Torture Survivors' Perception of The Physchosocial Consequences of The Internal Armed Conflict in Peru

Torture survivors´ perception of the psychosocial consequences of the internal armed conflict in Perú
Torture survivors´ perception of the

psychosocial consequences of the
internal armed conflict in Perú
Study of a sample of the population that received mental

health treatment in the Centre for Psychosocial Attention
(CAPS) in Lima
Carlos Saavedra Chávez

Haydeé Antón Sarmiento
Erika Cuba Oliveros
Libro PERCEPCION INGLES.indd 1 17/01/2011 05:03:38 p.m.

Study of a sample of the population that received mental health treatment in the Centre for Psychosocial Attention (CAPS) in Lima
Torture survivors´ perception of the psychosocial consequences

of the internal armed conflict in Perú
Study of a sample of the population that received mental health treatment in
the Centre for Psychosocial Attention (CAPS) in Lima
CAPS
Centro de Atención Psicosocial
Calle Caracas 2380, Jesús María, Lima 11

Teléfonos: (51-1) 462 1600 / 462 1700
Fax: (51-1) 261 0297
e-mail: psico@caps.org.pe
www.caps.org.pe
© Todos los derechos reservados
Diseño y diagramación: Miriam De la Cruz Ramírez

Impresión: Editorial ROEL S.A.C
Psje. Miguel Valcárcel 361 Urb. San Francisco - Ate
RUC: 20122879331
Tiraje: 500 ejemplares

Hecho el Depósito Legal en la Biblioteca Nacional del Perú Nº 2011-00289
Lima, diciembre de 2010
This publication, was made possible by the generous support of the American people
through the Office of Private and Voluntary Cooperation, Bureau for Humanitarian
Response, US Agency for International Development, under the terms of Matching Grant
Agreement No. FAO-G-00-00-00043-00. The opinions expressed herein are those of the
author(s) and do not necessarily reflect the views of the US Agency for International
Development or the United States Government.

Index
Presentation............................................................................................... 5
Introduction ............................................................................................... 9
1. Components of the Investigation of the IRPEC Project...................... 15

1.1. Component 1:
Creation of the self-perception scale
of psychosocial consequences of
political violence........................................................................ 15
1.2. Component 2:
Evaluating the results of individual
psychological interventions in CAPS (Lima) ............................. 18
1.3. Component 3:
Exploration of CAPS material prior to
the investigation ....................................................................... 20
2. Description of CAPS Patients............................................................ 23

2.1. Characteristics of the patients attended at
the CAPS main office in Lima (2004 – 2007)............................ 23
2.2. Specific characteristics of the IRPEC
study patients ........................................................................... 38
3. The self-perception scale of psychosocial consequences

of political violence........................................................................... 45
3.1. The scale................................................................................... 45
3.2. Measurement characteristics of the SSPCPV scale..................... 49
4. Quantitative results derived from the use of the scale........................ 55

4.1. Reliability of instrument´s scores............................................... 55

4.2. Suitability of CAPS current subscales and creation of

alternate categories through factor analysis ...................................... 55
4.3. Some analyses of the sample of 125 cases of the intake test ............. 64
4.4. Comparison of scores between intake and exit tests.......................... 72
4.4.1. General comparison............................................................. 72
4.4.2. Comparison of results between intake and
exit tests by subscales............................................................ 75
4.4.3. Comparison of results between the intake and
exit tests by sub-groups of the population............................. 77
Conclusions.............................................................................................. 81
Bibliografía............................................................................................... 89

Presentation
The Center for Psychosocial Attention (CAPS) started out as a group of

psychotherapists who were called on to provide immediate treatment to
people affected by the internal armed conflict the country went through
between 1980 and 2000. Those who had been tortured, the relatives of the
disappeared and murdered, the innocent people who had been imprisoned
by the so-called “hooded judges”, the displaced, among others, went to the
offices of the National Coordinator for Human Rights (CNDDHH) seeking
information, justice and support. These people’s urgent need for emotional
support in order to cope with their losses became apparent to human rights
defenders, who, listening to so many painful accounts, also felt psychological
pressure. The group of psychologists who were called responded with the
ethical obligation to compensate for the deficiencies in the mental health
services of a State which, in addition, was an active part of the conflict. The
task of providing mental health services for those affected by the conflict was
– and still is – enormous in spite of the years that have passed and all efforts
on the part of civil society were/are insufficient.
For several years the work of the mental health team of the National
Coordinator for Human Rights – which years later would acquire its own
name, CAPS - was totally dedicated to responding to the emergencies and
demands for attention by the people themselves and associations of those
affected by the political violence as well as the processes of truth, justice
and reparation that made up the Truth and Reconciliation Commission.
During the period of conflict and in the first few post-conflict years what was
important was to attend to the survivors’ needs for care and reparation. Thus,
CAPS had little mental and organizational capacity to record its experiences
with those affected in a more systematic way.
The experience of human rights and mental health organizations in Latin

America during conflict and post-conflict periods is in many respects similar
to that of CAPS. Field work with the affected, which was the main focus of
the team’s efforts, was gradually enriched by theoretical developments in the

Latin American region. The psychosocial focus on traumatic experiences

and the importance of systematic documentation of the evidence of the
consequences of torture stand out among the above-mentioned theoretical
and practical developments.
More than a need which arose within the institutions themselves, the demand
for computerized records, standardized formats, monitoring and evaluation
processes of institutional practices, objective evidence of the results of our
work in treating affected people, were perceived as external requirements,
established by cooperation agencies, academic circles or even agents
interested in dismantling the defense of human rights.
In 2006 the IRPEC Project (International Research and Program Evaluation

Collaborative) of the Centre for Victims of Torture (CVT) found that our
institution was better organized, had more experience in the work involving
treatment of the affected as well as improved levels of prevention and mental
health promotion among them, and that in addition to this, it was taking its
first steps towards influencing public policies. As we are at a stage involving
greater reflection and re-organization, we were interested in the proposal to
increase our capacity to monitor, evaluate and investigate CAPS interventions
with affected people.
Thus, with the contribution of the IRPEC Project, the Monitoring and
Evaluation Program was progressively implemented in the institution. The
first steps taken in this direction involved the development of instruments
in order to evaluate the comprehensive treatment given to people but the
program has broadened its scope to finally include institutional procedures
which enable us to evaluate and follow up on the results and objectives
achieved in the projects. The implementation of the above-mentioned
Program was a challenge, and not an easy one, as at the beginning there
was resistance to the experience of external evaluations, which, in spite of
producing positive results and recommendations, were always a cause for
certain concern. CAPS currently includes monitoring and evaluation in the
design, execution and evaluation of its activities, a procedure that enables us
to constantly improve the effectiveness of our institutional work.
Some time later the Research Area was established, constituted by the
Monitoring and Evaluation team and incorporating more members of the
CAPS team in carrying out the specific tasks required by the development of
this investigation.

An example of these new dynamics in the Research Area was the gathering of
the necessary information to construct the Self-perception scale of psychosocial
consequences associated with political violence. Far from being a scale built
solely on the basis of related bibliography and the psychotherapists’ clinical
knowledge as a result of their experience with those affected by political
violence, the team gathered relevant information in three communities
largely made up of people affected by political violence: one in Lima, another
in Junín and the third in Ayacucho. These were communities where CAPS
had worked on a community-based proposal for mental health. Hence, the
participation of mental health promoters trained by CAPS was essential, as
will be outlined in the pages which describe how the scale was built. What
we would like to stress is that the Research Area did not arise as a parallel
process, independent from the other programs implemented by CAPS, but
rather that the directors, therapists, social workers, psychiatrist, administrative
staff – as well as the members of the Monitoring and Evaluation Program –
reorganized their daily functions tasks in order to achieve the results of the
investigation.
The study, whose results are shown in this text, forms part of the development
of the Research Area. Its main objectives were to depict the population
attended to at CAPS and the results that they themselves perceived, and
likewise to know what general and specific changes occurred as a result of
the therapies carried out in the institution. These objectives were measured
employing quantitative techniques. We would also like to mention that
the IRPEC Project included a qualitative study that seeks to examine the
factors which would explain the benefits and limitations of the treatments.
This study is based on in-depth interviews employing the technique of illness
narratives constructed by patients and therapists, contrasting the viewpoints
of both regarding different aspects of the process and the results. This study
was proposed as a complement to the work carried out with quantitative
techniques and was initially planned to be part of this book. However, it has
been decided that the results of the qualitative research should be presented
in a future publication.
The book we present today is the first formal experience of the Research Area
of the Center for Psychosocial Attention (CAPS) and we are very pleased with
the findings and the challenges these pose for us. It could not be otherwise: the
systematized information obtained provides us with a roadmap to continue
to improve the quality of our work. We know that it is a pilot experience,
that can be improved, like everything in life, but this publication is essentially

the reflection of the continuous work of the human group that makes up
CAPS. The commitment we make as an institution to do things even better
now has in the activities of Monitoring and Evaluation and in the Research
Area, irreplaceable tools that have been integrated into our organization in a
systematic way. The support given to us by the Centre for Victims of Torture
of Minnesota (CVT) through the IRPEC project has been and is gratefully
appreciated.

Introduction
This book attempts to be a synthesis of the results of the research that the
IRPEC (International Research and Program Evaluation Collaborative)
project promoted in Peru with CAPS (Center for Psychosocial Care, Centro
de Atención Psicosocial) as a partner. Before a specific discussion of the
particular components of the research carried out in Peru a brief description
will be given of the IRPEC Project and CAPS participation in it.
BRIEF DESCRIPTION OF THE IRPEC PROJECT

This project started in the Research Department of CVT (Center for Victims of
Torture in Minnesota, USA). This organization would subsequently coordinate
the project activities which would focus on several countries in America, Africa
and Asia, especially in Sierra Leone, Kenya, Pakistan, Cambodia and Peru.
The main objective of this several-year long project (starting in 2005 and still
continuing) was to develop in some of the treatment centers for torture victims
participating in the International Capacity Building (ICB)1 project, CAPS
being one of them, capacities for research and evaluation of rehabilitation
programs based on objective evidence.
The following specific objectives are outlined in the official information about
the project:
1 THE INTERNATIONAL CAPACITY BUILDING PROJECT is an initiative of CVT directed at the

development of capacities and the implementation of direct services in 19 rehabilitation
centers for victims of torture (in the project called partner centers) in different regions of
the world: Bangladesh, Bulgaria, Cambodia, Ethiopia, Guatemala, India, Kenya, Kosovo,
Namibia, Nepal, Pakistan, Palestine, Peru, Rumania, Rwanda, Sierra Leone, South Africa,
Sudan and Uganda. The project has provided technical assistance subsidies and
regional training workshops, with the purpose of developing abilities in clinical work,
investigation and the evaluation of programs, and in technological and organizational
development.

a) To increase the ability to monitor and evaluate the effectiveness of

their interventions with torture survivors (evaluation of the results and
processes) in the IRPEC centers.
b) To develop in the IRPEC centers capacity to conduct research with
the torture survivors (with a particular focus on investigation of the
interventions).
c) To develop “regional expert centers” with the skills and capacity to
become a resource for other centers or programs in their region regarding
program evaluation and research.
d) To create tools and methodologies for the evaluation of programs which
have proved useful and can be effectively implemented by organizations
carrying out advocacy activities/education and treatment for torture
survivors, related groups and the general public.
The project has been designed to develop skills and create tools, first to
answer basic questions concerning the evaluation of programs and then
to create the capacity to respond to more complex questions over time.
IRPEC started off with the following assumption: first, as an initial strategy,
to encourage “research experts” to answer complex research questions in
a scenario destined for failure and frustration. Moreover, this strategy does
not develop or avoid the development of internal local skills (in the partner
centers)2 that should support future efforts of evaluation and research. The
latter point, related to the sustainability of work, is of key importance for the
objectives of this specific project.
Below are summarized some of the beliefs and assumptions on which the
IRPEC project is based:
l It is of fundamental importance to develop local capacities, including

the teams of the centers participating in IRPEC at the different stages
of the process, from the drawing up and design of plans, projects or
research methodologies or monitoring and evaluation, to data collection
and their analysis and interpretation.
l Collaborative relationships should be developed with partners in the
project so that the needs of each of the organizations may be met, while
at the same time creating in them the capacity to use their findings, which
2 In this case these are the 19 torture rehabilitation centers participating in the ICB project
outlined in footnote 1.
10

will in turn contribute to broader knowledge regarding the treatment of

torture cases.
l When it comes to evaluating individual recovery there should be
emphasis on the individual’s ability to adapt and function in daily life
and the physical and psychological post-traumatic symptoms. This is
an important point or objective of the project: to develop tools that will
contribute to the increasing “measurable areas” of adaptive aspects. To
date, most of the tools to measure the recovery of survivors of torture
are related to the measurement of psychological symptoms of anxiety,
depression or post-traumatic stress.
l It is proposed that work should be carried out with partner organizations,
training them in research methodologies, in order to create culturally
appropriate tools which explore not only symptomatology, but also the
patients’ recovery in areas related to their “functioning” in everyday
life. This is seen as one of the main ways in which the project has the
opportunity to contribute in the field of treatment for victims of torture.
This has resulted in the production of culturally specific tools.
l The starting point should be an in-depth exploration of local ideas and
assumptions about what constitutes well-being, adaptation and suffering.
The project has constructed tools, which have successfully incorporated
these local conceptions, in order to measure the recovery. The instrument
used in this research is precisely an example in this regard.
l We suggest that the impact of interventions be measured beyond
the individual and temporal dimension, that is to say, in families and
the community as a whole, and should include the post-intervention
situation and follow-up measurements.
CAPS PARTICIPATION IN IRPEC

