Armed conflict exposure types are not equally associated with access to psychosocial support: A study of over 8 million victims of the Colombian armed conflict.

Background: The Colombian armed conflict has endured for almost 60 years. Colombia has a national psychosocial support service, called PAPSIVI, which is the largest initiative in history to address the psychosocial needs of civilians.

Aims: Understand the extent to which PAPSIVI reaches priority groups and provides access to psychosocial support for victims of the conflict, something only previously tested in small studies.

Methods: We used anonymised data from the register of victims of the armed conflict, including over 8 million individuals, with linked data to identify PAPSIVI access at the national level. We conducted univariable logistic regressions and multilevel logistic regression models adjusted for a range of potential confounders to examine associations.

Results: Higher odds of PAPSIVI access were observed for females, those who register sex as 'other', older people, individuals from ethnic minorities, those on subsidised healthcare regimes and people with disabilities. Many specific exposures to the armed conflict were associated with increased levels of PAPSIVI access, including some of those reflecting the most severe exposures - namely, sexual violence, torture, physical injury, psychological injury and forced disappearance. Nevertheless, those affected by confinement, child recruitment to armed groups and homicide showed reliably lower levels of PAPSIVI access. In key marginalised groups, exposure to displacement and sexual violence was associated with lower rates of access.

Conclusions: PAPSIVI successfully provides access to mental health support for key demographic groups and for a range of exposures to the armed conflict although areas of under-access indicate the need to better understand and address barriers to care.