Social Agency and Psychosocial Recovery: A Resilient Perspective on the Social Determinants of Mental Health in a Community Affected by the Colombian Armed Conflict

Social Agency and Psychosocial Recovery: A Resilient Perspective on the Social Determinants of Mental Health in a Community Affected by the Colombian Armed Conflict | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Social Agency and Psychosocial Recovery: A Resilient Perspective on the Social Determinants of Mental Health in a Community Affected by the Colombian Armed Conflict Diana Marcela Bedoya-Gallego, Daniel Gomez Gomez, Efrén Castaño Gallego This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5307047/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Armed conflict in Colombia has severely affectedthe mental health of individuals and communities. Factors such as poverty, inequality and social exclusion have exacerbated consequences such as depression and posttraumaticstress disorder. However, a perspective that transcends the mental deficit paradigm in addressing the social determinants of health in these contexts allows us to recognize how political and social conditions determine people's physical and mental health and the need to strengthen their skills and capacities. The Colectivo Tejiendo Memoria, composed of older adult victims of the conflict, is a remarkable example of the capacity for organization and psychosocial recovery through collective memory and civil resistance in the province of Sonsón, Antioquia. Methods: A qualitative approach based on the action without harm (ASD) methodological framework was used to implement photo elucidation workshops and mediate group interviews to capture the memories and experiences of the participants. The contentanalysis allowed codifying the actions, agents and knowledge generated by the group around psychosocial recovery and community agency. Results: This study reveals that the collective has played a crucial role in the preservation of historical memory, the promotion of emotional well-being and the generation of social agency; its actions have allowed the creation of safe spaces for psychosocial recovery through rituals, commemorations and the visibility of the victims. This promoted their consolidation as political actors who manage and sustain memory and reparation in their community. Conclusions: The experience of the Colectivo Tejiendo Memoria offers an innovative approach to the social determinants of mental health in the context of armed conflict, highlighting the capacity of communities to manage their own recovery through practices of resistance and solidarity. Community mental health Psychosocial resilience Social agency Historical memory Action without harm. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The armed conflict in Colombia is known as one of the most complex and prolonged in the world; it has extended for more than half a century, involving various actors (guerrillas, paramilitary groups, criminal gangs) and the structure of the social system (the State and private enterprise), which has generated significant effects in multiple dimensions, including serious human rights violations, slowing economic and social development, and traumas in the construction of culture and collective memory, which are expressed in human and material losses, as well as in the impact on the mental health of the population [5]. According to the Truth Commission Report [9], at least 450,666 people lost their lives, more than 100,000 were victims of forced disappearance, 50,770 were kidnapped, between 26,900 and 35,641 children and adolescents were recruited to serve in the illegal armed forces, and 32,446 people were victims of acts against freedom and sexual integrity. Thus, an analysis of the conflict from the perspective of the social determinants of health [11] reveals that associated factors such as poverty, inequality, limited access to basic services [6], social exclusion and, in general, human rights violations have exacerbated mental health problems such as posttraumatic stress, anxiety and depression [18, 24, 27]. A differentiated review of population groups revealed that children and adolescents exposed to violence from an early age tend to have symptoms of behavioral disorders and severe emotional problems [4, 25]. Women, particularly those vulnerable to gender violence in conflict contexts, face alarming rates of depression and anxiety [12, 29]. Internally displaced people, with 8 million people in Colombia [9], represent one of the most affected groups; the loss of their homes and communities, added to the uncertainty and difficult living conditions in settlements, exacerbates their psychological suffering [1, 2]. For their part, ex-combatants and their families face the challenge of reintegration into civilian life, facing stigmatization and economic difficulties that aggravate their health [7, 23]. Owing to the above, the Community Psychosocial Rehabilitation Strategy for Coexistence and NonRepetition, proposed by the Social Promotion Office and the Ministry of Health and Social Protection of Colombia [21], proposes the need for an intersectional understanding that cumulatively recognizes both the life experiences of people and their potential and vulnerabilities according to the contexts in which their development takes place. In this sense, a perspective of social determinants is adopted as a vehicle for understanding the complex relationships on which armed conflict is configured, which involves, among other factors, demographic dynamics; environmental, socioeconomic and cultural structural aspects of the territories; and an analysis of power relationships, roles, visions and understandings built throughout the experience of the conflict. In this context, the damage and suffering derived from both the victimizing facts of the conflict and the absence of a social response of justice by the state and institutions have led victims to organize and promote recovery and healing actions [9]. In this context, older adults play a crucial role in the preservation of historical memory and the transmission of knowledge; they are the ones who remember and narrate the stories of the conflict, act as guardians of the collective memory of their communities, and work essentially to recognize and learn from the mistakes of the past and promote reconciliation and justice [15]. In addition, older adults are also a vital source of emotional support and resilience for younger generations. Through the transmission of stories and experiences, they offer a sense of continuity and belonging, helping communities rebuild their identity and strengthen their social ties. This process of knowledge transmission is crucial for the psychological and emotional recovery of war-affected communities. Examples of the above approach can be found in the work carried out in some provinces of Colombia, such as San Carlos Antioquia [13] and Montes de María [8], communities in which older adults have led initiatives to document and narrate the stories of the violence suffered by their community and sustain actions of reparation and reconciliation, given the lack of systematization of institutional programs of the State and private organizations. In this context, the present work seeks to document the memory of the actions, agents and knowledge of the Colectivo Tejiendo Memoria, a group of older adults located in the province of Sonsón Antioquia-Colombia, a province that, owing to its geographical location characterized by a wide territorial extension, especially at a rural level, the interconnection with approximately 10 provinces and its mountainous topography, has been victim of the settlement and actions of various armed groups outside the law related to the Colombian armed conflict. In this way, we seek to respond to the need to recognize and legitimize the knowledge and actions of community-based organizations promoted by older adults, as they constitute situated knowledge to address in an intersectoral manner the social and emotional suffering caused and, thus, offer a different approach to the social determinants of health and the effects of armed conflict on mental health while transcending the psychopathological perspective to highlight practices that promote well-being built from resistance, solidarity and rituality. Method Methodological design The action without harm (ASD) approach is the axis on which the methodological design of the research is based. This approach recognizes that the intervention actions carried out by