The Center for Psychosocial Attention (CAPS) is one of the few institutions in
Peru dedicated to psychological treatment for survivors of the political violence
that affected the country during the period 1980-2000. It has carried out this
work for the last sixteen years, initially within the National Coordinator for
Human Rights and then as an independent institution. In the early years the
services essentially consisted of psychotherapy or individual psychological
counseling basically from a psychodynamic perspective. Subsequently
social attention services and psychiatric care were added. Over the years the
11

institution has evolved, providing other types of services linked to the field
of mental health, including group or community work. The psychodynamic
perspective remains the main framework of approach in the different services
but in recent years other social science disciplines with other approaches have
been incorporated.
It is necessary to emphasize that the psychologists that provide psychological

counseling services and psychotherapy make up the largest group in CAPS. It
is also important to say that along the years this group has standardized certain
criteria for attention, which means that the institution carries a particular
hallmark even though in a field such as that of psychological treatment there
is evidently a lot of scope for the individual approach of each therapist.
CAPS developed the Monitoring and Evaluation Program in the middle of

2004 and began implementing it on a permanent basis at the end of that year.
The initial impetus for the creation of this program was given by a project
(“Actions for Prevention and Mental Health Care and Human Rights within
the Framework of the Comprehensive Reparations Program”) financed by
USAID, which began in June 2004. The first contacts with the coordinators of
IRPEC occurred in 2005 but the IRPEC project only began operating officially
with CAPS as an associate member in 2006. The contact with the IRPEC
personnel in 2005 helped to shape the Monitoring and Evaluation plan and
some methodological aspects.
Before the formal incorporation of CAPS into IRPEC in 2006, the Monitoring
and Evaluation Program and Comprehensive Care Area of the institution had
already carried out joint studies regarding the work in psychotherapy. They
had, for example, developed several assessment tools which were applied to
different beneficiaries of the services. The results were added to the Recovery
Cards. Since 2004, the institution had been developing a complete database
with socio-demographic information on the patients as well as with data of
their victim status, diagnosis and a complete record of the sessions and type
of service received. Based on this information a report was written in 2006
in which a sample of patients was taken and different variables were crossed
such as age, gender, combination of services, number of sessions, diagnosis
and recovery indicators. Earlier, in 2005, a specific qualitative study had been
carried out on patients who had left the therapeutic treatment in order to start
an investigation into the effects of the therapeutic process and the reasons for
leaving it.
12

However, despite the significant efforts of CAPS to develop the area of

monitoring and evaluation, until 2007 it had not developed systematic or
rigorous tools to measure the results of individual psychological intervention
which should have included a better selected sample, more accurate
instruments for measuring recovery and a more detailed analysis of the
narratives of patients and therapists.
IRPEC constantly supported the activities of the M&E area during 2006 and
2007, not only through financial support, but also with technical advice and
offered the possibility to exchange learnings between different partner centers
of the project through on-site workshops or apprenticeships. After two years
of developing and consolidating the area, and learning we agreed with CVT
to move on to another stage: to undertake a serious investigation into the
effects of psychotherapeutic interventions in CAPS itself.
The results of this research are precisely the subject of this book. Below we are
going to present the four components of this work.
13

14

1
Components of the Investigation
of the IRPEC Project
1.1. COMPONENT 1:
CREATION OF THE SELF-PERCEPTION SCALE
OF PSYCHOSOCIAL CONSEQUENCES OF
POLITICAL VIOLENCE
1.1.1 INTRODUCTION
One of the principal lines of research within the IRPEC project is the
development of screening protocols (clinical and epidemiological) to identify
psychological consequences associated with political violence. The following
activity forms part of this category. The work consisted of developing a
methodology to create a tool that had previously been used in several countries
and continues being used as an initiative of the Research Department of the
Center for Victims of Torture in Minneapolis.
1.1.2. OBJECTIVE
The creation of an instrument for identifying mental health problems in adult
survivors of political violence that would include the cultural characteristics
of the people and which could be used in general health services and mental
health institutions.
1.1.3. METHODOLOGY EMPLOYED IN CONSTRUCTING THE SCALE

The objective of this work was to create an instrument for measuring mental
health problems (behavioral, relational, social, psychological, somatic)
derived from situations of political violence, which would identify a certain
population, using their own local terms.
15

The idea was that the items of the instrument would correspond to what that
particular society and culture conceives as a mental health problem resulting
from political violence and, in addition to this, that they should be aspects
which could be modified by psychological treatment.
We worked in three different areas: rural (Huancasancos, Ayacucho),

semi-rural (Hualashuata, Junín) and urban (Huanta, Lima). In these three
communities, CAPS has developed a variety of psychological interventions
(individual, group or community) and we had the necessary contacts to carry
out a proper collection of information.
The methodology employed to develop the instrument had various stages

which will be described briefly below.
First of all, we chose people in each of these three areas to conduct ethnographic
interviews ensuring that we had a similar number of men and women. Thirty
interviews were held in each community, making a total of ninety. These
interviews were based on a simple question: “Could you describe in short
sentences three or four problems that a person who has experienced political
violence has?” The respondent should think of a specific person they knew
and describe their particular problems instead of making generalizations3.
If they did not know anyone personally, the interview was discarded. Each
respondent had to describe a man and a woman.
The result of each interview was a list of problems per interviewee. On

average there were eight problems per person. Finally, after thirty interviews,
we obtained approximately 240 different problems for each community.
Work on the ethnographic interviews involved a second stage. Every problem

identified by each respondent was placed on a card, numbered to distinguish
it. Once we had the cards ready, we organized a meeting with a group of seven
people of the community, specifically inviting community promoters familiar
3 At the beginning the idea was to choose people of a community at random. However,
in practice, in the first place that we went to in the marginal urban zone of Huanta in
Lima, we realized that this was very complicated. The main problem is that the people
regard it as very peculiar that a stranger should come to ask questions of that type, which
are very sensitive because of the problems experienced in the past and because of the
remaining fears of persecution among the population. We therefore opted to interview
people recommended by others whom we already knew (from work previously carried
out). This diminishes considerably the fear of being interviewed and helps it to flow.
16

with the work with victims of political violence. The aim of this meeting was
that everyone should classify or sort the cards into different groups. They
were asked to group the cards into categories, name the category and note
the order of importance (depending on the frequency of items per category).
Later, when everyone had finished their own sorting, the lists of categories
of each person were written on a board or a flipchart. Everyone was asked
to explain briefly what type of descriptions they included or what they meant
by them, which could generate some discussion in the group. After this
everybody was asked to sit at the same table, they were given another pile
of the same cards and asked to make together a group and classification of
the cards.
After compiling the information obtained from the sorting meetings, we

prepared short reports in which we placed the different lists of problems
obtained, adding individual entries on the meaning of the various items (for
the participants).
The next step was to compare the three lists of the three communities and
attempt to develop a common list based on the total or partial coincidences
found. In order to do this we had to revise even the cards which stated what
each category represented. To obtain the final list we had to hold several
meetings. The Monitoring and Evaluation team of CAPS and a group of
therapists of the institution also participated in them. When we had the list of
items or problems, we proceeded to draw up the questions which the patients
would be asked, transforming each item into a question. The final categories
and questions should reflect the views expressed by the participants in the
study, employing the same terms used by them.
1.2. COMPONENT 2:
EVALUATING THE RESULTS OF INDIVIDUAL
PSYCHOLOGICAL INTERVENTIONS IN CAPS
(LIMA)
1.2.1. INTRODUCTION
Before 2008, CAPS had already carried out some studies into the results of
psychotherapeutic work. However, systematic or rigorous investigation into
17

the results of individual psychological interventions which would involve the

follow-up of patients and the use of standardized quantitative tools had not
been developed. This is exactly what the present component of the research
aims to do, which we also consider it its main component.
1.2.2. OBJECTIVES
l To determine the statistical reliability of the newly created tool.
l To ascertain the degree of recovery of the patients who attend the service
of psychotherapy, both globally as well as in certain areas.
l To relate the recovery of the patients with other socio-demographic
variables.
l To group the items of the recently created tool into a set of factors
through statistical analysis and compare them with the areas (categories
of problems) currently existing in the people treated at CAPS.
1.2.3. METHODOLOGY
To measure the results of therapeutic interventions we resorted to the new
tool we described in component No.1 of the research: the Self-perception
Scale of the Psychosocial Consequences of Political Violence (the one based
on the methodology used by the Research Department of the Center for
Victims of Torture in Minneapolis.)
The initial purpose of the sample was to receive all the patients who had been
survivors of torture (according to the broad sense of the term adopted by the
UN, which includes survivors of massacres and relatives of those tortured,
murdered and disappeared), who would receive psychological treatment in
CAPS throughout 2008. All these patients had to be given the scale before
the start of therapy and after fourteen weeks4. However, upon reaching
December 2008 it was decided to expand the period of taking in new patients
by a further three months due to the low number of patients that had been
attended at that point.
It is important to say that our aim was always that that new tool (which
from now on we will call SSPCPV –Self-perception Scale of Psychosocial
Consequences of Political Violence) should become the official tool for
measuring the psychological interventions carried out in CAPS.
18

At first we had an initial sample of 70 patients with the entry scales and 42
with entry and exit scales. We produced the final research report in August
2009 with these cases. In early 2010, while writing this book, we had a larger
number of cases in the CAPS database, because the tool had been continued
to be used after the investigation. We decided to re-do all our analyses with
the new, enlarged sample. Finally, in this book we are using a sample of 125
patients with entry scales and 56 with entry and exit scales.
1.2.4. ANALYSIS
Component 2 of IRPEC should first of all measure the degree of statistical

reliability of the test. Subsequently we had to determine the degree of
psychological recovery of the patients who attended the services, exploring the
overall changes found (mean differences), those found among the 38 different
items and the ones found among the areas or general sub-areas identified by
the CAPS psychotherapists5.
Additionally, we crossed recovery items with a series of socio-demographic

variables (income, sex, education, place of origin, degree of rurality, etc.) as
well as variables directly related to the patient (type of effects, diagnosis) and
the treatment (number of sessions, type of therapist, combination of other
services).
Finally, a factor analysis was conducted with the various items of the test and
we compared it with the recovery areas formulated in CAPS.
At the stage of statistical analysis constant support was received from the
research team of CVT.
4 This coincides more or less with the period of twelve sessions of the treatment plan that
CAPS has decided to establish.
5 As has been explained, as soon as the new tool was created in CAPS, the 38 items were
classified into broader categories. The result was a list of 8 areas. This was done jointly
by the team of therapists and the investigation team, the result of several discussion
meetings.
19

1.3. COMPONENT 3:
EXPLORATION OF CAPS MATERIAL PRIOR TO
THE INVESTIGATION
1.3.1. PRESENTATION
With a view to developing future research based on what CAPS has collected
regularly during the work of monitoring and evaluation of both individual
and group therapeutic processes, we believed that we should first start with
a review and compilation of the materials used so far. We considered this
the first step to develop a more thorough investigation in the future, which
would try to explain the results of the therapeutic processes by crossing both
quantitative and qualitative variables.
The first thing we attempted was to do as much as we could to complete

the database with information from the instruments we had used throughout
several years. At the start of this work (2007) there were some gaps or a
considerable amount of material that had not been entered into the M & E
system. We decided to enter into our database the maximum possible amount
of information from the files, which included both socio-demographic data
as well as other type of data regarding the patients (diagnosis, conditions of
victim, test results, etc.).
We set ourselves December 2007 as a deadline for admission of patients (just

before the entrance of the patients of the Second IRPEC Component) and
June 2004 as the starting date, when the USAID project started in CAPS and
also the time when we had much more complete information in the database.
After having done it as well as possible, we explored the possibilities offered
for research, that is, we looked in the different variables to see if we had a
good enough sample. The variables were then related, after conducting a
preliminary analysis of this information. This material should be useful for
suggesting future avenues of research, which could be carried out in the
coming years.
20

1.3.2. OBJECTIVES
l Relate the characteristics of the patients receiving treatment (number of

sessions6, diagnosis, combination of services7, gender of the therapist,
etc.) with other socio-demographic variables of the person (gender, age,
rural/urban origin, level of education, economic status, etc.).
l Relate patients’ type of recovery (according to categories on the recovery
scale) with socio-demographic variables (gender, age, rural/urban origin,
level of education, economic status, etc.) and characteristics of the
patients receiving treatment (number of session, diagnosis, combination
of services, gender of the therapist, etc).
1.3.3. ACTIVITIES
Input of quantitative information

There were several variables in the database for which there was no virtual
information available. We had to update the data. We had to reopen the
books containing case histories and record this information in the database.
Statistical work and preliminary analysis of existing information
This work began with discussion meetings of the research team to decide
which information needed to be crossed.
This was followed by a process of transforming information of the various

variables of the database (or recodifying of variables) in the SPSS program
in order to be analyzed. For example, some constant variables such as age
or number of sessions were transformed into categorical variables such as
age groups (from 0 to 10 years, 10 to 20 years, etc.), groups of numbers of
sessions (from 11 to 15 sessions, 16 to 20 sessions, etc.). This transformation
is based on different syntaxes developed in this program.
6 Number attended.
7 Number (total) of services used.
21

Subsequently we proceeded to use the statistical tools of the program and to

develop different cross correlations between variables.
In this process we had the valuable support of Greg Vinson from CVT,
who came to Lima especially to work on the various syntaxes and develop
statistical reports.
The strictly statistical work had two stages. The first supported by Greg Vinson
(2008) and the second, from mid-2009. In the latter, new reports were written
and, in general, the previous ones were re-written incorporating the changes
in the database (the new entries since 2008).
In this book we present only a small part of this work. Specifically, data of
the CAPS psychotherapy patients in Lima, as this is a similar sample to that
presented in the main IRPEC study.
22

2
Description of CAPS Patients
2.1. CHARACTERISTICS OF THE PATIENTS

ATTENDED AT THE CAPS MAIN OFFICE IN LIMA
(2004 – 2007)
In this section we will present some data from patients who began treatment
in CAPS Lima office between June 2004 and December 2007, that is to
say, before the start of the IRPEC project. The information comes from the
database of the institution and will give a better idea of the type of patients
CAPS has attended in the past, which can serve as a framework or context
to help us explain the findings of the IRPEC project. This sample amounted
to 443 persons. We are going to present the information from only a few
variables, generally others than those we present for the IRPEC project sample
later in this document8.
l VICTIM STATUS
On entering the CAPS the beneficiaries should provide information regarding

themselves including the types of human rights violations of which they have
been victims. We call “victim status” the type of human rights violation/s that
people have suffered. Each person can have more than one category. This is
why the number of statuses which can be seen in the following table (708) is
much higher than the number of people (443).
In the table below we can see that the most common status is torture, followed
by relative of a murdered person, victim of domestic violence, relative of a
tortured person and others9.
8 This is just a small proportion of all the work done for Component 4 of the IRPEC Project
which we have already summarized in the Chapter 1.
9 The category others covers different conditions which are put together there due to the
low frequency.
23

