“With mental health and land, we have enough to live”—social determinants of mental health in fifteen conflict-affected municipalities of Montes de María, Colombia: a convergent parallel mixed methods study

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.

Methods
A convergent parallel mixed methods design was conducted involving leaders and community members of Montes de María in Colombia, a region deeply affected by the armed conflict. 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. Concurrently, we held 35 focus groups and 2 regional meetings with 167 leaders to further explore the social determinants of mental health in the region. Both quantitative and qualitative analyses were conducted, triangulating the information to ensure comprehensive and robust findings.

Results
The quantitative data analysis showed significative relations among different social determinants of health (SDH) and the mental health variables of anxiety, depression and stress. Social support and sense of community appear to be protective factors for mental health. Qualitative data revealed 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, social cohesion, and community resistance strategies promote mental health in Montes de María.

Conclusions
The results suggest social determinants of health 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 policies and robust support to address mental health and socioeconomic issues in Montes de María.