public and private actors in communities affected by various forms of violation are not exempt from producing harm as part of the impact of their actions on the development of the daily lives and processes of the communities [28]. In this sense, the DNH emerges as an ethical posture and constant reflection on the research practices carried out in these communities while enabling the creation of methodological strategies adjusted to local conditions, mitigating the reproduction of revictimizing scenarios and the opportunity for horizontal and collaborative construction of knowledge between institutional actors and agents, communities, organizations and civilians who share their experiences. In the case of Colombia, an ethics of minimums has been proposed as a framework for DNH that considers 3 principles for its application: dignity, autonomy and freedom [28], which represent pillars for the recognition of diversity and multiculturalism present in the country insofar as they allow the recognition of the capacities of the agents, the genuine recognition of otherness, and the recognition of the capacity to choose and make decisions of individuals regarding the development of research projects [28]. Participants The Colectivo Tejiendo Memoria comprises 35 people, mostly older adults, who have been direct and indirect victims of armed conflict, specifically since the late 1990s. It is a diverse group of civilians with experience in local participation scenarios, such as the Mesa de Víctimas, the Costurero de la Memoria, and the Juntas de Acción Comunal. In addition, some are retired teachers or professionals in various fields, such as psychology and history. The collective plays a dual role in the study: first, because its actions over time are being studied and analyzed; second, because it has been integrated as a coresearcher on the basis of a methodological strategy designed to promote a participatory scenario of knowledge construction, it is also supported by the action without harm approach [28]. Data collection technique In coherence with the DNH approach, a cyanotyping and photo elucidation workshop was proposed for the construction of the data with three objectives: first, to innovate on the techniques and instruments of the research process; second, to enhance the narrative of the actors of the collective around their actions and knowledge; and finally, to minimize the impact of extractivist research practices through the active integration of the participants in the development of the technique. Photo elucidation consists of the introduction of archival photographs during the development of interviews to promote dialogs that mobilize emotions and understanding of specific moments or events that have already occurred [3, 14, 20]. For Harper [14], this type of interview, which is mediated by the image decenters the focus of the traditional version of the technique, since the image concentrates the attention and proposes an experience of mutual learning and understanding of the meanings of photography. The development of the workshop had two phases. In the first phase, 30 photographs were selected from the group's archive to make visible processes, events, actions and key participants of the collective. This first selection was formally analyzed by the research team to identify possible meanings in the images and prepare questions for the second phase. Aspects such as visual description, context of the photograph, predominant visual elements, communicative intention, people in the image, and general observations were taken into account. The second phase was developed through a meeting space in the province of Sonsón with 8 members of the collective, who were previously selected following a strategy of convenience. This workshop was developed at three time points. First, 30 previously selected photographs were obtained, from which the final sample of 6 photographs was consolidated to be part of the application of the photo elucidation technique through a group interview. The second moment had the objective of carrying out an exercise of photographic development by means of the cyanotype technique, using the negative of the photos and paper emulsified with ferrotype, which was reactive to sunlight. The material was given to the participants of the collective, and instructions were given so that each one could prepare a cyanotype with negative and emulsion paper (see Figure 1). In the third moment, the group interview was carried out, for which the metaphor of development was proposed as an unveiling, that is, as an image that, beyond its formal aspects, speaks of a time and narrates the experiences of the Weaving Memory Collective. Analysis The analysis of the information was carried out in two steps. The first was the analysis of the photographs selected for the sample on the basis of their intrinsic values, following the technique of content analysis with images [10, 26], so that the initial categories (actions, agents, roles and knowledge) could be decanted, systematized, integrated and refined. Figure 2 shows the information content generated for each category, revealing that the two most robust categories were actions and knowledge. Results The results are grouped into three periods, each of which accounts for three historical periods that led to the consolidation of the Colectivo Tejiendo Memoria as a civil organization in the province of Sonsón. The coding accounted for (1) the relevance of the actions oriented toward psychosocial recovery, (2) the historical actions of civil resistance as background of the collective and (3) the agency achieved throughout this history from diverse learning, product of self-management and activism. Figure 3 shows the codes that emerged in the content analysis. A recent history with a long past Although the collective has been meeting for the past 3 years, its members have participated, through other organizations, in various activities of civil resistance to armed conflict since 2000. One of these organizations was the Community Assembly, whose purpose was to develop social causes in rural and urban areas of the province. As part of this assembly, a humanitarian committee was consolidated, whose members developed concrete mediation actions with armed actors between 2001 and 2002: “The humanitarian committee then, what it did was to negotiate with armed groups for, to say something, when there was the guerrilla takeover, when there was, excuse me, the whole conflict, Argelia was closed, and they dared to go and talk to armed groups, and they managed to get some trucks with food to Argelia from here in Sonsón, because it was totally... in humanitarian corridor” (Member of the Collective, 2023). This first period shows precisely how citizens organized themselves to confront armed violence and contribute to peace through autonomy, self-management and activism. Actions that make agency possible We observe in the participants a capacity to mobilize according to the specific needs of the community at each historical moment, both during and after the conflict. Specifically, during the most violent episodes, their actions were oriented toward humanitarian management and civil resistance, but once the direct effects of the military confrontation were mitigated, according to the participants of the collective, the actions of resistance focused on other axes, training, management of interinstitutional links, and attention to the victims of the conflict. This period after the armed confrontation was marked by the community's interest in continuing to develop actions to contribute to the construction of peace in the province, which allowed the consolidation of groups and organizations that worked to make the victims visible, weaving interinstitutional links and, consequently, beginning to open up possibilities of agency in a community hit by the effects of violence. Forms and times of recovery The present, that is, the last 3 years, shows the consolidation of the Colectivo Tejiendo Memoria as a civil organization in which men and women, older adults from the province of Sonsón, victims of armed conflict, gather to carry out activities for their psychosocial recovery. It is also a space of management from which the memory of the victims is dynamized through commemorative actions, events and rituals in which the municipal community is invited to participate. These actions, which are the product of a history of several decades, reflect the processes developed by the actors of the collective over time. They are actions