VICTIM STATUS Frequency

Tortured 127
Relative of murdered person 58
Domestic violence 53
Relative of tortured person 45
Others 40
Relative of imprisoned person 39
Relative of disappeared person 39
Pardoned 38
Acquitted 37
Displaced 35
Relative of pardoned person 35
Relative of murdered person 32
Relative of a former prisoner – served 27
sentence
Relative of acquitted person 26
NGO Personnel 19
Served sentence 15
Refugee 8
Relative of a displaced person 8
Personnel of the Armed Forces 7
Does not belong to the target population 7
Rape victim 7
Conditional freedom 6
TOTAL 708
24

l SIGNS AND SYMPTOMS PRESENT AT THE BEGINNING OF TREATMENT
Prior to the beginning of the IRPEC research (before 2008) every time a
patient started psychotherapy in the institution the therapists made a note of
the symptoms, on observing his or her behavior or after a series of questions.
This procedure was repeated towards the end of treatment. The assessments
were transferred onto a symptomatology file of 35 items. Unfortunately, we
only have a sample of an acceptable size in the case of the files filled at the
start of the treatment.
Below we are going to show the results of these entry files (frequency of
occurrence of each symptom). It is worth adding that the total number of
patients with these entry evaluations is 277.
25

SYMPTOMS Number Percentage of cases
Sadness 148 53%

Generalized anxiety 101 36%
Decreased self-esteem 99 36%
Insomnia 87 31%
Mistrust 81 29%
Fears / phobias 73 26%
Impulsiveness 72 26%
Poor appetite 61 22%
Violent behavior/hostility 55 20%
Nightmares (traumatic) 53 19%
Feeling of emptiness 51 18%
Suspiciousness 49 18%
Problems of attention 47 17%
Flat affect 44 16%
Hypervigilance 40 14%
Problems with short-term memory 39 14%
Decreased libido 34 12%
Excessive appetite 26 9%
Incongruous affect 25 9%
Flashbacks 23 8%
Panic attack 15 5%
Hypersomnia 15 5%
Paranoid delusions 15 5%
Lack of awareness of problem 10 4%
Amnesic episodes 9 3%
Increased libido 8 3%
Dissociative symptoms 8 3%
Euphoria 7 3%
Substance abuse 6 2%
Compulsive obsessions 6 2%
Altered reality testing 6 2%
Problems with spatial awareness 6 2%
Disruptive behavior (children) 5 2%
Depressive delusions 4 1%
Depersonalization 3 1%
26

We can see that the ten symptoms most commonly reported by the
psychologists in order of importance are: sadness, generalized anxiety,
decreased self-esteem, insomnia, mistrust and fears/phobias, impulsiveness,
poor appetite, violent behavior/hostility, nightmares (traumatic).
l DIAGNOSES
In the main office of CAPS in Lima it is common practice to record a diagnostic

impression when the beneficiary starts at the institution. In the entry period
between July 2004 and December 2007, 245 cases were diagnosed according
to criteria of Axis I of DSM IV10. The results, carried out in CAPS, showing a
group of 10 major areas are presented below:
Proportion of patients grouped in diagnostic

categories
10 When CAPS first started, the psychotherapists did not have the custom of diagnosing
patients according to DSM IV criteria. Since CAPS therapists are psychodynamically
oriented they preferred to use psychodynamic categories. On the other hand, CAPS
psychiatrists always used DSM criteria. Between 2004 and 2005 the institution decided to
standardize diagnostic criteria and chose to make the use of DSM obligatory.
27

We can see that the most common diagnoses were depressive disorders (48%,
almost half); the next most frequent are anxiety disorders (14%), followed
by post-traumatic stress (12%), those associated with psychosis (8%) and
adaptive disorders (5%).
Cross-tabulating the diagnoses with the gender variable we find only two
statistically significant results: the proportion of women diagnosed with
depressive disorders is significantly higher and so is the proportion of men
diagnosed with anxiety disorders. Cross-tabulating the diagnoses with other
variables we do not find statistically significant results.
l NUMBER OF SESSIONS OF TREATMENT ATTENDED
CAPS has also kept a record of the number of sessions patients attended in
different services. Below we present a summary of what was found in the
database before 2008. First, there is a small table with general information
regarding this, which shows that the maximum number of sessions was
303. The set has an average of 19.74 sessions with a standard deviation of
29.94.

Sample Maximum Average Standard
No. of deviation
sessions
TOTAL NUMBER OF 443 303 19.74 29.944

SESSIONS

The following graph shows the frequency of sessions, having grouped sessions
together starting from the eleventh. One of the interesting points we have
discovered while exploring this issue is that 50% of the people do not exceed
8 sessions:
28

Frequency of cases by number of attended sessions
In the following table we have crossed-tabulated the variable of number of

sessions with type of service. We can see that the type of service with the
highest average of sessions is physical therapy, followed by psychotherapy,
social care, and finally psychiatry.
NUMBER OF SESSIONS Sample Maximum Average Standard

no. of deviation
sessions
Psychotherapy 281 119 15.48 20.09
Social work 316 131 6.10 12.10
Physical therapy 30 98 20.37 22.86
Psychiatry 179 56 6.62 9.52
Below we are going to cross-tabulate with the number of sessions but we will
restrict it to psychotherapy sessions as this sample is the most similar (the
same type of service) to the one in the study regarding the SSPCPV Scale.
29

By victim status: When doing a cross-tabulation of the average number of

psychotherapy sessions with the different victim statuses, we discovered that
rape victims have a considerably higher average (58 sessions) but this figure
is not reliable because of the small sample of cases (only 3 valid cases). This
group is followed by relatives of murdered people, who had far fewer sessions,
a mean of 21.49, the families of disappeared persons with an average of
20.53 sessions and last, personnel from the Armed Forces with an average of
20.40. The refugee group has the lowest average number of sessions (only
4.5). We also find that tortured people have an average of 15.46 sessions.
The corresponding table is below:
VICTIM STATUS Number of individual psychology sessions
Mean Valid number Standard

of cases Deviation
Rape victim 58.00 3 23.39
Relatives of murdered person 21.21 62 25.54
Relatives of disappeared persons 20.53 19 26.51
Armed Forces personnel 20.40 5 23.84
Relatives of persons of other 17.05 95 20.60

statuses
NGO personnel 16.53 19 13.59
Tortured people 15.46 72 20.11
Displaced people 13.22 18 13.46
Former prisoners 11.80 49 14.26
Domestic violence victims 10.74 43 11.80
Other statuses 9.64 25 12.77
Refugees 4.50 6 5.47
30

By age groups: When we associate the average number of psychotherapy

sessions with age groups we found that the group with the highest average
number of sessions is the one between 51 and 60 years of age while the
lowest average belongs to the group over 60 years of age. However, on
carrying out the ANOVA statistical test on one factor and post hoc multiple
comparisons, we did not find any statistically significant differences between
the different groups.
AGE GROUPS Number of individual psychology sessions
Mean Number of Standard

valid cases deviation
0 to 10 years 19.64 14 24.62
11 to 20 years 14.00 47 18.62
21 to 30 years 16.10 60 21.85
31 to 40 years 12.58 81 13.06
41 to 50 years 17.15 48 21.64
51 to 60 years 21.71 24 30.63
Over 60 years 12.57 7 16.33
By gender: We have crossed the means of psychotherapy sessions with the

gender variable and have found that the average number of sessions for
women (16.33) is higher than that for men (14.15). However, this difference
is not statistically significant.
By origin: Cross-tabulating the average of sessions according to rural/urban

origin we can see that those of urban origin have a higher average (16.07)
than those of rural origin (11.18). Even though the difference is big, it is not
statistically significant.
31

By level of education: When looking at the number of psychotherapy

sessions by level of education of the beneficiaries we discovered important
differences. However, it is interesting that the two highest peaks of sessions
are at the two extremes of levels of education: those with no education
(average of 20.60 sessions)11 and those with higher education (average of
17.07 sessions):
LEVEL OF Number of individual psychology

EDUCATION sessions
Mean Valid Standard

number of Deviation
cases
None 20.60 5 29.42
Primary school 15.10 41 19.43
Secondary school 13.40 99 16.70
Higher education 17.07 122 22.17
This could be related to the pressure exercised by deprivations/aspirations on

patients with a lower level of education (eager to find a space for themselves
and a person who listens to and understands them) and, in the case of those
with a higher level of education, there could be a greater understanding of
the nature of the treatment.
By diagnosis: When we crossed the average number of psychotherapy

sessions with diagnoses we found that the cases of psychosis have the highest
average number of sessions (22.5), followed by depressive disorders (20.31),
post-traumatic stress (15.04) and anxiety disorders (14.9). However, these
differences are not statistically significant.
11 Unfortunately the sample is only 5 cases.
32

l INDICATORS OF RECOVERY
CAPS had used another kind of measurement of patient recovery for a

number of years before using the scale introduced by the IRPEC project. It
was a more qualitative or interpretive type of assessment.
In this assessment (which was carried out at the end of the therapy
or when it was interrupted) the patient had four scoring options: IR0
NO EVIDENT IMPROVEMENT; IR1 RELIEF OF SYMPTOMS; IR2
IMPROVED INTERPERSONAL RELATIONS; IR3 GREATER PERSONAL
INTEGRATION.
These categories were not mutually exclusive, except for IR0 (NO EVIDENT
IMPROVEMENT). People could show recovery in one of the other three
areas, in two or in all three.
The final decision on the status of each case was taken by the Coordinator of
Comprehensive Attention, and was based on two main sources:
l The Evaluation of the Therapist regarding the case when the therapy
was completed or interrupted. This was recorded in a file in which he
noted his assessment (stating the corresponding indicators of recovery)
and justifying them.
l The patient’s Recovery File, which was a sheet summarizing the different
instruments that were in the patient’s clinical history. It contained
evaluations of symptoms made by the psychotherapist and/or psychiatric
and/or physiotherapeutic evaluations.
The results shown below were taken from a sample of 167 cases12. The first
noticeable point is that the percentage of people who have achieved some
degree of recovery is very high: 85.6%. In addition to this, 137 (82%) of
those 143 persons, i.e. the vast majority, reached a level of symptom relief,
97 (58.1%) achieved an improvement in their interpersonal relations and
a quarter of the patients (43 people, 25.7%) achieved better personal
integration.
13 Let us remember that a person may have been qualified with more than one indicator as
the sum of the scores is not 167.
33

RECOVERY INDICATORS Number % of valid

of cases cases
NO EVIDENT IMPROVEMENT 24 14.4
RELIEF OF SYMPTOMS 137 82.0
IMPROVED INTERPERSONAL RELATIONS 97 58.1
GREATER PERSONAL INTEGRATION 43 25.7
Total 167 100.0
The recovery indicators were also cross-tabulated with other variables.
With the type of victim: We can see that the NGO staff category has a higher
proportion of persons with the indicator “better interpersonal relations” and
the indicator “greater personal integration” (statistically significant regarding
many categories). Importantly, in this category there are no patients who have
not experienced at least some improvement13. On the other hand, the relatives
of murdered people and the relatives of disappeared people complete the
treatment with “better interpersonal relations” compared to other conditions.
Among the other categories we observe differences in the types of indicators
of recovery but they are not statistically significant.
13 A very distinctive feature of this group is that it is formed by persons with a high level of
education.
34

RECOVERY Tortured Relative of Former Relative of Displaced Relative NGO Victim of Others
INDICATORS person murdered prisoner disappeared person of other Personnel domestic
person person violence
N14 %15 N % N % N % N % N % N % N % N %
NO EVIDENT
IMPROVEMENT 10 26 5 13 7 26 0 - 2 17 9 14 0 - 3 12 3 23
SYMPTOM RELIEF 28 72 32 80 20 74 12 86 10 83 53 80 13 100 22 88 10 77
BETTER
INTERPERSONAL
RELATIONS 18 46 26 65 13 48 11 79 8 67 37 56 11 85 10 40 8 62
GREATER
PERSONAL
INTEGRATION 5 13 11 28 3 11 5 36 3 25 12 18 8 62 4 16 4 31
With age groups: While doing the Z-test of proportionality, we found

the following statistically significant differences: The 41 to 50 year-old age
group has a higher proportion of people with “symptom relief” compared to
the 21 to 30 year-old age group but a much smaller proportion of people
with “greater personal integration” as compared to several other groups.
Furthermore, the group of 51 to 60 years has a higher proportion of people
with “better interpersonal relations” compared to the 0 to 10 year-old age
group.
RECOVERY INDICATORS 0 to 10 11 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70 Over 70

years years years years years years years years
N16 %17 N % N % N % N % N % N % N %
NO EVIDENT
IMPROVEMENT 1 10 2 8 8 22 10 19 2 7 1 9 0 - 0 -
SYMPTOM RELIEF 7 70 22 88 26 72 43 81 25 93 9 82 4 100 1 100

BETTER INTERPERSONAL
RELATIONS 4 40 14 56 25 69 28 53 13 48 9 82 3 75 1 100
GREATER PERSONAL
INTEGRATION 2 20 5 20 13 36 14 26 2 7 5 45 2 50 0 -
14 Number of cases.
15 Percentage of cases within this victim status.
16 Number of cases.
17 Percentage of cases within this age group.
35

