EVALUATION OF TWO COMMUNITY-BASED MENTAL HEALTH INTERVENTIONS FOR AFRO-COLOMBIANS VICTIMS OF VIOLENCE v1
Authors: J. Bonilla-Escobar Francisco , Fandiño-Losada Andrés , M. Martínez-Buitrago Diana , Santaella-Tenorio Julián , Tobón-García Daniel , J. Muñoz-Morales Edgar , I. Gutiérrez-Martínez. María , K. Bass Judith , K. Murray Laura , Bolton Paul , Dorsey Shannon 
Published: April 2018

Background: There are mental health consequences for individuals and communities that have been exposed to violence. The armed conflict in Colombia has caused death and massive displacement. In the Pacific region, displacement has been preponderant in Buenaventura and Quibdó. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict.Objective: To evaluate two community interventions in mental health designed to decrease symptoms of depression, anxiety, and post-traumatic stress symptoms in Afro-Colombian victims of violence in Buenaventura and Quibdó.Methods: A single-blind randomized controlled trial will be conducted in two municipalities of the Colombian Pacific in which participants will be randomly assigned to a cognitive-behavioral intervention -Common Elements Treatment Approach (CETA) (Group A), a Narrative Community-Based Group Therapy (NCGT) Intervention (Group B) and a control/waiting list group. Assessments of mental health symptoms and dysfunction will be performed at baseline and two weeks after the treatment for Group A and B participants and after three to four months in the control group. Symptoms will be assessed with a validated survey which includes elements from the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire and relevant local symptoms; dysfunction will be assessed with a locally-validated gender-specific scale. Missing values will be handled using multiple imputation methods. Means will be calculated for scales and sub-scales. The primary outcomes will be changes in depression, anxiety and post-traumatic stress symptoms; secondary outcomes will be changes in the Total Mental Health Symptom (TMHS) and dysfunction scales. Differences at baseline will be assessed with the specific test accordingly to the type of variable. Using mixed models we will perform intention to treat analyzes and sensitivity analyzes removing those participants without follow up. Co-variables included in mixed-models will be those significant at the p<0.10 level identified using: 1) simple logistic regressions clustered by counselor to identify baseline differences between intervention and control groups; 2) mixed models to determine interactions between potential co-variables and time on symptoms and dysfunction scores. Furthermore, models will be adjusted for age, gender, education and marital status. Sub-groups analyzed by gender and civil status will be conducted. Extreme values in scales (> or < 4 standard deviations) will be identified as potential outliers and will be excluded in a sensitivity analysis to evaluate its impact on intervention outcomes. Effect sizes will be calculated using Cohen’s d statisticExpected results: Evaluation of the effectiveness of two mental health interventions in order to describe alternatives for treatment in Afro-Colombian victims of violence in the Colombian Pacific Coast.