasefire, Guatemala continues to be a violent country with one of the highest homicide rates in the world. We investigated potential associations between violence, mental health, and substance abuse in post-conflict Guatemala using a community-based survey of 86 respondents living in urban and rural Guatemala. Overall, 17.4% of our respondents had at least one, direct violent experience during the civil war. In the post-conflict period, 90.7% of respondents reported being afraid that they might be hurt by violence, 40.7% screened positive for depression, 50.0% screened positive for PTSD, and 23.3% screened positive for alcohol dependence. Potential associations between prior violent experiences during the war and indicators of PTSD and aspects of alcohol dependence were found in regression-adjusted models (p < 0.05). Certain associations between prior civil war experiences, aspects of PTSD and alcohol dependence in this cohort are remarkable, raising concerns for the health and safety of the largely indigenous populations we studied. Higher than expected rates of depression, PTSD, and substance abuse in our cohort may be related to the ongoing violence, injury and fear that have persisted since the end of the civil war. These, in turn, have implications for the growing medical and surgical resources needed to address the continuing traumatic and post-traumatic complications in the post-conflict era. Limitations of the current study are discussed. These findings are useful in beginning to understand the downstream effects of the Guatemalan civil war, although a much larger, randomly sampled survey is now needed.
Highlights
Between 1960 and 1996 Guatemala experienced a violent civil war during which some 200,000 non-combatant civilians were killed, 440 villages were destroyed and over one million Guatemalans were displaced—both internally and into southern Mexico [1,2]
The objective of this study was to examine the extent, nature, and impact of past and present-day violence in a community-based, in-country sample of Guatemalans in order to determine if any associations exist between this violence and downstream sequelae related to mental health and substance abuse
46.5% of respondents were both positive for PTSD and reported being afraid that they might be hurt by violence in the post-conflict period and 22.1% of respondents were both positive for alcohol dependence using the CAGE and reported being afraid that they might be hurt by violence in the post-conflict period
Summary
Between 1960 and 1996 Guatemala experienced a violent civil war during which some 200,000 non-combatant civilians were killed, 440 villages were destroyed and over one million Guatemalans were displaced—both internally and into southern Mexico [1,2]. Those killed included indigenous individuals, laborers, academics, religious leaders, and others who were clearly non- combatants [3]. Peace accords were signed between a number of rurally based guerrilla forces and Guatemala’s national army. The daily murder rate rose from 17 in 2008 to 20 in 2009 and the 2006 homicide rate of 108 per 100,000 in the capital Guatemala City was one of the highest in the Americas, significantly higher than the United States’ national rate of 5.6 per 100,000 [6,7] and over twice that of Detroit which was called America’s most murderous city with a homicide rate of 47 per 100,000 that same year [8]
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