With gender: A higher percentage of men did not present improvement;

women have higher percentages in the indicators of improvement. But in no
cases are these differences statistically significant after performing the Z-test
of proportionality.
RECOVERY INDICATORS Number % of valid Number % of valid

of men cases of cases
column women column
NO EVIDENT IMPROVEMENT 11 18.03 13 12.26
SYMPTOM RELIEF 48 78.69 89 83.96
BETTER INTERPERSONAL RELATIONS 32 52.46 65 61.32
GREATER PERSONAL INTEGRATION 14 22.95 29 27.36
With rural/urban origin: We found that the percentage of people who

do not show improvement is slightly higher among the population of urban
origin and the percentage who experience symptom relief is higher among
the rural population. However, in the other categories (“better interpersonal
relations” and “greater personal integration”) the urban-origin population has
a higher proportion. Having said this, we must add that having done the
corresponding statistical test, these differences are not statistically significant.
With level of education: There is a higher proportion of people who do

not show any improvement in the group that has elementary education and
a greater proportion of people who experience some form of improvement
in the group that has higher education. Likewise, in the group that has
higher education there is a higher proportion of people with other indicators.
However, despite the tendency that the higher the level of education the
greater the chance of recovery, particularly in the indicators “better personal
relations” or “personal integration”, after using the Z-test of proportionality,
this trend is not statistically significant.
With the number of sessions of psychotherapy: This time we have

created broader categories of numbers of sessions so that the information
may be less dispersed.
36

RECOVERY INDICATORS 1 to 5 6 to 12 13 to 20 21 to 30 Over 30

sessions sessions sessions sessions sessions
Number of Number of Number of Number of Number of
cases cases cases cases cases
NO EVIDENT 6 12 4 1 1
IMPROVEMENT
SYMPTOM RELIEF 16 42 34 18 27
BETTER INTERPERSONAL 6 19 32 13 27
RELATIONS
GREATER PERSONAL 1 9 12 10 11
INTEGRATION
At first glance we can see that the greater the number of sessions a patient
has, the greater the evidence of some improvement and also that there is a
positive correlation between the number of sessions and the likelihood of
going beyond “symptom relief” to “better interpersonal relations” and “greater
personal integration”. On doing the Z-test of proportionality we found both a
significant difference for groups with more than thirteen sessions on the first
two of these indicators of recovery as well as a larger number of patients who
showed no improvement among those who had less than thirteen sessions.
Session 12 was set as a cutoff point because this is the maximum number of
sessions in CAPS’ new strategy for focal therapies. We can see that the group
which has between 6 and 12 sessions (this is how long patients are generally
currently in therapy given the new strategy) achieves symptom relief in up to
77.8% of cases, better interpersonal relations in 35.2% of cases and greater
personal integration in only 16.7% of cases.
37

2.2. SPECIFIC CHARACTERISTICS OF THE IRPEC

STUDY PATIENTS
Below we are going to show a few characteristics of the sample of 125 people
who did the entry test.
l GENDER
The population is mainly female, with women constituting 66.4% of the cases
while only 33.6% are men. This gender distribution is different from that of
patients prior to 2008; in the latest sample there is a higher proportion of
women than in previous years18.
GENDER
Frequency Percentage
Men 42 33.6
Women 83 66.4
Total 125 100
l BIRTHPLACE
Regarding the department of birth, nearly half of the population (44.8%)

comes from Lima. Ayacucho is the second most common place of birth with
17.6% of the cases; the third is Junín with 7.2% of the cases and the fourth,
with 5.6%, is Huánuco. In general, this distribution of patients by department
of origin is almost identical to that of previous years in the main offices of
CAPS19.
18 In the previous CAPS database the proportion of women was 55.5% while the proportion
of men was 44.5%.
19 In the CAPS database prior to 2008, 43.3% of patients had been born in Lima and 16.2%
in Ayacucho; Junín and Huánuco are the next two most frequent places of origin, with
6.5% and 4.5% respectively.
38

ANCASH 1 0.8
APURIMAC 6 4.8
AREQUIPA 2 1.6
AYACUCHO 22 17.6
CAJAMARCA 2 1.6
CALLAO 1 0.8
CUSCO 4 3.2
HUANCAVELICA 2 1.6
HUANUCO 7 5.6
ICA 2 1.6
JUNIN 9 7.2
LA LIBERTAD 1 0.8
LIMA 56 44.8
PASCO 2 1.6
PIURA 1 0.8
PUNO 3 2.4
SAN MARTIN 1 0.8
TUMBES 1 0.8
FOREIGNER 2 1.6
Total 125 100
l MARITAL STATUS
Here we present the proportion of people according to marital status. This

proportion is similar to that of psychology patients in previous years.
39

Single 42 33.6
Married/consensual union 66 52.8
Divorced/separated/ 14 11.2
widowed
Total 122 97.6
No data 3 2.4
125 100
l RURAL / URBAN ORIGIN
The proportion of urban residents is significantly higher if we look at the

valid percentage: 64.8% are of urban origin and 35.2% are of rural origin.
This distribution is identical to the one CAPS previously had for psychology
services. While 64% of the patients treated in Lima between 2004 and 2007
are of urban origin, 36% are of rural origin.
Frequency Percentage Valid

percentage
Rural 37 29.6 35.2
Urban 68 54.4 64.8
Total 105 84.0 100
No data 19 16.0
125 100
l AGE

In the sample we found an average age of 38.04 with a standard deviation
of 12.73. Shown below is the distribution of persons by age groups in a
frequency table and in a comparative graph.
18 to 20 21 to 30 31 to 40 41 to 50 51 to 60 61 to 70
Frequency 12 18 31 27 32 5
40

Proportion of patients in different age categories

We can see that there is a balanced distribution of the different age groups
with the exception of people over 60 which make up a very small minority
(only 4%). We found very similar proportions of age groups in the former
sample of CAPS patients (prior to 2008)20. An interesting fact is that if we
take into account that the decisive period of political violence of the country
took place between 1980 and 1995, we can deduce that the patients below
the age of 30 who were included in our sample, around 25% of the total,
are probably mostly children or grand-children of the direct victims, since it
is unlikely that they could have been directly involved as children, although
in some cases they could have been minors who witnessed human rights
violation or massacres.
l LEVEL OF EDUCATION
Regarding the level of education (last level of studies whether completed or

incomplete) our sample has the following characteristics:
20 In the previous database we found an average age of 38.47 with a standard deviation
of 12.27 if we do not include patients below the age of 18 (to make a similar sample to
the one in the study which does not include people under 18).
41

Frequency Percentage Valid Cumulative

percentage percentage
None 3 2.4 2.5 2.5
Elementary 16 12.8 13.2 15.7
Secondary 52 41.6 43.0 58.7
University studies 50 40.0 41.3 100
Total 121 96.8 100
No data 4 3.2
125 100
Comparing the population who went to the main office of CAPS for
psychological treatment between 2004 and 2007 we have similar proportions
regarding level of education in our sample if we consider the valid percentage.
In previous years, 2.4% had no education, 17.1% had primary education,
38.6% had secondary education and 42% had higher education.
In order to have a better idea of the kind of survivors that approach CAPS
requesting attention we have compared them with the total number of people
at a national level who reported to the Truth and Reconciliation Commission
(TRC) that they had been tortured21. We find very important differences:
torture victims of the armed conflict (who testified before the TRC) generally
have significantly lower levels of education than the patients who have come
to CAPS and have participated in the IRPEC Project22. These differences are
shown in the following graph which compares both groups according to level
of education:
21 The information we are showing was taken from the Final Report of the Truth and
Reconciliation Commission (TRC, 2003).
22 These groups, however, are not completely comparable: As we mentioned earlier
the patients that were included in the IRPEC project belong to the broad category of
tortured. That is to say, not all these people were directly tortured but could be relatives
of murdered, disappeared or tortured people or witnesses of massacres. The comparison
is still interesting though.
42

Comparison between CVR torture victims and CAPS IRPEC patients
This comparison makes us think that the type of survivors that comes to
CAPS is not representative of the majority of victims at a national level, but is
a particular type of victim. Another important point is that education level is
related to two other variables: the degree of urbanization and socioeconomic
status, where the higher the level of education the greater the likelihood
of urbanization and better socioeconomic status. Unfortunately, we could
not compare these variables in the two samples through lack of available
information23. However, we can state that the patients that come to CAPS not
only are more highly educated than the average torture victims at a national
level, but are more urban and have higher socioeconomic status.
l VICTIM STATUS
With regard to the type of victim the patients participating in the sample
are, we found that 41.6% of them were directly tortured, 38.4% are direct
relatives of victims (who were neither killed nor disappeared)24, 25.6% had
23 In the CAPS sample we have information regarding rural-urban origins but not in the TRC
sample, although some information in the TRC such as the victims’ mother tongue or
occupation indicate a much higher degree of rurality than in the CAPS sample. In the
TRC 70% of the victims have Quechua as their mother tongue and 45% are peasants.
Regarding socioeconomic status we do not have information in either of the samples.
24 This category includes relatives of former prisoners, current prisoners and of tortured
people.
43

been in prison, 24.8% are relatives of murdered people, 8.8% are relatives of
disappeared people, 7.2% are displaced, 3.2% are victims of sexual abuse,
1.6% are military personnel, 0.8% are NGO staff and 8.0% belong to other
categories25 26.
Victim Status
Tortured Relative of NGO Former Relative of Sexual Displaced Military Relative Others
murdered staff prisoner disappeared violence personnel of other
member person victim statuses
52 31 1 32 11 4 9 2 48 10
41.6% 24.8% 0.8% 25.6% 8.8% 3.2% 7.2% 1.6% 38.4% 8.0%
The sample for the IRPEC study is different in this aspect, in comparison
to the patients who received treatment in the psychology services of CAPS
before 2008. A strict condition of the study was to work with patients who
belonged to the broad category of tortured people (which, in addition to
people who were directly tortured, includes relatives of the disappeared,
murdered and tortured, rape victims and witnesses of massacres). In the CAPS
database prior to the study we found that a large number of those treated
also belonged to this broad category of torture, but it also included other
types of people affected by sociopolitical violence who attended the services,
such as displaced people, residents of disaster areas or staff of human rights
NGOs27.
25 Among them there are people with conditional freedom, rape victims, armed forces
personnel, NGO personnel.
26 It is worth remembering that the categories are not exclusive. A patient may belong to
more than one. That is why the sum of categories (199) is much higher than the number
of cases (124).
27 In the CAPS database prior to 2008 we found that 27.9% of the patients had been directly
tortured, while relatives of murdered people constituted 20.9%, relatives of disappeared
people 9.7%, other relatives 28.1%, former prisoners 18.66% and the category “others”
amounted to 32.84%.
44

3
The self-perception scale of
psychosocial consequences of
political violence
3.1. THE SCALE28

1. Do you get nervous?
a) Always (4); b) Very often (3); c) Sometimes (2); d) Seldom (1);
e) Never (0)
2. Are you able to carry out well the activity (work, studies, etc.)
you do?
e) Never (0)
3. Do you feel your mood suddenly changes?

e) Never (0)
4. Do you feel you can claim your rights?

e) Never (4)
5. Have you beaten or physically attacked other people

(neighbors, friends, family)?
e) Never (4)
28 We have placed the options of answers and then in parentheses the score for those
answers.
45

6. Do you have sudden and strong memories of horrible images

you have experienced?
e) Never (0)
7. Are you patient with others?

e) Never (4)
8. Does drinking alcohol create problems for you or for others?

e) Never (0)
9. Are you able to finish the things you start?

e) Never (4)
10. Are you bad-tempered?

a) Totally (4); b) A lot (3); c) Regular (2); d) Little (1); e) Not at all (0)
11. Do you avoid talking about the period of political violence?

e) Never (0)
12. Do you have to make a big effort to get on with life?

e) Never (0)
13. Do you feel traumatized?

e) Never (0)
14. Do you like the things you do?

46

15. Have you drawn away from your family?

16. Have you verbally attacked other people (neighbors, friends,

family)?
e) Never (0)
17. Do you feel sad?

e) Never (0)
18. Do you have nightmares?

e) Never (0)
19. Do you believe that your situation will improve?

20. Have you drawn away from your friends and neighbors?
21. Do you mistrust people who surround or approach you?

a) Completamente (4); b) Mucho (3); c) Regular (2); d) Poco (1);
e) Nada (0)
22. Does your body hurt due to worries?

e) Never (0)
23. Do you find it difficult to remember things or retain ideas?

e) Never (0)
47

24. Do you feel you are neglecting your appearance?

e) Never (0)
25. Do you find it easy to concentrate on what you are doing?

26. Do you feel you are not worth much?

e) Never (0)
27. Do you neglect or have you neglected your family or children?

e) Never (0)
28. Do you get upset thinking that violence may return?

e) Never (0)
29. Are you afraid to leave your house?

e) Never (0)
30. Do you take drugs other than alcohol or tobacco?

e) Never (0)
31. Do you feel that your sleep is restful?

e) Never (4)
32. Do you participate in social or community meetings?

e) Never (4)
48

33. Do you have or have you had a wish to die?

e) Never (0)
34. Do you feel a desire to take revenge?

e) Never (0)
35. Do you feel that your body trembles?

e) Never (0)
36. Do you feel lost with regard to your future?

e) Never (0)
37. Do you feel you have lost affection for your family or people
close to you?
38. Do you feel happy with the way you are?