that have been constituted from self-management, participation and activism. The relevance of the collective and its impact on psychosocial recovery is based precisely on the persistence of these actions over time, i.e., the history accumulated since the 1990s as mediators with armed groups and the search for management, training and institutional articulation possibilities until the consolidation of the collective as a safe space to promote healing processes. Resistance and the search to make memory visible are key in this whole process: “(...) We have persisted, and we will not give up because this is memory, and this, in a way, is the voice of those who have no voice. So we have to continue, and we are not going to let others want to extinguish or exterminate this, because we do have this ownership” (Collective member, 2023). Encounter: a safe space and a condition for agency The recognition of the condition of being a community implies not only the sharing of experience and feelings but also the need to reestablish security and common well-being. The implacable force of violence that seemed to expropriate freedom encouraged the determined action of questioning fear to preserve life. Thus, when reading the history of the collective, the encounter is located as an expression and principle of its capacity for agency, that is, the encounter as a space of interconnection and secure linkage, allowed, integrating the individual as a resource, to transcend individual needs to configure ways to penetrate an oppressive dynamic in the midst of terror and work for the transformation of a reality that disrupted dignity. Consequently, the historical bond of those who make up the collective narrates a collective agency that finds it necessary to strengthen the link as a political action, which cares for and reclaims life through the commemoration of memory. Figure 4 shows the logic of interdependence between the findings, proposing a relationship that flows between the stories of the past as binding events and the emergence of the encounter as a condition of agency for the care of life, which is mediated by the use of rituals and the definition of inexorable principles for peaceful coexistence. Ritual and its role in psychosocial recovery In relation to the above, ritual actions have represented both the exercise of symbolizing moments and places associated with the victimizing facts and lost persons, as well as scenarios to favor joint healing, through the supportive and empathic word that is woven in regular meetings and commemoration events. Thus, considering that the pain caused by the war is inscribed in their individual and collective histories, ritualizing history and memory configures a form of reparation and reconciliation; the light, for example, represents the lost beings, the life that does not cease and the horizon of actions that lead to transformation. The fabric represents the union of solidarity, the meeting of versions that together shape their memories and the collective strength to overcome the pain and assume themselves as managers of nonrepetition. The flowers, the beauty and color of life, do not fade, despite the associated pain. In this way, characterizing each commemoration event—such as “Trochas por la vida”, “Día del detenido desaparecido”, “9 de abril”, and “Memoria y solidaridad con las víctimas”, among others—making use of these symbols and rituals not only implies evoking the pain, the people and the memories they do not wish to forget but also determines the actions present in their function of psychosocial recovery and agency for nonrepetition. Discussion The aim of this paper was to explore the social determinants of health that transcend the psychopathological reading [ 18 , 24 , 27 ] of the emotional suffering caused by armed conflict in light of the experience of psychosocial recovery that a group of older adults has experienced in the province of Sonsón, Antioquia, Colombia. Although social determinants favor the identification of the factors that affect the physical and mental health of individuals and communities, as well as their consequences, when analyzing the contexts and the complex relationships that arise in these contexts, it is necessary to recognize the potentialities that have allowed people to face violence and generate conditions for overcoming damage, especially emotional damage [ 9 , 15 , 21 ]. This approach establishes a reference that dialogs with the sciences of resilience, particularly those that, on the basis of a multisystemic model, define resilience as the continuous result of many processes in which adaptive capacities are distributed in networks that, in an interconnected manner, are committed to restoring balance so that life can continue [ 19 ]. Thus, it makes sense that the main finding of this study defines the encounter as the expression of the capacity for organization and agency, which is characterized as an interconnection through which people have been regaining security from an individual perspective but with an effect on the social system, as they jointly found ways to exhort the imposition of violent actors and build resistance actions that, on the basis of solidarity action, concretized responses that helped to restore dignity. A substantial aspect of the psychosocial recovery processes promoted by the members of the Colectivo Tejiendo Memoria is that they not only attended past events related to the period of recrudescence of the Colombian armed conflict, which coincides with similar studies [ 30 , 17 ] but also served as a platform for them to sustain actions over time that have resulted in two purposes: 1. Memory is preserved through ritual resources as a device for the defense of life, both of those who died as victims of the conflict and of those who remained resisting and contributing to the transformation of social reality. 2. The configuration of a sense of political agency, as they recognize the need to create conditions for nonrepetition, exercising the role of those who narrate what they have experienced and the resources through which they have been learning to overcome it, thus promoting scenarios of collective healing. Thus, an organic exercise is identified that can be understood as a functional system, that is, the collective consolidated itself as a territorial link through which they have been legitimized as a platform that allows the circulation of management: they are in charge of managing and sustaining the commemoration spaces, which has given rise to recognition of what they are called to continue making memory visible from the exercises that, as a collective, they have led. In this way, they have put institutionalism under tension when it does not respond to the need that they denounce as a collective; that is, they establish themselves as political managers of institutional management, a fact that is nourished by their active exercise in the different bodies of civil participation available to the province. These findings coincide with other developments [ 31 ], which, on the basis of an intersectional reading, draw attention to political participation as a perspective of reflection and understanding of the dynamics that mark the forms of social organization and the conditions that give them influence in the public sphere, a necessary aspect in an approach to the social determinants of health that integrates the different systems involved in the emergence of affect on the physical and mental health of people. On the other hand, it is necessary to mention the methodological approach used in this research. Through identification among the participants, a framework of empathy emerged that allowed the development of the technique to take place in a collaborative scenario for the construction of meaning and memories around the elucidated facts. A methodological strategy is articulated to other initiatives that find audiovisual resources not only to explore people's experiences but also to foster the potential and identification between communities that share stories related to armed conflicts [ 16 , 22 ]. However, although relevant aspects of the victimizing events and psychosocial recovery strategies promoted by the collective were addressed, optimal use requires prior organization and documentary management strategies on the part of the communities. Finally, the findings presented here are offered as an input to transcend the paradigms of mental deficits in the approach to social determinants of health in contexts affected by armed conflict, so it is still