3.2. SPECIFIC CHARACTERISTICS OF THE SSPCPV

SCALE
This tool is used in CAPS to measure problems of mental health as a
consequence of political violence and is applied to patients – victims of
torture29. It consists of 38 questions with five options or levels of answer
(Likert scale).
29 Definition of torture in the United Nations Convention against Torture and Other Cruel,
Inhuman or Degrading Treatment or Punishment to which are added as victims the
relatives of murdered, disappeared and tortured people and witnesses of massacres.
49

The scale is an interview carried out by a psychologist (not a self-administered

tool). It is administered after the patients have gone through an admission
interview with the psychologist, which serves to fill in the Patient’s Treatment
Record. This preliminary interview serves, among other things, to determine
whether the patient is a victim of torture and eligible for treatment at CAPS.
The psychologist, who administers the scale, has instructions to read out loud
the 38 questions, exactly as they are written. She puts on the table two thick
strips of card of different colors on which are written the different answer
options and explains that according to the possible answers she will show the
interviewee another strip and asks him/her to choose one of the five answer
options on the strip he/she will be given. She stops to explain or rephrase the
question if, and only if, the person says that he/she does not understand it
or shows misunderstanding through his/her answers. The interview normally
takes between 30 and 45 minutes.
Furthermore, it should be highlighted that after administering the SSPCPV

Scale the patients go through a clinical interview with the institution
psychiatrist.
The psychologist who carried out the interview immediately enters the results
of the interview and the administered scale in the database using a template
designed especially for this purpose. This information is subsequently checked
by the assistant in the Comprehensive Attention Area to detect possible errors
or gaps.
We should indicate that there exist only two possible types of answers in the
scale: the ones which denote intensity: totally, a lot, regular, little or not at all;
and the ones which denote frequency: always, very often, sometimes, seldom
and never.
The score is from 0 to 4. Since we are talking about identifying mental health
problems, the higher the score, the bigger the problem. However, the scale
alternates questions framed positively with those framed negatively, so in
some cases never or not at all (and totally or always) may mean 0 and in
other cases 4.
For example, in the first question: Are you nervous? (negative meaning) the
option never is scored 0 (weak presence of the problem), while in question
50

no.7: Are you patient with others? (positive meaning) the option never is
given 4 (strong presence of the problem).
The following questions of the scale have a positive meaning: 2, 4, 7, 9, 14,

19, 25, 31, 32 and 38. The questions that have a negative meaning are: 1,
3, 5, 6, 8, 10, 11, 12, 13, 15, 16, 17, 18, 20, 21, 22, 23, 24, 26, 27, 28, 29,
30, 33, 34, 35, 36 and 37.
It is important to add that the items of the scale have been divided into
categories. As soon as the tool was created in November 2007, a group of
therapists held meetings with the Research Team in CAPS in order to create
these categories, which are: depression, anxiety, trauma management, social
ties and relations, personal strengths, addictions, self-esteem and control of
aggression.
The template, on which the answers of the scale are collected, also classifies
the items in these wider categories. That is to say, it automatically calculates the
score obtained in each of these categories. This way any authorized interested
person may easily gain access to the condition of a patient in the different
areas which are being measured, as the automatic calculation gives both the
corresponding percentage for each category and the total percentage.
Below we show the questions that correspond to each of these categories:
l SOCIAL TIES AND RELATIONS:
15. Have you drawn away from your family? 20. Have you drawn away
from your friends or neighbors? 21. Do you mistrust people who surround
or approach you? 27. Do you neglect or have you neglected your family or
children? 32. Do you participate in social or community meetings? 37. Do
you feel you have lost affection for your family or people close to you?
l CONTROL OF AGGRESSION:
5. Have you beaten or physically attacked other people (neighbors, friends,

family)? 7. Are you patient with others? 10. Are you bad-tempered? 16. Have
you verbally attacked other people (neighbors, friends, family)? 34. Do you
feel a desire for revenge?
51

l ADDICTIONS:
8. Does drinking alcohol create problems for you or for others? 30. Do you
take drugs other than alcohol or tobacco?
l DEPRESSION:
12. Do you have to make a big effort to get on with life? 17. Do you feel sad?
19. Do you believe that your situation will improve? 24. Do you feel you are
neglecting your appearance? 33. Do you have or have you had a wish to die?
l ANXIETY:
1. Do you get nervous? 18. Do you have nightmares? 22. Does your body
hurt due to worries? 29. Are you afraid to leave your house? 31. Do you feel
that your sleep is restful? 35. Do you feel that your body trembles?
l TRAUMA MANAGEMENT:
6. Do you have sudden and strong memories of horrible images you have
experienced? 11. Do you avoid talking about the period of political violence?
13. Do you feel traumatized? 28. Do you get upset thinking that violence may
return?
l SELF-ESTEEM:
4. Do you feel you can claim your rights? 14. Do you like the things you do?
26. Do you feel you are not worth much? 38. Do you feel happy with the
way you are?
l PERSONAL STRENGTHS:
2. Are you able to carry out well the activity (work, studies, etc.) you do? 3.
52

Do you feel your mood suddenly changes? 9. Are you able to finish the things
you start? 23. Do you find it difficult to remember things or retain ideas? 25.
Do you find it easy to concentrate on what you are doing?
Finally, we should say that the instrument does not contain questions which
allow us to measure the internal truthfulness of the statements. Nevertheless, we
want to indicate that we do not consider it indispensable to ask the population
we work with this type of questions. In principle, interviewees (patients or
candidate patients) would not have many reasons to not answer truthfully,
which could be the case if they were to use the admission to therapy to obtain
other benefits or if they felt obliged to be subjected to an examination they
would later want to deliberately evade (presenting themselves as “normal”).
It should be stressed that we do not consider it a good idea to pose additional

questions as we do not believe that that the administration of the instruments
should take a long time. Let us remember that administering this scale of
38 items takes a significant amount of time and, that in addition to this, the
patient has both a prior interview and subsequently another one, with the
psychiatrist.
We would also like to point out that at the moment the scale does not have
parameters which would allow us to identify particularly distinctive behaviors
in comparison to the normal population. This is due to the instrument still
being at the initial stages of use. We would need a larger sample of cases to
be able to find certain parameters or to apply the same scale with a control
population. However, we should indicate that we hope to carry out both
tasks in the near future.
53

54

4
Quantitative results derived from
the use of the scale
4.1. RELIABILITY OF THE INSTRUMENT

One of the first data which was essential to obtain were those related to the
reliability of the test scores. We would have not been able to feel comfortable
working with the statistical results if we had not been sure from the beginning
that our test scores were completely reliable.
In this case we did not need exit tests, the intake ones were sufficient, and
as we ideally needed a large number of tests, we decided to calculate the
reliability with all the intake tests we had at the time of writing the final report.
That is to say, we used 125 tests.
We obtained a Cronbach’s alpha of 0.906, a number that indicates that the

test scores are highly reliable. This coefficient is a measure of reliability or
internal consistency of an instrument and is based on the strength of the
correlations between item responses. When the coefficient is sufficiently high
it means that there is a high correlation between the items. In other words, a
reliable instrument is one in which the different items in each of the tests tend
to have similar values. In our case, the figure of 0.906 is much higher than the
0.7 indicated as the minimum to consider the instrument reliable.
4.2. SUITABILITY OF CAPS CURRENT SUBSCALES

AND CREATION OF ALTERNATE CATEGORIES
THROUGH FACTOR ANALYSIS
As mentioned above, the SSPCPV Scale was divided into areas by the
CAPS team so it could be read more easily and therefore be more useful for
therapists. These categories were agreed on by a group of CAPS therapists
during several discussion meetings. However, even now nobody knows to
55

what extent the items belonging to each group behave similarly so as to be

considered part of the same group in empirical terms.
In this section we are going to do several things: first, we are going to explore
the level of reliability of the subscales currently used in CAPS; we will then
create alternate groups or categories using factor analysis and after that we
will measure the level of reliability of these new categories. In addition to this
we will also show which items of the scale have lower correlations with the
others. It is important to pay attention to these items because in the future
we may discard them from some analyses in order to get more accurate or
reliable results in empirical terms.
We have to indicate that the current sample is not very large (125 cases) and
therefore not sufficiently stable so as to make definite assertions. Some of
the conclusions will be provisional until we can collect more data. It would
have been desirable to have a sample bigger than 200 cases. Sometime in
the future CAPS will have a larger sample of patients, at which point we will
perform the same kind of analysis and see if there are important differences.
Regarding the new categories we have created using factor analysis, in the
future some items could be regrouped; in other words we could discover that
they fit better in other categories.
The reliability of the current subscales (areas or categories) used by CAPS is

presented in the following table:
AREAS CRONBACH’S ALPHA NUMBER OF ITEMS
TIES AND SOCIAL RELATIONS 0.650 6
CONTROL OF AGGRESSION 0.721 5
ADDICTIONS 0.262 2
DEPRESSION 0.639 6
ANXIETY 0.768 6
TRAUMA MANAGEMENT 0.562 4
SELF-ESTEEM 0.676 4
PERSONAL STRENGTHS 0.558 5
In the table we can see that only two categories have a Cronbach’s Alpha
higher than 0.7: Control of Aggression and Anxiety. This means that only two
56

categories have acceptable levels of reliability, the other categories do not

have high enough correlations between the different items. It would have been
better to have had more solid categories. It is possible that this will change
for the better in the future with a larger number of cases. Independently of
the usefulness of such groupings or of the decision to continue using them,
areas should be created based on empirical evidence. So in the future even
if we decided to maintain the current areas in CAPS, we could have another
way of measuring the results of treatment. What we will do next is create new
categories.
We will use factor analysis to create other subscales based on the degree
of correlations between the items that we find in our sample. The intention
behind carrying out a factor analysis is to discover if the observed variables
can be explained largely or entirely in terms of a smaller number of variables
which we call factors. Each factor would correspond to a possible new
subscale.
Prior to the preparation of the tables we calculated the coefficients of Kaiser-

Meyer-Olkin (better known as KMO) using the SPSS program. This coefficient
helps to assess the suitability of factor analysis with a given sample. If it is
higher than 0.5, factor analysis can be considered possible. In our case, we
have a KMO of 0.791, which is far higher than 0.5. For this reason we may
consider that it is feasible to carry out this type of analysis.
We have produced the factor table with the statistical program SPSS. This
packet, when asked to do the factor analysis with the sample of 125 cases
and 38 items, automatically produces a list of 11 factors. The program only
considers factor groupings with eigenvalues higher than 1.0. However, this
number of factors is usually excessive. What we should do, rather, is to find
a number that we consider more reasonable or which matches our specific
needs. We can tell the SPSS program the number of factors that we want
to have and ask it to group the items according to that. In this regard we
have chosen 8 in order to be better able to compare the factors with the 8
categories created by the therapists.
After choosing the number of factors we obtained the table of variances to

see how much of the variance of all the variables could be explained by the 8
factors. We then found that some variables had very low coefficients and we
decided to discard them from the analysis. We chose to discard those variables
with coefficients lower than 0.3. They were the following four variables:
57

4. Do you feel you can claim your rights?

11. Do you avoid talking about the period of political violence?
24. Do you feel you are neglecting your appearance?
25. Do you find it easy to concentrate on what you are doing?
After that we asked the program to perform a factor analysis using the
principal axis method. We found that the eight factors can explain 46.123%
of the total variance. Additionally, we asked the program to produce a table
with rotated factors using the varimax method. Mathematically, with multiple
factors, there is a virtually infinite number of equivalent solutions. We have to
choose one, preferably the “simplest”. The argument regarding the simplest
solution is: given a series of equivalent solutions we choose the more austere,
i.e. the one that explains the most with the cleanest (clearest) set of factors. In
other words, each factor should explain some of the variables (items) but it
should be as disconnected (not related) as possible from the others. Rotations
such as varimax (used to produce the chart we present) examine possible
solutions and return the simplest one.
The following table, obtained by varimax rotation and consisting of eight

factors, has cells of a different color for each factor. The numbers of the
test items are listed in the first column on the left. The abbreviations of the
questions are in the second column.
TABLE 1: TABLE OF ROTATED COMPONENTS (VARIMAX)

Factor

1 2 3 4 5 6 7 8
I1 Nervousness .573 .073 .065 .041 .126 .187 -.036 .060
I2 Underachievement .263 .188 -.042 .214 .657 .010 .093 -.069
I3 Changeable moods .449 .067 .173 .217 .017 .379 .055 -.052
I5 Physical aggression .053 .134 .179 .488 .057 .044 -.061 .115
I6 Bad memories .606 .286 .068 .148 -.143 -.080 .185 -.066
I7 Impatience .165 .147 -.107 .463 .192 .123 .184 -.143
I8 Alcohol problems .167 .146 -.136 -.008 .050 -.098 .251 .780
I9 Cannot finish things .064 .190 .078 .115 .488 .145 -.069 .070
58

I10 Bad mood .300 .048 -.022 .617 .025 .301 .085 -.076
I12 Does not try to improve .206 .079 .132 -.087 .327 .393 .193 .106
I13 Believes to be suffering from .559 .364 .241 -.008 .171 -.079 .015 -.126
trauma
I14 Unable to enjoy activities -.033 .173 .238 -.031 .550 -.072 .312 -.111
I15 Isolated from the family .010 .105 .478 .174 .059 .288 .175 .029
I16 Verbal aggression .075 .061 .209 .748 .079 -.178 .164 .067
I17 Sadness .422 .417 .266 .098 .001 .058 .205 -.248
I18 Nightmares .505 .318 .103 .190 .037 .136 -.061 .021
I19 Hopelessness .055 .057 .248 .081 .513 .121 -.005 .270
I20 Isolated from friends .216 .127 .541 .324 .058 .141 .021 -.058
I21 Suspicion .144 .555 .161 .068 .056 .262 .014 .027
I22 Body aches .630 .213 .046 .085 .158 .086 -.039 .005
I23 Poor memory .180 .489 .019 .061 .206 .067 .011 .179
I26 Low self-esteem .275 .253 .548 -.111 .272 .187 .321 .089
I27 Neglects his/her family .048 .115 .146 .085 .064 -.005 .613 .034
I28 Fear of recurrence of violence .217 .414 .132 .091 .134 .052 .168 -.107
I29 Fear of going out .243 .630 .064 .076 .245 .050 .092 -.067
I30 Drug abuse -.102 -.081 .120 .026 .047 -.059 -.129 .510
I31 Does not have restful sleep .415 .182 .201 .184 .181 .027 .132 .148
I32 Does not participate in .030 .123 .175 .059 .049 .523 -.085 -.113
community life
I33 Death wish .177 .383 .283 .179 .019 .122 .088 -.014
I34 Desire for vengeance -.030 .054 .127 .418 .079 .118 .524 -.020
I35 Body tremors .340 .430 .043 .128 .223 .136 .094 .103
I36 Unsure of the future .235 .202 .577 .128 .254 .176 .130 .059
I37 No affection for relatives .178 .271 .174 .085 .104 .489 .122 -.088
I38 Feels bad about the way he/ .433 .088 .458 -.037 .351 .124 .083 .072
she is
Next, we list the 8 factors obtained and try to give them a name:
Factor 1
This factor is made up of the following items:
59

1. Do you get nervous?

3. Do you feel your mood suddenly changes?
6. Do you have sudden and strong memories of horrible images you have
experienced?
13. Do you feel traumatized?
17. Do you feel sad?
18. Do you have nightmares?
22. Does your body hurt due to worries?
31. Do you feel that your sleep is restful?
This factor contains items normally classified as anxiety (nervousness,

nightmares), mood disorders (moodiness, sadness), somatization (body
aches) and trauma (horrible memories, trauma awareness). Although this
factor is difficult to name, we have decided to call it “Emotional instability”.
Factor 2
This factor is composed of the following items:
21. Do you mistrust people who surround or approach you?