necessary to expand evidence to strengthen this proposal. Conclusions This manuscript provides a renewed vision of the social determinants of mental health in the context of armed conflict, emphasizing the capacities of communities to organize and manage their psychosocial recovery from a positive perspective. The methodological approach of action without harm, together with the photo elucidation technique, allowed sensitive capture of the experiences of the participants, highlighting how older adults have led healing processes through the preservation of historical memory and the use of rituals as devices of resistance and reparation. The main contribution of this study lies in demonstrating that, despite the serious effects caused by the conflict, the affected communities possess a remarkable capacity for resilience and agency. These practices of resistance have allowed not only the emotional recovery of victims but also the creation of meeting spaces where new forms of coexistence and peace are woven. Thus, the manuscript contributes to transcending the traditional psychopathological approach to mental health in scenarios of violence, highlighting the importance of memory, solidarity and collective action as key tools for nonrepetition and social transformation. Declarations Acknowledgments: We would like to thank Club Deportivo el Boca and Colectivo Tejiendo Memoria. Author contributions: All authors made substantial contributions to the conception of the work, DMB y DG wrote and revised the manuscript, EC field data collected. All authors have approved the submitted version and have agreed both to be personally accountable for the author’s own contributions and to ensure questions related to the accuracy or integrity of any part of the work. Funding: This study was financed by Corporación Universitaria Minuto de Dios-UNIMINUTO and Corporación Resurgir para la PAZ-RESURPAZ, through Agreement 2024-078. Data availability: The set of data generated in this study are not available in public repositories because they contain sensitive information, which requires guaranteeing the confidentiality of the participants. However, they can be consulted through the corresponding author. Ethical approval and consent to participate: This study was conducted in accordance with the regulations for health research in Colombia, and was approved by the ethics committee of UNIMINUTO. Participants were informed of their right to refuse or withdraw from the study at any time, without adverse consequences. Informed consent was obtained from each participant, and the investigators undertook to safeguard the confidentiality and anonymity of the data collected. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests. References Alzugaray Ponce C, Fuentes Aguilar A, Villagrán Valenzuela L, Moraga Torres R. 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Apoyo mutuo, liderazgo afectivo y experiencia clínica comunitaria. Acompañamiento psicosocial para la “rehabilitación” de víctimas del conflicto armado. El Ágora USB. 2016;16(2):427-451. Available in: https://www.redalyc.org/pdf/4077/407755354005.pdf Vivas O, Gómez JL, Rango J. Un aporte al estudio de las formas de organización social desde la orilla de la participación política en Colombia: Artículo de reflexión sobre los resultados de la investigación Fundamentación de la línea de investigación académica sobre las formas organizativas de agenciamiento colaborativo de problemas de grupos vulnerables 2014-2015. Cuad Latinoam Adm. 2015. Available in: https://doi.org/10.18270/cuaderlam.v11i21.1621 Additional Declarations No competing interests reported. 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Bedoya-Gallego","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYDCCGwwMEmAGO3PjAxCbDSrB2EBQCzNjswFUC1g1UVraJJAtwKmF73bzwRsf2+zs+psZ26p5d1hE80n3mD/4wGAju+EA88MHWLRI3jmWbDmzLTl5xmHGttu8ZyRy22TOGDbOYEgz3nCAzdgAixaDGzlm0rxtzMkMYC1tQC0SOYbNPAyHEzcc4GGTwKol/xtQS32yPFBLMZKW/3i05LABtRy2MwBqYUbScgCnFqBfjC1nnDueYHiYsVlyLlhLWuHMGQbJxjMPY/cLMMQe3vhQVm0vd7z54Ie3bXW582ckb/jwocJOtu94M9YQAwNGNobEBjQHAzEzLvUg8IfBHp/0KBgFo2AUjHAAAPv/Z8X2UCCrAAAAAElFTkSuQmCC","orcid":"","institution":"Corporación Universitaria Minuto de Dios","correspondingAuthor":true,"prefix":"","firstName":"Diana","middleName":"Marcela","lastName":"Bedoya-Gallego","suffix":""},{"id":371276336,"identity":"f6fcb247-0dbd-43ee-8cc0-f0fe1171c83a","order_by":1,"name":"Daniel Gomez Gomez","email":"","orcid":"","institution":"Corporación Universitaria Minuto de 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codes\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5307047/v1/2ffa7adb5204506eac8abb0e.png"},{"id":68470591,"identity":"45e9a906-d4c9-4eda-9c3d-abc6543a6acc","added_by":"auto","created_at":"2024-11-07 15:01:30","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":97546,"visible":true,"origin":"","legend":"\u003cp\u003eLogic of interdependence between encountersand agency\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5307047/v1/095ee96711467e73204a1cab.png"},{"id":68472048,"identity":"197698e1-541c-46e4-b7f6-932834e86f79","added_by":"auto","created_at":"2024-11-07 15:17:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1052593,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5307047/v1/4d6b4392-9f38-4f40-a0f2-df028a827b85.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Social Agency and Psychosocial Recovery: A Resilient Perspective on the Social Determinants of Mental Health in a Community Affected by the Colombian Armed Conflict","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe armed conflict\u0026nbsp;in Colombia\u0026nbsp;is known as one of the most complex and prolonged in the world;\u0026nbsp;it\u0026nbsp;has extended for more than half a century, involving various actors (guerrillas, paramilitary groups, criminal gangs) and the structure of the social system (the State and private enterprise), which has generated significant effects in multiple dimensions, including serious human rights violations, slowing economic and social development,\u0026nbsp;and\u0026nbsp;traumas in the construction of culture and collective memory, which are expressed in human and material losses, as well as in the impact on the mental health of the population [5].\u003c/p\u003e\n\u003cp\u003eAccording to the Truth Commission Report [9], at least 450,666 people lost their lives, more than 100,000 were victims of forced disappearance, 50,770 were kidnapped, between 26,900 and 35,641 children and adolescents were recruited to serve in the illegal armed forces,\u0026nbsp;and 32,446 people were victims of acts against freedom and sexual integrity.\u003c/p\u003e\n\u003cp\u003eThus, an analysis of the conflict from the perspective of the social determinants of health [11] reveals that associated factors such as poverty, inequality, limited access to basic services [6], social exclusion and, in general, human rights violations have exacerbated mental health problems such as\u0026nbsp;posttraumatic\u0026nbsp;stress, anxiety and depression [18, 24, 27].\u003c/p\u003e\n\u003cp\u003eA differentiated review of population groups\u0026nbsp;revealed\u0026nbsp;that children and adolescents exposed to violence from an early age tend to have symptoms of behavioral disorders and severe emotional problems [4, 25]. Women, particularly\u0026nbsp;those\u0026nbsp;vulnerable to gender violence in conflict contexts, face alarming rates of depression and anxiety [12, 29]. Internally displaced\u0026nbsp;people, with\u0026nbsp;8 million\u0026nbsp;people\u0026nbsp;in Colombia [9], represent one of the most affected groups; the loss of their homes and communities, added to the uncertainty and difficult living conditions in settlements, exacerbates their psychological suffering [1, 2]. For their part, ex-combatants and their families face the challenge of reintegration into civilian life, facing stigmatization and economic difficulties that aggravate their health [7, 23].\u003c/p\u003e\n\u003cp\u003eOwing\u0026nbsp;to the above, the Community Psychosocial Rehabilitation Strategy for Coexistence and\u0026nbsp;NonRepetition, proposed by the Social Promotion Office and the Ministry of Health and Social Protection of Colombia [21], proposes the need for an intersectional understanding that cumulatively recognizes both the life experiences of people and their potential and vulnerabilities according to the contexts in which their development takes place. In this sense, a perspective of social determinants is adopted as a vehicle for understanding the complex relationships on which armed conflict is configured,\u0026nbsp;which involves, among\u0026nbsp;other factors, demographic dynamics;\u0026nbsp;environmental, socioeconomic and cultural structural aspects of the territories;\u0026nbsp;and\u0026nbsp;an analysis of power\u0026nbsp;relationships, roles, visions and understandings built throughout the experience of the conflict.