23. Do you find it difficult to remember things or retain ideas?
28. Do you get upset thinking that violence may return?
29. Are you afraid to leave your house?
33. Do you have or have you had a wish to die?
35. Do you feel that your body trembles?
This factor is associated with items linked to post-trauma stress, anxiety and
depressión that express difficulties in capacity to resist, cope with and recover
from a threatening situatiry we therefore agreed to call it “Vulnerability”.
Factor 3
60

15. Have you drawn away from your family?

20. Have you drawn away from your friends and neighbors?
26. Do you feel you are not worth much?
38. Do you feel happy with the way you are?
Some of them are linked to self-esteem and others to isolation so we have
called this factor “Self-esteem (F)”, adding the (F) to distinguish it from the
category of the same name in the classification currently used by CAPS.
Factor 4
5. Have you beaten or physically attacked other people (neighbors, friends,

family)?
7. Are you patient with others?
10. Are you bad-tempered?
16. Have you verbally attacked other people (neighbors, friends, family)?
Some of the items are related to aggression (physical or verbal) or, in a wider
sense, to irritability (bad temper, impatience) so we will call this factor “Control
of Aggression (F). We use (F) to distinguish it from the other category of the
same name in the current classification used by CAPS.
Factor 5
2. Are you able to carry out well the activity (work, studies, etc.) you do?
9. Are you able to finish the things you start?
14. Do you like the things you do?
19. Do you believe that your situation will improve?
61

All these items are related to personal performance in daily activities and
the pleasure that they imply but there is another related to hopelessness. We
decided to call this group “Self-efficacy”.
Factor 6
12. Do you have to make a big effort to get on with life?

32. Do you participate in social or community meetings?
37. Do you feel you have lost affection for your family or people close to
you?
It was a little difficult to name this group but we decided to use the following
term: “Apathy”.
Factor 7
27. Do you neglect or have you neglected your family or children?

34. Do you feel a desire for revenge?
It was a little difficult to name this group but we decided to use the term:
“Hostility toward others”.
Factor 8
8. Does drinking alcohol create problems for you or for others?

30. Do you take drugs other than alcohol or tobacco?
62

As this factor is related to drugs and alcohol abuse we called it “Addictions”.

In this case it has the same name as the current CAPS classification. However,
we have not added F because it is made up of the same items as the other
category.
In the following table we show the results of the reliability tests we performed
with these factors:
AREAS CRONBACH’S ALPHA NUMBER OF ITEMS
F1 “Emotional instability” 0.822 8
F2 “Vulnerability” 0.754 5
F3 “Self-esteem (F)” 0.794 5
F4 “Control of Aggression (F)” 0.692 4
F5 “Self-efficacy” 0.665 4
F6 “Apathy” 0.562 3
F7 “Hostility toward others” 0.569 2
F8 “Addictions” 0.262 2
We can see that when using factors we have much more reliable groups.
Three factors have Cronbach’s Alpha higher than 0.70 and the fourth one
has almost 0.7 (scoring 0.692). The higher degree of reliability means that
these groups are more useful for research purposes than the current ones.
We will therefore use them from now on when we explore the results of the
scale and will attempt to classify them by area, but will continue to also use
the current CAPS categories. It is worth noting that the factors that have very
few items (i.e. two items such as Hostility toward others and Addictions) tend
to have a very low Cronbach’s Alpha. So we cannot say that these groups
are not reliable30.
Before finishing this part we will talk about the differences between these
two groupings. If we make a superficial comparison between them, we can
see at first glance that there are more coincidences in some groups than in
30 It would not be the case if we used, for example, five items for Addictions and wanted to
see how reliable the group they make up is. It would be possible to measure reliability in
this case.
63

others. It is obvious that they appear entirely in Addictions and Control of

Aggression and in a large part in Anxiety, Self-esteem, Trauma management
and Social Ties and Relations, but they do not occur in Depression and
Personal Strengths.
4.3. SOME ANALYSES OF THE SAMPLE OF 125 CASES

OF THE INTAKE TEST
In an attempt to characterize the group made up by the sample of 125 cases of
the patients who took the intake test, we have crossed the means of the scores
with the socio-demographic characteristics which can be found as areas in
the CAPS database. The only variables with results worth mentioning were
found in gender, age groups, level of education and victim status.
l GENDER
With regard to gender, in general terms there are no significant differences

between the scores. On exploring the specific areas created by the CAPS
therapists, we find that the only area where there significant differences is the
case of Addictions (which is made up of the same items as factor 8), where
men achieve a significantly higher average (0.4878 vs. 0.1084, sig. 000).
l AGE
When we treat age as a continuous variable and explore the correlation

between age and intake test averages we find a Pearson’s r coefficient of
-0.235, which means that there is a significant negative correlation: the older
the patient the lower the score in the intake tests (fewer existing problems).
However, when we divide the age variable into subgroups and explore the
means of the intake tests of these subgroups we can see that the older the
patient does not always mean the lower the score. We found, rather, (see the
following table) that there is an increasing average between the ages of 18
and 30, a peak (highest score) between 31 and 40 and a decreasing average
until the group of those aged over 60:
64

Intake test
AGE GROUPS means
From 18 to 20 Mean 1.6228
N 12
Standard .45626
Deviation
N 18
Standard .55870
Deviation
N 31
Standard .54773
Deviation
N 27
Standard .52483
Deviation
N 32
Standard .52291
Deviation
Over 60 Mean .9895
N 5
Standard .56059
Deviation
Total Mean 1.6202
N 125
Standard .55689
Deviation
When we carry out the ANOVA test to relate age groups with intake test
averages, we find a significance level of 0.005, which shows that each age
group has a different tendency regarding scores in the intake tests. While
applying the post hoc Games-Howell test we find that there is a specifically
significant difference among those aged between 31 and 40 (mean of 1.86)
65

and those between 51 and 60 (mean of 1.43). In their intake tests the first
group shows significantly more problems than the second.
When comparing the scores in the subscales currently used in CAPS with age
groups we also find important differences. When treating age as a continuous
variable we find a correlation with the following subscales: Ties and social
relations (r = -0.290; p = 0 0.01), Depression (r = -0.256; p = 0.004), Self-
esteem (r = -0.239; p = 0.007) and Personal Strengths (r =-0.271). All the
coefficients are negative which shows that the older the patient is the lower
the likelihood of problems with ties and social relations, depression, self-
esteem and personal strengths. However, when we look at the corresponding
histograms we see that this decrease occurs as from the age of 38.
When we treat age as a categorical variable and apply the Games-Howell

post hoc tests to determine significant differences between age groups, we
find that:
In Ties and social relations the means of the group aged over 60 are significantly
lower (fewer problems) than among the group aged between 21 and 30 and
those between 31 and 40, and the means of the group of 31 to 40 year-olds
are significantly higher (larger number of problems) than the means of the
group of 51 to 60 year-olds.
In Depression the means of the group aged between 31 and 40 are significantly
higher (larger number of problems) than those of the group of 51 to 60 year-
olds.
In Trauma management the means of the group of 31 to 40 year-olds are

significantly higher (larger number of problems) than those of the group of
18 to 20 year-olds.
When comparing the scores on the subscales created by factor analysis

we find certain important differences in some factors. Treating age as a
continuous variable we find that there is a correlation between age and the
following subscales: Factor 3 (“Self-esteem (F)”) (r = -0.238; p = 0.007),
factor 6 (“Apathy”) (r = -0.262; p = 0.003) and factor 7 (“Hostility toward
others”) (r = -0.275; p = 0.002). Since all the coefficients are negative we
could interpret them as follows: the older the patient the lower the occurrence
of problems related to self-esteem (F), Apathy and Hostility toward others.
66

However, when we look at the histogram we see that this decrease starts as
from the age of 38.
When we treat age as a categorical variable and apply the Games-Howell

post hoc tests to determine significant differences between age groups, we
find that:
In factor 3 (“Self-esteem (F)”), the means of the group of 31 to 40 year-olds

are significantly higher (larger number of problems) than those of the group
of the over 60 year-olds.
In factor 6 (“Apathy”), the means of the group of 31 to 40 year-olds are

significantly higher (larger number of problems) than those of the group of
51 to 60 year-olds.
In factor 7 (“Hostility toward others”), the means of the group aged over 60
are significantly lower (fewer problems) than those of all the other groups, and
the means of the group of 21 to 30 year-olds are significantly higher (larger
number of problems) than the means of the group of 41 to 50 year-olds.
Similarly, there are significant statistical differences between the means of

intake tests of people with different levels of education. When applying
the ANOVA test for the general means of the intake tests using the level of
education as a factor we find a significance level of 0.019, which means that
the level of education can affect the intake mean score.
We find (see the table below) that there is an increasing mean from the group
of people with no education to those with primary education, and a peak
(highest score) in the group with secondary education and a descending
mean in the group with university or technical education:
67

LEVEL OF EDUCATION Intake means

None Mean 1.4649
N 3
Standard .78962
deviation
Primary education Mean 1.6891
N 16
Standard .51427
deviation
Secondary education Mean 1.7814
N 52
Standard .50846
deviation
University or technical Mean 1.4426
level N 50
Standard .57632
deviation
Total Mean 1.6214
N 121
Standard .56088
deviation
When we apply the Games-Howell post hoc tests to determine significant

differences between the intake tests in people with different levels of education
we find that the overall mean of the group with secondary education is
appreciably higher (larger number of problems) than that of the group with
university or technical education.
When comparing the scores of CAPS current subscales according to level

of education (using the one way ANOVA test) we also find some important
differences in the following groups: Trauma management and personal
strengths.
When applying the Games-Howell post hoc tests to determine significant

differences between levels of education, we find that:
In Ties and social relations, Anxiety, Trauma management and Personal

strengths the means of the group with secondary education are significantly
higher (larger number of problems) than the group with university or technical
education.
68

When comparing the scores of the subscales created by factor analysis

according to level of education (using the one way ANOVA test) we also find
some important differences in the following groups: Factor 2 (“Vulnerability”)
and factor 6 (“Apathy”).
When applying the Games-Howell post hoc tests to determine significant

differences between levels of education, we find that:
In factor 2 (“Vulnerability”) the means of the group with secondary education

are significantly higher (larger number of problems) than those of the group
with university or technical education; and in factor 6 (“Apathy”) the means
of the group with primary education are significantly higher (larger number
of problems) than the group with university or technical education.
l VICTIM STATUS
Regarding the multiple variable of “victim status” we have found some

statistically significant differences between different victim statuses in the
means of the overall scores and those of some subscales in the intake tests.
First, let us see the table with the means of the overall score of the intake tests
for each of the victim statuses:
Victim status
Tortured Displaced Former Relative of Relative of Relative of Other victim
person person prisoner murdered disappeared others31 conditions
person person
Overall mean Overall mean Overall mean Overall mean Overall mean in Overall mean in Overall mean in
in intake tests in intake tests in intake tests in intake intake tests intake tests intake tests
tests
1,54 1,96 1,44 1,90 1,79 1,59 1,58
31 Relatives of victims except relatives of murdered or disappeared people, which belong

to a different category.
69

We can see that displaced people and the relatives of murdered people have
the highest scores while former prisoners have the lowest one.
We have performed the t test on independent samples. The results are

below:
Regarding the overall intake score means we have found that the group of
relatives of murdered people have significantly higher means (larger number
of problems) than all the other categories except the relatives of disappeared
people and displaced people.
Regarding the means in the CAPS current subscales we have seen that:
In Ties and social relations the relatives of murdered people and displaced
people have significantly higher scores than tortured people and former
prisoners.
In Aggression control we can see that tortured people have significantly lower
means (fewer problems) than displaced people, relatives of disappeared
people and relatives of other victim statuses; and former prisoners have lower
means (fewer problems) than relatives of disappeared people and relatives of
other victim statuses.
In Addictions tortured people have significantly higher means (larger number

of problems) than former prisoners.
Relatives of murdered people have noticeably higher scores (larger number

of problems) in Depression than tortured people, former prisoners, relatives
of other statuses and other victim statuses; in Anxiety than former prisoners
and relatives of other statuses; in Trauma management they have higher
scores than tortured people, former prisoners and relatives of other statuses;
in Self-esteem they have higher scores than former prisoners, relatives of
other statuses and other victim statuses; and in Personal strengths they have
higher scores than tortured people and former prisoners.
When we compare the scores of the subscales created by factor analysis

according to victim statuses we also find some important differences in the
following groups:
70

In factor 1 (“Emotional instability”), tortured people, former prisoners and

relatives of other statuses have significantly lower scores (fewer problems)
than displaced people, and relatives of murdered and disappeared people.
In factor 2 (“Vulnerability”), relatives of murdered people have noticeably

higher scores (larger number of problems) than tortured people, former
prisoners and relatives of other statuses; and displaced people have significantly
higher scores (larger number of problems) than former prisoners.
In factor 3 (“Self esteem (F)”), tortured people, former prisoners and relatives
of other statuses have significantly lower scores (fewer problems) than
displaced people and relatives of murdered people.
In factor 4 (“Control of Aggression (F)”), tortured people and former prisoners

have visibly lower scores (fewer problems) than displaced people and relatives
of other statuses.
In factor 6 (“Apathy”), relatives of murdered people have significantly higher

scores (larger number of problems) than tortured people, former prisoners,
relatives of disappeared people and victims of other statuses.
In factor 8 (“Addictions”), tortured people have noticeably higher scores