\u003c/p\u003e\n\u003cp\u003eIn this\u0026nbsp;context, the damage and suffering derived from both the victimizing facts of the conflict and the absence of a social response of justice by the\u0026nbsp;state\u0026nbsp;and institutions\u0026nbsp;have\u0026nbsp;led victims to organize and promote recovery and healing actions [9]. In this context, older adults\u0026nbsp;play\u0026nbsp;a crucial role in the preservation of historical memory and the transmission of knowledge; they are the ones who remember and narrate the stories of the conflict,\u0026nbsp;act\u0026nbsp;as guardians of the collective memory of their communities, and\u0026nbsp;work\u0026nbsp;essentially\u0026nbsp;to recognize and learn from the mistakes of the past and promote reconciliation and justice [15].\u003c/p\u003e\n\u003cp\u003eIn addition, older adults are also a vital source of emotional support and resilience for younger generations. Through the transmission of stories and experiences, they offer a sense of continuity and belonging, helping communities rebuild their identity and strengthen their social ties. This process of knowledge transmission is crucial for the psychological and emotional recovery of war-affected communities.\u003c/p\u003e\n\u003cp\u003eExamples of the above approach can be found in the work carried out in some provinces of Colombia,\u0026nbsp;such as San Carlos Antioquia [13] and Montes de María [8], communities in which older adults have led initiatives to document and narrate the stories of the violence suffered by their community and sustain actions of reparation and reconciliation, given the lack of systematization of institutional programs of the State and private organizations.\u003c/p\u003e\n\u003cp\u003eIn this\u0026nbsp;context, the present work seeks to document the memory of the actions, agents and knowledge of the\u0026nbsp;Colectivo Tejiendo Memoria, a group of older adults located in the province of Sonsón Antioquia-Colombia,\u0026nbsp;a province that, owing\u0026nbsp;to its geographical location characterized by a wide territorial extension, especially at a rural level, the interconnection with approximately 10 provinces and its mountainous topography, has been victim of the settlement and actions of various armed groups outside the law related to the Colombian armed conflict.\u003c/p\u003e\n\u003cp\u003eIn this way, we seek to respond to the need to recognize and legitimize the knowledge and actions of community-based organizations promoted by older adults, as they constitute situated knowledge to address in an intersectoral manner the social and emotional suffering caused and, thus, offer a different approach to the social determinants of health and the effects of armed conflict on mental health while transcending the psychopathological perspective to highlight practices that promote well-being built from resistance, solidarity and rituality.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cstrong\u003eMethodological design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe action without harm (ASD) approach is the axis on which the methodological design of the research is based. This approach recognizes that the intervention actions carried out by public and private actors in communities affected by various forms of violation are not exempt from producing harm as part of the impact of their actions on the development of the daily lives and processes of the communities [28].\u003c/p\u003e\n\u003cp\u003eIn this sense, the DNH emerges as an ethical posture and constant reflection on the research practices carried out in these communities while enabling the creation of methodological strategies adjusted to local conditions, mitigating the reproduction of revictimizing scenarios and the opportunity for horizontal and collaborative construction of knowledge between institutional actors and agents, communities, organizations and civilians who share their experiences.\u003c/p\u003e\n\u003cp\u003eIn the case of Colombia, an ethics of minimums has been proposed as a framework for DNH that considers 3 principles for its application: dignity, autonomy and freedom [28], which represent pillars for the recognition of diversity and multiculturalism present in the country insofar as they allow the recognition of the capacities of the agents, the genuine recognition of otherness, and the recognition of the capacity to choose and make decisions of individuals regarding the development of research projects [28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Colectivo Tejiendo Memoria comprises 35 people, mostly older adults, who have been direct and indirect victims of armed conflict, specifically since the late 1990s. It is a diverse group of civilians with experience in local participation scenarios, such as the Mesa de V\u0026iacute;ctimas, the Costurero de la Memoria, and the Juntas de Acci\u0026oacute;n Comunal. In addition, some are retired teachers or professionals in various fields, such as psychology and history.\u003c/p\u003e\n\u003cp\u003eThe collective plays a dual role in the study: first, because its actions over time are being studied and analyzed; second, because it has been integrated as a coresearcher on the basis of a methodological strategy designed to promote a participatory scenario of knowledge construction, it is also supported by the action without harm approach [28].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn coherence with the DNH approach, a cyanotyping and photo elucidation workshop was proposed for the construction of the data with three objectives: first, to innovate on the techniques and instruments of the research process; second, to enhance the narrative of the actors of the collective around their actions and knowledge; and finally, to minimize the impact of extractivist research practices through the active integration of the participants in the development of the technique.\u003c/p\u003e\n\u003cp\u003ePhoto elucidation consists of the introduction of archival photographs during the development of interviews to promote dialogs that mobilize emotions and understanding of specific moments or events that have already occurred [3, 14, 20]. For Harper [14], this type of interview, which is mediated by the image decenters the focus of the traditional version of the technique, since the image concentrates the attention and proposes an experience of mutual learning and understanding of the meanings of photography.\u003c/p\u003e\n\u003cp\u003eThe development of the workshop had two phases. In the first phase, 30 photographs were selected from the group\u0026apos;s archive to make visible processes, events, actions and key participants of the collective. This first selection was formally analyzed by the research team to identify possible meanings in the images and prepare questions for the second phase. Aspects such as visual description, context of the photograph, predominant visual elements, communicative intention, people in the image, and general observations were taken into account.\u003c/p\u003e\n\u003cp\u003eThe second phase was developed through a meeting space in the province of Sons\u0026oacute;n with 8 members of the collective, who were previously selected following a strategy of convenience. This workshop was developed at three time points. First, 30 previously selected photographs were obtained, from which the final sample of 6 photographs was consolidated to be part of the application of the photo elucidation technique through a group interview.\u003c/p\u003e\n\u003cp\u003eThe second moment had the objective of carrying out an exercise of photographic development by means of the cyanotype technique, using the negative of the photos and paper emulsified with ferrotype, which was reactive to sunlight. The material was given to the participants of the collective, and instructions were given so that each one could prepare a cyanotype with negative and emulsion paper (see Figure 1).