(larger number of problems) than former prisoners.
If we look at the overall mean scores as well as those of the different subscales
we can see some trends:
Relatives of murdered people have generally higher scores than tortured

people, former prisoners and relatives of other statuses.
Displaced people also frequently have higher scores than tortured people and
former prisoners.
Finally, tortured people and former prisoners also frequently have lower
scores not only than relatives of murdered or displaced people but also than
the relatives of disappeared people or relatives of victims of other statuses.
71

4.4. COMPARISON OF RESULTS BETWEEN INTAKE

AND EXIT TESTS
4.4.1. GENERAL COMPARISON
We have compared the results of intake and exit tests of 56 patients. The
overall average of the intake tests is 1.54 (let us remember that the test scores
range from 0 to 4), while the overall average of the exit tests is 1.17. Therefore,
we have a much lower mean in the exit tests, a difference of 0.37. This means
that on average the patients have left with lower scores (fewer problems) in
the survey, which would indicate a better state of mental health. To confirm
this we should see whether this difference is statistically significant, for which
we need to conduct other tests.
In this case it would be best to conduct a t-test on related samples. However,

before doing this we should perform the test of normality of the sample
since the t-test is only valid for samples with presumption of normality. Thus,
we carried out the Kolmogorov-Smirnov test of normality, finding that the
distributions were normal (Sig. > 0.05).
It was therefore possible to use the t-test for related samples. After doing it
we found that the difference between the intake and exit tests was statistically
significant: There was a significance (bilateral) of 0.000. Let us remember that
a significance lower than 0.05 is sufficiently high. In this case the figure is far
exceeded.
We will present different charts below. The first one contains the means of the
intake tests (M1) and the exit tests (M2) and also with the standard deviations
and standard errors of the mean.
Statistics of related samples
Mean N Std. Std. Error

Deviation Mean
Pair 1 M1 1.5381 56 .60610 .08099
M2 1.1701 56 .51502 .06882
72

The next table shows the results of the t-test for related samples, showing:
the mean differences, standard deviation, standard error of the mean,
confidence intervals for the difference at 95%, t, the degrees of freedom and
the significance.
Prueba de muestras relacionadas
Related differences t df Sig. (2-tailed)

Mean Std. Std. Error 95% Confidence
Deviation Mean Interval of the
difference
Upper Lower
Pair 1 M1
- .36795 .59543 .07957 .20849 .52741 4.624 55 .000
M2
We wanted to try to verify the significance with another statistical test, which
has the advantage of not requiring very large samples or presumption of
normality32. We therefore carried out the Wilcoxon test.
We found out that 40 out of 56 patients had lower means in the exit survey
(which implies improvement), 14 had higher averages (which implies
worsening) and 2 had the same intake and exit means (which implies no
change)33. The Asymp. Sig. (2-tailed) indicates the overall significance level in
this test, which must be lower than 0.05 for the difference in the means to be
significant. In this case the value is 0.000, indicating a significant difference.
34 Although let us remember that our sample is close to normal according to the Kolmogorov-
Smirnov test we performed.
35 For the time being we have not carried out a particular analysis of the cases where the
exit means are higher than the intake ones. However, we believe they deserve to be
analyzed more thoroughly.
73

Ranks
Sum of
N Mean Rank Ranks
M2 - M1 Negative Ranks 40a 30.68 1227.00
Positive Ranks 14b 18.43 258.00
Ties 2c
Total 56
a M2 < M1
b M2 > M1
c M2 = M1
Contrast Statisticsb
M2 - M1
Z -4.173(a)
Asymp. Sig. (2-tailed) .000
a Based on positive ranges.

b Wilcoxon Signed Ranks Test.
l SIZE OF THE EFFECT
In addition to parametric tests like t and non-parametric tests, like Wilcoxon,

a test was carried out to calculate the size of the effect (change). In this case
we used Cohen’s d. This test is done by dividing the difference between the
means by the standard deviation of the intake tests. If we look at the previous
table where we obtained the Student’s t we will see this data. The difference
between the means is 0.36795 and the standard deviation is 0.60610.
Cohen’s d: 0.36795/0.60610 = 0.61.
74

The d obtained is 0.61. Knowing that the ds of 0.5 indicate a medium effect
and the ds above 0.7 indicate a large effect, we can say that in our sample
if we compare the results of the intake and exit tests, the effect is between
medium and large.
4.2.2. COMPARISON OF RESULTS BETWEEN INTAKE AND EXIT TESTS BY

AREAS
First we are going to explore the differences between the means between
time 1 (before starting therapy) and time 2 (14 weeks after the beginning of
therapy) in the subscales created by CAPS. We have produced a table with
the main results of the t tests performed on related samples:
SUBSCALES MEAN STANDARD t SIG. COHEN’S d

DIFFERENCES DEVIATION (2-TAILED)
Ties and social -0.37 0.83 -3.31 0.00 -0.46
relations
Control of -0.42 0.67 -4.74 0.00 -0.67

Aggression
Addictions -0.08 0.57 -1.05 0.30 -0.16
Depression -0.43 0.79 -4.04 0.00 -0.53
Anxiety -0.47 0.87 -4.06 0.00 -0.59
Trauma -0.25 1.05 -1.75 0.09 -0.25
management
Self-esteem -0.35 0.73 -3.63 0.00 -0.41
Personal -0.34 0.81 -3.17 0.00 -0.46
Strengths
We can see that all the areas except Addictions and Trauma management
have statistically significant mean differences (Sig. < 0.05). In other words,
the patients show recovery in all the areas except for Trauma management
and Addictions. However when the effect size is calculated, only three areas
have a medium size effect (> 0.5): Depression (0.53), Anxiety (0.59) and
Control of Aggression (0.67). It is worth noting that the effect size of the latter
is almost large.
75

Now we will do the same for the subscales previously created by factor
analysis. In the next table we can see the main results of the t tests performed
on related samples:
SUBSCALES MEAN STANDARD T SIG. (2 COHEN’S d

DIFFERENCES DEVIATION TAILED)
F1 “Emotional -0.47 0.83 -4.26 0.00 -0.62
instability”
F2 “Vulnerability” -0.52 0.81 -4.77 0.00 -0.67
F3 “Self-esteem (F)” -0.43 0.88 -3.68 0.00 -0.45
F4 “Control of -0.45 0.78 -4.29 0.00 -0.63
Aggression (F)”
F5 “Self-efficacy” -0.08 0.81 -0.75 0.46 -0.10
F6 “Apathy” -0.30 0.99 -2.30 0.03 -0.30
F7 “Hostility toward -0.24 0.84 -2.16 0.04 -0.29
others”
F8 “Addictions” -0.08 0.57 -1.05 0.30 -0.16
We can see that all areas except F5 (“Self-efficacy”) and F8 (“Addictions”)

have statistically significant mean differences (Sig. < 0.05). When calculating
the sizes of the effect we find much more defined groups than in the other
categorizations (CAPS current subscales). This means that the sizes of the
effects in the groups are larger or smaller than in the other classification.
This is because the items belonging to each group are more related to each
other so they have a more similar behavior. We can see three groups with
effect sizes higher than 0.6 (medium to large): F1 (“Emotional instability”),
F2 (“Vulnerability”) and F4 (“Control of Aggression (F)”). Since these
three groups also have high Cronbach’s Alphas we could think that the
improvement should be clearer in these areas, while in F3 (“Self-esteem”)
(another factor with a high Alpha) the improvement is less clear. We can also
notice that some of the groups have very small effect sizes, in particular F5
(“Self-efficacy”) (d = 0.10), F8 (“Addictions”) (d = 0.16) and F7 (“Hostility
toward others”).
76

4.4.3. COMPARISON OF RESULTS BETWEEN THE INTAKE AND EXIT

TESTS BY SUB-GROUPS OF THE POPULATION
We have tried to compare a few sub-groups of patients to see if there are any
differences in relation to the experienced changes as shown in the intake and
exit tests. To do this, we have compared not only the overall means, but also
those that correspond to the areas established in CAPS.
As the groups compared represent small samples, which could be 15, 20 or

25 cases per group, we decided to use the Wilcoxon test instead of the t-test
because it is less reliable with such small samples.
l GENDER
We found important differences between men34 and women35 regarding

differences between the mean in the intake and exit tests, not in the overall
scores where both men and women have significant differences but in the
subscale scores.
First let us look at the subscales currently used in CAPS. Men only
have significant differences in two areas (“Control of Aggression” and
“Depression”) while women have significant differences in all the areas except
“Addictions”.
When using the subscales created by factor analysis we find three groups
where men have significant differences: F1 (“Emotional instability”), F2
(“Vulnerability”) and F4 (“Control of Aggression (F)”), while women improved
significantly in the same areas and also in F3 (“Self-esteem (F)”). Unlike the
classification currently used in CAPS, here we find more areas where women
do not improve significantly.
34 Sample of 17 cases.
77

l PLACE OF ORIGIN
Regarding rural/urban place of origin, we found certain differences: people

from rural areas36 show no significant differences between the means in the
intake and exit tests, while people from urban areas37 do show significant
differences. When we explore the subscales we find that:
In the subscales currently used in CAPS the people from rural areas only show
significant differences in the area of “Control of Aggression”. The group of
people from urban areas shows significant differences in all the areas except
“Addictions” and “Trauma management”.
When working with subscales created by factor analysis we find that people of
rural origin only show significant differences in F4 (“Control of Aggression (F)”)
while people of urban origin show significant differences in F1 (“Emotional
instability”), F2 (“Vulnerability”), F3 (“Self-esteem (F)”) and F4 (“Control of
aggression (F)”).
l MARITAL STATUS
When exploring overall scores we find that married38 and single39 people have
significant differences between intake and exit test scores but not divorced
people40.
Regarding specific subscales we can see that:
When exploring CAPS current subscales we find that married people show
significant differences in the means in all areas except “Addictions” while
single people show significant changes in only four areas: Ties and social
relations, Control of aggression, Depression and Anxiety. Divorced people,
on the other hand, do not show differences in any of the areas.
40 Sample of just 8 cases..
78

When using subscales created by factor analysis we find that both married
and single people show significant differences in the following four areas: F1
(“Emotional instability”), F2 (“Vulnerability”) F3 (“Self-esteem (F)”) and F4
(“Control of Aggression (F)”), while divorced people do not show differences
in any of the areas.
l VICTIM STATUSES
First of all we must say that we have excluded the smallest subsamples from
the analysis: Displaced people, relatives of disappeared people and victims of
other statuses, with 4, 5 and 6 cases respectively.
Regarding the overall scores we found that the only group that does not show
significant differences between the means in the intake and exit tests was that
of former prisoners41.
On exploring the subscales we find the following:
In the subscales currently used in CAPS former prisoners do not show significant
differences in any area. Tortured people42 show differences in only three
areas: Control of aggression, Depression and Anxiety. Relatives of victims of
other statuses43 do not show significant differences in Ties and social relations,
Addictions and Trauma management. Relatives of murdered people44 show
significant mean differences in all the areas except “Addictions”.
In the subscales created by factor analysis we find that former prisoners,

unlike what happens in the current subscales used in CAPS, do show mean
differences in one area: F1 (“Emotional instability”). Meanwhile, tortured
people only show differences in two areas: F1 (“Emotional instability”) and
F2 (“Vulnerability”). Relatives of murdered people show differences in all
the areas except F5 (“Self-efficacy”) and F8 (“Addictions”). Relatives of
victims of other statuses only show differences in three areas: F1 (“Emotional
instability”), F3 (“Self esteem (F)”) and F4 (“Control of Aggression (F)”).
43 Different from relatives of murdered or disappeared people. The sample is 22 cases.
79

It is worth remembering the information about the intake scores of the victims
of different statuses. There we found that the group whose scores were by
far the highest was the relatives of murdered people and the group with the
lowest scores was that of former prisoners. Now we are seeing that the greatest
changes have been found in the former group and the smallest changes in the
latter. The difference in the changes between both groups is so big that the
relatives of murdered people began treatment with an overall mean of 1.90
and after fourteen weeks they had a mean of 1.23. Former prisoners, on the
other hand, began with an overall mean of 1.44 and had a mean of 1.22 in
the exit tests (which is even lower than the final mean of the other group).
Regarding the level of education we have to say first that we have excluded
from the analysis the group without any formal education and the group with
only primary education because the samples are too small: the first group has
one case and the second one, five cases.
If we see the differences in the mean in the overall scores, we find that
both the groups with secondary and university or technical education have
significant differences between the intake and exit tests. When exploring
specific subscales we find the following:
In the subscales currently used by CAPS the group that has secondary
education shows significant differences in four areas (Ties and social relations,
Control of aggression, Depression and Anxiety), while the group that has
university or technical education shows significant differences in only two
areas (Control of aggression and Depression).
When working with the subscales created by factor analysis we find that the
group that has secondary education shows significant differences in four areas:
F1 (“Emotional instability”), F2 (“Vulnerability”), F3 (“Self-esteem (F)”) and
F4 (“Control of Aggression (F)”). The group with university or technical
education shows significant differences in only two areas: F2 (“Vulnerability”)
and F4 (“Control of Aggression (F)”).
80