\u003c/p\u003e\n\u003cp\u003eIn the third moment, the group interview was carried out, for which the metaphor of development was proposed as an unveiling, that is, as an image that, beyond its formal aspects, speaks of a time and narrates the experiences of the Weaving Memory Collective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnalysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of the information was carried out in two steps. The first was the analysis of the photographs selected for the sample on the basis of their intrinsic values, following the technique of content analysis with images [10, 26], so that the initial categories (actions, agents, roles and knowledge) could be decanted, systematized, integrated and refined. Figure 2 shows the information content generated for each category, revealing that the two most robust categories were actions and knowledge.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe results are grouped into three periods, each of which accounts for three historical periods that led to the consolidation of the Colectivo Tejiendo Memoria as a civil organization in the province of Sons\u0026oacute;n. The coding accounted for (1) the relevance of the actions oriented toward psychosocial recovery, (2) the historical actions of civil resistance as background of the collective and (3) the agency achieved throughout this history from diverse learning, product of self-management and activism. Figure 3 shows the codes that emerged in the content analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA recent history with a long past\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough the collective has been meeting for the past 3 years, its members have participated, through other organizations, in various activities of civil resistance to armed conflict since 2000. One of these organizations was the Community Assembly, whose purpose was to develop social causes in rural and urban areas of the province. As part of this assembly, a humanitarian committee was consolidated, whose members developed concrete mediation actions with armed actors between 2001 and 2002:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The humanitarian committee then, what it did was to negotiate with armed groups for, to say something, when there was the guerrilla takeover, when there was, excuse me, the whole conflict, Argelia was closed, and they dared to go and talk to armed groups, and they managed to get some trucks with food to Argelia from here in Sons\u0026oacute;n, because it was totally... in humanitarian corridor\u0026rdquo; (Member of the Collective, 2023).\u003c/p\u003e\n\u003cp\u003eThis first period shows precisely how citizens organized themselves to confront armed violence and contribute to peace through autonomy, self-management and activism.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eActions that make agency possible\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe observe in the participants a capacity to mobilize according to the specific needs of the community at each historical moment, both during and after the conflict. Specifically, during the most violent episodes, their actions were oriented toward humanitarian management and civil resistance, but once the direct effects of the military confrontation were mitigated, according to the participants of the collective, the actions of resistance focused on other axes, training, management of interinstitutional links, and attention to the victims of the conflict.\u003c/p\u003e\n\u003cp\u003eThis period after the armed confrontation was marked by the community\u0026apos;s interest in continuing to develop actions to contribute to the construction of peace in the province, which allowed the consolidation of groups and organizations that worked to make the victims visible, weaving interinstitutional links and, consequently, beginning to open up possibilities of agency in a community hit by the effects of violence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eForms and times of recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe present, that is, the last 3 years, shows the consolidation of the Colectivo Tejiendo Memoria as a civil organization in which men and women, older adults from the province of Sons\u0026oacute;n, victims of armed conflict, gather to carry out activities for their psychosocial recovery. It is also a space of management from which the memory of the victims is dynamized through commemorative actions, events and rituals in which the municipal community is invited to participate.\u003c/p\u003e\n\u003cp\u003eThese actions, which are the product of a history of several decades, reflect the processes developed by the actors of the collective over time. They are actions that have been constituted from self-management, participation and activism. The relevance of the collective and its impact on psychosocial recovery is based precisely on the persistence of these actions over time, i.e., the history accumulated since the 1990s as mediators with armed groups and the search for management, training and institutional articulation possibilities until the consolidation of the collective as a safe space to promote healing processes. Resistance and the search to make memory visible are key in this whole process:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;(...) We have persisted, and we will not give up because this is memory, and this, in a way, is the voice of those who have no voice. So we have to continue, and we are not going to let others want to extinguish or exterminate this, because we do have this ownership\u0026rdquo; (Collective member, 2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEncounter: a safe space and a condition for agency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe recognition of the condition of being a community implies not only the sharing of experience and feelings but also the need to reestablish security and common well-being. The implacable force of violence that seemed to expropriate freedom encouraged the determined action of questioning fear to preserve life.\u003c/p\u003e\n\u003cp\u003eThus, when reading the history of the collective, the encounter is located as an expression and principle of its capacity for agency, that is, the encounter as a space of interconnection and secure linkage, allowed, integrating the individual as a resource, to transcend individual needs to configure ways to penetrate an oppressive dynamic in the midst of terror and work for the transformation of a reality that disrupted dignity.\u003c/p\u003e\n\u003cp\u003eConsequently, the historical bond of those who make up the collective narrates a collective agency that finds it necessary to strengthen the link as a political action, which cares for and reclaims life through the commemoration of memory. Figure 4 shows the logic of interdependence between the findings, proposing a relationship that flows between the stories of the past as binding events and the emergence of the encounter as a condition of agency for the care of life, which is mediated by the use of rituals and the definition of inexorable principles for peaceful coexistence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRitual and its role in psychosocial recovery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn relation to the above, ritual actions have represented both the exercise of symbolizing moments and places associated with the victimizing facts and lost persons, as well as scenarios to favor joint healing, through the supportive and empathic word that is woven in regular meetings and commemoration events.\u003c/p\u003e\n\u003cp\u003eThus, considering that the pain caused by the war is inscribed in their individual and collective histories, ritualizing history and memory configures a form of reparation and reconciliation; the light, for example, represents the lost beings, the life that does not cease and the horizon of actions that lead to transformation. The fabric represents the union of solidarity, the meeting of versions that together shape their memories and the collective strength to overcome the pain and assume themselves as managers of\u0026nbsp;nonrepetition. The flowers, the beauty and color of life,\u0026nbsp;do\u0026nbsp;not fade, despite the\u0026nbsp;associated\u0026nbsp;pain.\u003c/p\u003e\n\u003cp\u003eIn this way, characterizing each commemoration event\u0026mdash;such as \u0026ldquo;Trochas por la vida\u0026rdquo;, \u0026ldquo;D\u0026iacute;a del detenido desaparecido\u0026rdquo;, \u0026ldquo;9 de abril\u0026rdquo;, and \u0026ldquo;Memoria y solidaridad con las v\u0026iacute;ctimas\u0026rdquo;, among others\u0026mdash;making use of these symbols and rituals not only implies evoking the pain, the people and the memories they do not wish to forget but also determines the actions present in their function of psychosocial recovery and agency for nonrepetition.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe aim of this paper was to explore the social determinants of health that transcend the psychopathological reading [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] of the emotional suffering caused by armed conflict in light of the experience of psychosocial recovery that a group of older adults has experienced in the province of Sons\u0026oacute;n, Antioquia, Colombia. Although social determinants favor the identification of the factors that affect the physical and mental health of individuals and communities, as well as their consequences, when analyzing the contexts and the complex relationships that arise in these contexts, it is necessary to recognize the potentialities that have allowed people to face violence and generate conditions for overcoming damage, especially emotional damage [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis approach establishes a reference that dialogs with the sciences of resilience, particularly those that, on the basis of a multisystemic model, define resilience as the continuous result of many processes in which adaptive capacities are distributed in networks that, in an interconnected manner, are committed to restoring balance so that life can continue [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThus, it makes sense that the main finding of this study defines the encounter as the expression of the capacity for organization and agency, which is characterized as an interconnection through which people have been regaining security from an individual perspective but with an effect on the social system, as they jointly found ways to exhort the imposition of violent actors and build resistance actions that, on the basis of solidarity action, concretized responses that helped to restore dignity.\u003c/p\u003e \u003cp\u003eA substantial aspect of the psychosocial recovery processes promoted by the members of the Colectivo Tejiendo Memoria is that they not only attended past events related to the period of recrudescence of the Colombian armed conflict, which coincides with similar studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] but also served as a platform for them to sustain actions over time that have resulted in two purposes: 1. Memory is preserved through ritual resources as a device for the defense of life, both of those who died as victims of the conflict and of those who remained resisting and contributing to the transformation of social reality. 2. The configuration of a sense of political agency, as they recognize the need to create conditions for nonrepetition, exercising the role of those who narrate what they have experienced and the resources through which they have been learning to overcome it, thus promoting scenarios of collective healing.\u003c/p\u003e \u003cp\u003eThus, an organic exercise is identified that can be understood as a functional system, that is, the collective consolidated itself as a territorial link through which they have been legitimized as a platform that allows the circulation of management: they are in charge of managing and sustaining the commemoration spaces, which has given rise to recognition of what they are called to continue making memory visible from the exercises that, as a collective, they have led.\u003c/p\u003e \u003cp\u003eIn this way, they have put institutionalism under tension when it does not respond to the need that they denounce as a collective; that is, they establish themselves as political managers of institutional management, a fact that is nourished by their active exercise in the different bodies of civil participation available to the province.\u003c/p\u003e \u003cp\u003eThese findings coincide with other developments [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which, on the basis of an intersectional reading, draw attention to political participation as a perspective of reflection and understanding of the dynamics that mark the forms of social organization and the conditions that give them influence in the public sphere, a necessary aspect in an approach to the social determinants of health that integrates the different systems involved in the emergence of affect on the physical and mental health of people.\u003c/p\u003e \u003cp\u003eOn the other hand, it is necessary to mention the methodological approach used in this research. Through identification among the participants, a framework of empathy emerged that allowed the development of the technique to take place in a collaborative scenario for the construction of meaning and memories around the elucidated facts. A methodological strategy is articulated to other initiatives that find audiovisual resources not only to explore people's experiences but also to foster the potential and identification between communities that share stories related to armed conflicts [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, although relevant aspects of the victimizing events and psychosocial recovery strategies promoted by the collective were addressed, optimal use requires prior organization and documentary management strategies on the part of the communities.\u003c/p\u003e \u003cp\u003eFinally, the findings presented here are offered as an input to transcend the paradigms of mental deficits in the approach to social determinants of health in contexts affected by armed conflict, so it is still necessary to expand evidence to strengthen this proposal.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis manuscript provides a renewed vision of the social determinants of mental health in the context of armed conflict, emphasizing the capacities of communities to organize and manage their psychosocial recovery from a positive perspective. The methodological approach of action without harm, together with the photo elucidation technique, allowed sensitive capture of the experiences of the participants, highlighting how older adults have led healing processes through the preservation of historical memory and the use of rituals as devices of resistance and reparation.\u003c/p\u003e \u003cp\u003eThe main contribution of this study lies in demonstrating that, despite the serious effects caused by the conflict, the affected communities possess a remarkable capacity for resilience and agency. These practices of resistance have allowed not only the emotional recovery of victims but also the creation of meeting spaces where new forms of coexistence and peace are woven. Thus, the manuscript contributes to transcending the traditional psychopathological approach to mental health in scenarios of violence, highlighting the importance of memory, solidarity and collective action as key tools for nonrepetition and social transformation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments: We would like to thank Club Deportivo el Boca and Colectivo Tejiendo Memoria.\u003c/p\u003e\n\u003cp\u003eAuthor contributions: All authors made substantial contributions to the conception of the work, DMB y DG wrote and revised the manuscript, EC field data collected. All authors have approved the submitted version and have agreed both to be personally accountable for the author\u0026rsquo;s own contributions and to ensure questions related to the accuracy or integrity of any part of the work.\u003c/p\u003e\n\u003cp\u003eFunding: This study was financed by Corporaci\u0026oacute;n Universitaria Minuto de Dios-UNIMINUTO and Corporaci\u0026oacute;n Resurgir para la PAZ-RESURPAZ, through Agreement 2024-078.\u003c/p\u003e\n\u003cp\u003eData availability: The set of data generated in this study are not available in public repositories because they contain sensitive information, which requires guaranteeing the confidentiality of the participants. However, they can be consulted through the corresponding author.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval and consent to participate: This study was conducted in accordance with the regulations for health research in Colombia, and was approved by the ethics committee of UNIMINUTO. Participants were informed of their right to refuse or withdraw from the study at any time, without adverse consequences. Informed consent was obtained from each participant, and the investigators undertook to safeguard the confidentiality and anonymity of the data collected.