Conclusions
We identified the following characteristics of CAPS psychotherapy patients

prior to the IRPEC Project (2004 to 2007):
The most common type of victim was the one who had been tortured,
followed by relatives of murdered people, victims of family violence, relatives
of tortured people and relatives of imprisoned people.
The ten most common symptoms reported by the psychologists according to

treatment entry tests are, in order of importance: sadness, generalized anxiety,
decreased self-esteem, insomnia, mistrust and fears/phobias, impulsivity, poor
appetite, violent behavior/hostility, (traumatic) nightmares.
The most common diagnoses were depressive disorders (48%), anxiety

disorders (14%), followed by post-traumatic stress (12%), disorders associated
with psychosis (8 %) and adjustment disorders (5%). We also found that
the proportion of women diagnosed with depressive disorders is significantly
higher as is the proportion of men diagnosed with anxiety disorders.
Patients had an average of 19.74 sessions (including the different services

they could receive). However, almost half of the patients attended fewer than
8 sessions.
The type of service that had a higher average number of sessions was
physiotherapy (22.86), followed by psychotherapy (20.09), social attention
(12.10) and finally psychiatry (9.52).
Except for the victims of rape (whose sample was very small), the three types
of victim with the highest number of sessions, from highest to lowest were:
81

relatives of murdered people (21.49), followed by relatives of disappeared

people (20.53) and Armed Forces staff (20.40).
On exploring the number of psychotherapy sessions by level of education of

the beneficiaries we found the two highest peaks at both ends of the level of
education: Those with no education (20.60 sessions) and those with higher
education (17.07 sessions).
Using the recovery indicators employed by CAPS before the IRPEC project,
we found that the percentage of people who had achieved some degree of
recovery was quite high: 85.6%. Of these, 82% achieved symptom relief,
58.1% achieved improvement in their interpersonal relationships and a
quarter of the patients (25.7%) achieved greater personal integration.
Regarding the type of victim, we found that after treatment, among NGO staff
there was a significantly greater proportion of people with “better interpersonal
relationships” and “greater personal integration.” On the other hand, we
found that the relatives of murdered and disappeared people completed the
treatment with “better interpersonal relationships” compared to other types
of victim.
Regarding age we find the following significant differences: The group of

41-50 year-olds had a higher proportion of people with “symptom relief”
compared to those aged 21 to 30 and a much smaller proportion of people
with “greater personal integration” compared to some of the other groups.
On the other hand, the group of 51-60 year-olds had a higher proportion
of people with “better interpersonal relationships” compared to the group of
people aged 0-10.
Regarding the level of education, we find that there was a greater proportion
of people who did not show any improvement in the group who had received
elementary education and a larger proportion of people experiencing some
form of improvement in the group who had received higher education. Also
in the group of higher education, we found a greater proportion of people
with “better interpersonal relations” or “personal integration”.
When we cross recovery indicators with number of sessions we find that

the greater the number of sessions a patient has the greater the evidence of
some improvement and also the greater the number of sessions the greater
the likelihood of going beyond “symptom relief” to “better interpersonal
82

relationships” and “greater personal integration”. We also found in patients

with more than twelve sessions (current recommended termination point for
therapies in CAPS) a significantly higher proportion of individuals who had
achieved recovery in the latter two indicators compared to patients with fewer
sessions.
II
Regarding the patients who participated in the IRPEC study, in the 125
cases who completed intake tests, we found that they had the following
characteristics:
The population is predominantly female, with women constituting 66.4% of

the cases and men only 33.6%.
Regarding the region of birth, almost half of the population (44.8%) comes
from Lima. Ayacucho is the second most common place of origin with 17.6%
of the cases, while Junín is in third place with 7.2% of the cases and Huánuco
is fourth with 5.6%.
The proportion of urban residents is significantly higher: 64.8% are of urban

origin and 35.2% are of rural origin.
In the sample we found a mean age of 38.04 years and that there was a
balanced distribution of different age groups except for those over 60 who
represent a minority (4%).
Regarding the level of education we found a very small minority of

people (2.5%) without any kind of formal education, 13.2% have only
primary education, 43% and 41.3% have secondary and higher education
respectively.
Regarding the type of victim, we found that 41.6% of them had been directly
tortured, 38.4% are relatives of direct victims (who had been neither killed
nor disappeared), 25.6% had been in prison, 24.8% are relatives of murdered
people, 8.8% are relatives of disappeared people, 7.2% are displaced people,
3.2% are victims of sexual violence, 1.6% are members of the Armed Forces,
0.8% are NGO staff and 8% belong to other categories.
83

III
The application of the Self-Perception Scale of Psychosocial Consequences

of Political Violence (SSPCPV) to 125 patients (before beginning treatment)
gave us the following general results:
The reliability coefficient (Cronbach Alpha) in the sample is 0.906 which

is much higher than 0.6, taken as the minimum value for considering the
instrument reliable.
Regarding the subscales currently used in CAPS (Ties and Social Relations,
Control of Aggression, Addictions, Depression, Anxiety, Management of
Trauma, Self Esteem, Personal Strengths) we find that only two of these
subscales have an acceptable reliability coefficient (Alpha Cronbach’s alpha
greater than 0.7): Control of Aggression and Anxiety. The other categories
do not have enough correlations between the different items. The fact of not
having very strong categories encouraged us to develop alternative subscales
based on factor analysis.
We worked with eight factors. It turned out that four of the factors had
acceptable reliability coefficients (around 0.7 or more) unlike the subscales
currently used in CAPS (which only had two categories with acceptable
coefficients). Therefore, we decided to use them as alternative subscales.
Observing the characteristics of items for each factor we decided to give

names to these categories: Emotional Instability, Vulnerability, Self-Esteem
(F), Control of Aggression (F), Self-Efficacy, Apathy, Hostility toward others
and Addictions45.
Regarding the means in the intake tests (both the overall means and those
in the subscales), when we tried to relate them to other variables, we found
45 The category of Addictions has the same name in both categorizations (the one
currently used in CAPS and the one produced by factor analysis) and also corresponds
to the same items in both cases (items 8 and 30 on the scale). However, the two other
categorizations with the same name (Self-Esteem and Control of Aggression) do not
have exactly the same items so we differentiate them with an (F) in the cases produced
by factor analysis.
In this list the first four categories have reliability levels around or above 0.7.
84

only a few results worth mentioning and only when crossed with the following
variables: gender, age groups, level of education and type of victim.
Regarding gender we found only one significant difference: that there is a

significantly higher proportion of men with problems of addiction than
women.
Regarding age we found that the overall mean increases between the ages
of 18 and 30, there is a peak (highest score or larger number of problems)
in the 31-40 year-olds and then a decreasing mean until we reach the group
of people aged over 60. When exploring the subscales currently used in
CAPS we find that these trends are maintained in the following categories:
Ties and Social Relationships, Depression and Trauma management. And
in the subscales created by factor analysis these trends are maintained in
the following categories: Self-Esteem (F), Emotional Instability and Hostility
toward Others.
With reference to level of education, we found that there is an increase in the

overall mean starting from the group of people with no education to primary
school group, there is a peak (highest score or larger number of problems)
in the group with secondary education and a decreasing mean in the group
with college or technical education. Regarding the subscales currently used
by CAPS we found that the means for Ties and Social Relations, Anxiety,
Trauma management and Personal strengths are significantly higher (larger
number of problems) in the group with secondary education than in the
group with college or technical education. Regarding the subscales created
by factor analysis we found that the Vulnerability mean of the group with
secondary education is significantly higher (larger number of problems) than
that of the group with college or technical education, and the Apathy mean
is significantly higher (larger number of problems) in the group with primary
education than in the group with college or technical education.
When we explored the overall means according to victim status we found

that the group of relatives of murdered people has a significantly higher mean
(larger number of problems) than all the other categories except relatives of
disappeared people and displaced people. Similarly, when exploring both
the subscales currently used in CAPS and those created by factor analysis we
found some significant differences between the different types of victim.
85

IV
When comparing the results of the SSPCPV scale at intake (before starting
treatment) and at the end of the treatment (fourteen weeks later), which
involved 56 patients we found the following:
The overall mean of the intake tests is 1.54 while the overall mean of the
exit tests is 1.17. We therefore have a much lower mean in the exit tests. The
difference is of 0.37, indicating fewer problems or a better state of mental
health. When carrying out the t test for related samples we found that this
difference was statistically significant.
Additionally, when calculating the size of the effect between intake and exit
tests we found a Cohen d of 0.61, which indicates a medium to large effect.
When comparing the means in the intake and exit tests in the subscales
currently used by CAPS we found that there are significant differences in all
areas except Addictions and Trauma management. That is, patients show
recovery in all areas except the two mentioned. However, when calculating
the size of the effect only three areas have a medium size effect (> 0.5):
Depression (0.53), Anxiety (0.59) and Control of aggression (0.67).
When comparing the means in the intake and exits tests in the subscales
created by factor analysis we found that in all areas except Addictions and
Self-efficacy the means show statistically significant differences. However,
when calculating the sizes of the effect, we can see that there are only three
groups with effects greater than 0.6 (medium to large): Emotional instability,
Vulnerability and Control of aggression (F).
By comparing the intake and exit means for particular population subgroups
we found that:
There are important differences between men and women regarding the
differences between the means in the intake and exit tests, not regarding the
overall scores where both men and women have significant differences, but
in the subscale scores. In the subscales currently used in CAPS, men have
significant differences only in two areas, Control of aggression and Depression,
while women have significant differences in all areas except Addictions. When
using the subscales created by factor analysis we found three categories
where men have significant differences: Emotional instability, Vulnerability
86

and Control of aggression (F), while women improved significantly in the

same areas and also in Self-esteem (F).
With regard to rural-urban origin we found some differences: People of rural

origin show no significant differences in the means of the intake and exits
tests, while there are differences among the population of urban origin. When
we explore the subscales currently used in CAPS, people of rural origin only
show significant differences in the area of Control of aggression. Those of
urban origin show differences in all areas except Addictions and Trauma
management. When we explore the subscales created by factor analysis we
found that people from rural areas also showed significant differences only in
Control of aggression (F), while urban residents show significant differences
in Emotional instability, Vulnerability and Self-esteem (F).
On exploring marital status with regard to overall scores we found that

single and married people have significant differences in the means in the
intake and exit tests, but not those who are divorced. When we explore
the subscales currently used in CAPS, we find that married people show
significant differences in the means in all areas except Addictions, while
single people show significant changes in only four areas: Ties and Social
Relations, Control of aggression, Depression and Anxiety. When using the
subscales created by factor analysis we find that both married and single
show significant differences in the following four areas: Emotional instability,
Vulnerability, Self-esteem (F) and Control of aggression (F). Divorced people
show no difference in any area of either of the two categorizations.
Regarding the level of education, if we see the mean differences in the

overall scores, we find that both the groups with secondary and university or
technical education have significant differences in the intake and exit tests. In
the subscales currently used in CAPS, the group with secondary education
shows significant differences in four areas (Ties and social relations, Control
of aggression, Depression and Anxiety), while the group with university or
technical education, shows significant differences only in two areas (Control
of aggression and Depression). When working with the subscales created
by factor analysis, we find that the group with secondary education shows
significant differences in four areas: Emotional instability, Vulnerability,
Self-esteen and Control of aggression (F), while the group with university
or technical education shows significant differences only in two areas:
Vulnerability and Control of aggression (F).
87

88

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Instituto Colombiano de Antropología.
BIBEAU, G. y CORIN, E., 1994. Culturaliser l’épidémiologie psychiatrique.

Les systèmes de signes, de sens et d’action en santé mentale. In: Marc-Adélard
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Trudel & Y. Breton, dir.), Quebec: Presses de l’Université Laval.
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la Comisión de la Verdad y Reconciliación. Tomo VIII. Lima, CVR, 2003.
DESJARLAIS R., EISENBERG L., GOOD B., KLEINMAN A., 1995. World

Mental Health: Problems and Priorities in Low Income Countries. New
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GREENSON, R. 1976. Técnica y práctica del psicoanálisis. México DF: Siglo

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KLEINMAN, A., 1980. Patients and Healers in the Context of Culture.

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Torture Survivors' Perception of The Physchosocial Consequences of The Internal Armed Conflict in Peru

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Torture Survivors' Perception of The Physchosocial Consequences of The Internal Armed Conflict in Peru

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Torture survivors´ perception of the psychosocial consequences of the internal armed conflict in Perú

Torture survivors´ perception of the

Study of a sample of the population that received mental

Carlos Saavedra Chávez

Libro PERCEPCION INGLES.indd 1 17/01/2011 05:03:38 p.m.

Torture survivors´ perception of the psychosocial consequences

Calle Caracas 2380, Jesús María, Lima 11

© Todos los derechos reservados

Diseño y diagramación: Miriam De la Cruz Ramírez

Tiraje: 500 ejemplares

Libro PERCEPCION INGLES.indd 2 17/01/2011 05:03:38 p.m.

1. Components of the Investigation of the IRPEC Project...................... 15

2. Description of CAPS Patients............................................................ 23

3. The self-perception scale of psychosocial consequences

4. Quantitative results derived from the use of the scale........................ 55

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4.2. Suitability of CAPS current subscales and creation of

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The Center for Psychosocial Attention (CAPS) started out as a group of

The experience of human rights and mental health organizations in Latin

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Latin American region. The psychosocial focus on traumatic experiences

In 2006 the IRPEC Project (International Research and Program Evaluation

Libro PERCEPCION INGLES.indd 6 17/01/2011 05:03:39 p.m.

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BRIEF DESCRIPTION OF THE IRPEC PROJECT

1 THE INTERNATIONAL CAPACITY BUILDING PROJECT is an initiative of CVT directed at the

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a) To increase the ability to monitor and evaluate the effectiveness of

l It is of fundamental importance to develop local capacities, including

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will in turn contribute to broader knowledge regarding the treatment of

CAPS PARTICIPATION IN IRPEC

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It is necessary to emphasize that the psychologists that provide psychological

CAPS developed the Monitoring and Evaluation Program in the middle of

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However, despite the significant efforts of CAPS to develop the area of

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1.1.3. METHODOLOGY EMPLOYED IN CONSTRUCTING THE SCALE

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We worked in three different areas: rural (Huancasancos, Ayacucho),

The methodology employed to develop the instrument had various stages

The result of each interview was a list of problems per interviewee. On

Work on the ethnographic interviews involved a second stage. Every problem

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After compiling the information obtained from the sorting meetings, we

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the results of individual psychological interventions which would involve the

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Component 2 of IRPEC should first of all measure the degree of statistical

Additionally, we crossed recovery items with a series of socio-demographic

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The first thing we attempted was to do as much as we could to complete

We set ourselves December 2007 as a deadline for admission of patients (just

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l Relate the characteristics of the patients receiving treatment (number of

Input of quantitative information

Statistical work and preliminary analysis of existing information

This was followed by a process of transforming information of the various

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