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not Applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAlzugaray Ponce C, Fuentes Aguilar A, Villagr\u0026aacute;n Valenzuela L, Moraga Torres R. La adversidad y sus consecuencias psicosociales, comunitarias y exclusi\u0026oacute;n social. Rumbos TS. 2023;18(29):117-138. Available in: https://dx.doi.org/10.51188/rrts.num29.701\u003c/li\u003e\n \u003cli\u003eAyala Santos R, Coronel Ruiz LK, Ayala Garcia ET. Costos, da\u0026ntilde;os y consecuencias del conflicto armado en Colombia desde una mirada territorial y comunitaria. 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Buenos Aires: Siglo XXI; 2002.\u003c/li\u003e\n \u003cli\u003eLozano M, Mendoza Toraya M, Monta\u0026ntilde;a D, Parra Sandoval R. Participatory research, biographical narratives and peacebuilding: An experience with teachers in Tolima, Colombia. Teach Teach Educ. 2023;125:104054. Available in: https://doi.org/10.1016/j.tate.2023.104054\u003c/li\u003e\n \u003cli\u003eMart\u0026iacute;nez MJ, Pe\u0026ntilde;arata A. Perd\u0026oacute;n y resiliencia: reflexiones desde las experiencias de v\u0026iacute;ctimas del conflicto armado colombiano en San Juan Nepomuceno, Montes de Mar\u0026iacute;a, Colombia. Rev Estud Soc. 2023;86(10):103-136. Available in: http://journals.openedition.org/revestudsoc/55773\u003c/li\u003e\n \u003cli\u003eMart\u0026iacute;nez Veloza JA, Lamus F, Hern\u0026aacute;ndez Rinc\u0026oacute;n EH, Correal Mu\u0026ntilde;ez CA. Calidad de vida en una poblaci\u0026oacute;n rural afectada por el conflicto armado colombiano, 2020: estudio transversal. Rev Gerenc Pol\u0026iacute;t Salud. 2021;20:1-19. Available in: https://doi.org/10.11144/Javeriana.rgps20.cvpr\u003c/li\u003e\n \u003cli\u003eMasten AS, Motti-Stefadini F. Multisystem Resilience for Children and Youth in Disaster: Reflections in the Context of COVID-19. Advers Resil Sci. 2020. Available in: https://doi.org/10.1007/s42844-020-00010-w\u003c/li\u003e\n \u003cli\u003eMeo A, Dabenigno V. Im\u0026aacute;genes que revelan sentidos: ventajas y desventajas de la entrevista de foto-elucidaci\u0026oacute;n en un estudio sobre j\u0026oacute;venes y escuela media en la Ciudad de Buenos Aires. EMPIRIA Rev Metodol Cienc Soc. 2011;(22):13-41. Available in: https://www.redalyc.org/articulo.oa?id=297124014001\u003c/li\u003e\n \u003cli\u003eOficina de Promoci\u0026oacute;n Social y el Ministerio de Salud y Protecci\u0026oacute;n Social de Colombia. Estrategia de Rehabilitaci\u0026oacute;n Psicosocial Comunitaria para la Convivencia y la No Repetici\u0026oacute;n. 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Determinantes sociales, s\u0026iacute;ntomas y problemas mentales en poblaci\u0026oacute;n adulta v\u0026iacute;ctima de desplazamiento forzado por conflicto armado interno. Soacha, Colombia, 2019. Rev Colomb Psiquiatr. 2024;53(1):8-16. Available in: https://doi.org/10.1016/j.rcp.2022.08.001\u003c/li\u003e\n \u003cli\u003eRodr\u0026iacute;guez G\u0026oacute;mez JA, Fern\u0026aacute;ndez Arbel\u0026aacute;ez OL. Ni\u0026ntilde;os, Ni\u0026ntilde;as y Adolescentes en el Marco del Conflicto Armado Colombiano: Una Mirada Desde la Educaci\u0026oacute;n Rural. Cienc Lat Rev Cient Multidiscip. 2024;8(2):45-75. Available in: https://doi.org/10.37811/cl_rcm.v8i2.10268\u003c/li\u003e\n \u003cli\u003eRose G. Visual Methodologies: An Introduction to the Interpretation of Visual Materials. Londres: Sage Publications; 2001.\u003c/li\u003e\n \u003cli\u003eUberti O. Un an\u0026aacute;lisis del reclutamiento forzado de Ni\u0026ntilde;os, Ni\u0026ntilde;as Adolescentes y J\u0026oacute;venes (NNAJ) en el Departamento de Choc\u0026oacute;, Colombia. Encuentros. 2022;20(2):141-153. Available in: https://doi.org/10.15665/encuen.v20i02-Julio-dic.2883\u003c/li\u003e\n \u003cli\u003eVela MM, Rodr\u0026iacute;guez JE, Rodr\u0026iacute;guez AL, Garc\u0026iacute;a LM. Acci\u0026oacute;n sin Da\u0026ntilde;o como aporte a la construcci\u0026oacute;n de paz: propuesta para la pr\u0026aacute;ctica. Bogot\u0026aacute;: Armon\u0026iacute;a Impresores; 2011\u003c/li\u003e\n \u003cli\u003eVergara \u0026Aacute;lvarez ML, Manjarres MT, Mahecha Duarte D, Li\u0026ntilde;an M, Navarro-Obeid J, Vivas Dom\u0026iacute;nguez MA. Asociaci\u0026oacute;n entre bienestar psicol\u0026oacute;gico y bienestar social en mujeres v\u0026iacute;ctimas del conflicto armado. Rev Electron Psicol Iztacala. 2023;26(1):22-33. Available in: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=113365\u003c/li\u003e\n \u003cli\u003eVilla G\u0026oacute;mez JD, Londo\u0026ntilde;o NM, Gallego M, Arango LI, Rosso P\u0026eacute;rez M. Apoyo mutuo, liderazgo afectivo y experiencia cl\u0026iacute;nica comunitaria. Acompa\u0026ntilde;amiento psicosocial para la \u0026ldquo;rehabilitaci\u0026oacute;n\u0026rdquo; de v\u0026iacute;ctimas del conflicto armado. El \u0026Aacute;gora USB. 2016;16(2):427-451. Available in: https://www.redalyc.org/pdf/4077/407755354005.pdf\u003c/li\u003e\n \u003cli\u003eVivas O, G\u0026oacute;mez JL, Rango J. Un aporte al estudio de las formas de organizaci\u0026oacute;n social desde la orilla de la participaci\u0026oacute;n pol\u0026iacute;tica en Colombia: Art\u0026iacute;culo de reflexi\u0026oacute;n sobre los resultados de la investigaci\u0026oacute;n Fundamentaci\u0026oacute;n de la l\u0026iacute;nea de investigaci\u0026oacute;n acad\u0026eacute;mica sobre las formas organizativas de agenciamiento colaborativo de problemas de grupos vulnerables 2014-2015. Cuad Latinoam Adm. 2015. Available in: https://doi.org/10.18270/cuaderlam.v11i21.1621\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Community mental health, Psychosocial resilience, Social agency, Historical memory, Action without harm.","lastPublishedDoi":"10.21203/rs.3.rs-5307047/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5307047/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Armed conflict in Colombia has severely affectedthe mental health of individuals and communities. Factors such as poverty, inequality and social exclusion have exacerbated consequences such as depression and posttraumaticstress disorder. However, a perspective that transcends the mental deficit paradigm in addressing the social determinants of health in these contexts allows us to recognize how political and social conditions determine people's physical and mental health and the need to strengthen their skills and capacities.\u003c/p\u003e\n\u003cp\u003eThe Colectivo Tejiendo Memoria, composed of older adult victims of the conflict, is a remarkable example of the capacity for organization and psychosocial recovery through collective memory and civil resistance in the province of Sonsón, Antioquia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A qualitative approach based on the action without harm (ASD) methodological framework was used to implement photo elucidation workshops and mediate group interviews to capture the memories and experiences of the participants. The contentanalysis allowed codifying the actions, agents and knowledge generated by the group around psychosocial recovery and community agency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e This study reveals that the collective has played a crucial role in the preservation of historical memory, the promotion of emotional well-being and the generation of social agency; its actions have allowed the creation of safe spaces for psychosocial recovery through rituals, commemorations and the visibility of the victims. This promoted their consolidation as political actors who manage and sustain memory and reparation in their community.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe experience of the Colectivo Tejiendo Memoria offers an innovative approach to the social determinants of mental health in the context of armed conflict, highlighting the capacity of communities to manage their own recovery through practices of resistance and solidarity.\u003c/p\u003e","manuscriptTitle":"Social Agency and Psychosocial Recovery: A Resilient Perspective on the Social Determinants of Mental Health in a Community Affected by the Colombian Armed Conflict","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-07 15:01:26","doi":"10.21203/rs.3.rs-5307047/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31755cd2-f7df-4273-b2a5-903c4c5a522f","owner":[],"postedDate":"November 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-07T15:01:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-07 15:01:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5307047","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5307047","identity":"rs-5307047","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}