Journal of Applied Youth Studies

https://doi.org/10.1007/s43151-023-00111-0

ORIGINAL ARTICLE

Spiritual Disharmonies Among the Emberá Dobida:

Territorial, Bodily, and Linguistic Suffering

Felipe Agudelo Hernández1 · Jaramillo Mecha Chamorro2 ·

Nathalia Martínez Pastas3

Received: 30 September 2023 / Revised: 11 December 2023 / Accepted: 13 December 2023

© The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2024

Abstract
Suicide in children and young people from indigenous peoples of Latin America has
increased progressively. Social, political, cultural, and spiritual factors must be con-
sidered in its approach. A possible relationship with aspects such as food security
and the relationship with the territory is considered. The aim is to analyze the spirit-
ual disharmonies in an Embera Dobida community, displaced by the armed conflict.
Focus groups were held. Thematic analysis was used to synthesize the information.
It is highlighted that suicide in young people from this community may have under-
lying factors such as environmental or territorial suffering, food insecurity, difficulty
in communicating due to malnutrition and sadness, and low cultural competence in
the Western health system. Suicide in children and young people from indigenous
peoples requires approaches from participation, human rights, spirituality, and ter-
ritorial organization. Hunger, the weakening of one’s own culture, armed conflict,
migration, and other non-psychiatric clinical conditions are found to be associated
with suicidal behavior.

Keywords Indigenous people · Suicide · Food security · Territorial rights ·

Language barriers (UNESCO)

* Felipe Agudelo Hernández

afagudelo81703@umanizales.edu.co
1
University of Manizales, Public Health, Centro Liborio, Cod: 170001, Manizales, Caldas,
Colombia
2
Embera Dobida people-Caucamorro, Anserma, Caldas, Colombia
3
Universidad de Caldas, Pediatrics, Manizales, Caldas, Colombia

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 Journal of Applied Youth Studies

Introduction

It is estimated that approximately 700,000 people die by suicide annually (World

Health Organization (WHO) 2021). Suicide is not isolated within indigenous com-
munities; on the contrary, it is one of the most affected groups globally, as they
confront significant structural inequities (marginalization, cultural discrimination,
poverty), environmental suffering, and pain. (Livingston et al. 2019; Londoño 2021;
Ramos Camayo and Londoño Pérez 2022). The suicide rates among indigenous pop-
ulations, when compared to other communities, can account for up to 20% of all
suicides in certain countries within the region (Ramírez-Montes et al. 2018; Ramos
Camayo and Londoño Pérez 2022).
Structural inequities in indigenous children, adolescents, and youth can be attrib-
uted to the country’s history of violence and colonization (Elliott-Groves and Fry-
berg 2018). Marginalization of indigenous culture is a phenomenon that has been
going on for hundreds of years since colonization. Indigenous youth and children
are seen as possessors of another culture, language, and customs foreign to those in
main cities.
During colonization years, it was proposed that indigenous people leave aside
their customs and language in order to form a monoethnic nation. The idea of a
homogeneous nation meant that cultural heterogeneity was seen as a threat, as a way
of destabilizing the nation. This homogenization resulted in a cultural discrimina-
tion of indigenous people which is one of the main causes of inequity and results in
a situation of extreme poverty (Fernández et al. 2006).
Poverty impacts the well-being and identity of indigenous population, contrib-
utes to the expulsion from their families and the forced placement in non-indige-
nous foster homes, and leads to a transformation of their environment (Farfán et al.
2018; Siddiqui et al. 2020; Shim et al. 2022; Soeters et al. 2017). Individuals articu-
late their suffering and concerns through languages and practices, interacting with
social networks and systems of meaning (Kirmayer et al. 2023). Hence, the spir-
itual harmony of indigenous children and youth requires cohesion within the com-
munity, connection to culture, relationship with the land, and ethnic identity (Bryant
et al. 2021; Okpalauwaekwe et al. 2022; Ramos Camayo and Londoño Pérez 2022;
Salusky 2021).
Environmental suffering related to the territory has been conceptualized as solas-
talgia (“solace” and “desolation”), a term coined by Albrecht (2006) to denote
the distress caused by altering one’s relationship with the environment. While not
directly employed in the context of forced displacement, there have been approaches
that relate to phenomena such as mining (Canu et al. 2017), climate change (Albre-
cht 2005; Ellis and Albrecht 2017), natural events (Warsini et al. 2014), and envi-
ronmental modification due to hydroelectric projects (Porras Holguín 2019). In the
aforementioned cases, there is pain due to the modification of the environment and
marginalization (McNamara and Westoby 2011)
Pain due to marginalization has been associated to suicide. It has been described
that young people are more comfortable with an explanation of suicide as an under-
standable response to emotional or life difficulties. Many explain the desire to

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escape distressing emotions as driving young people to suicide. For the young, sui-
cide is a way out of hopelessness and helplessness (Stubbing and Gibson 2018). The
abrupt and forced loss of relationship with the territory to which indigenous popula-
tion belong has been associated with new settlements, food insecurity, deforestation,
biodiversity impact, alteration of production activities (such as fishing, in the case
of the Embera people, or agriculture), health issues, suicidal behavior, loss of tradi-
tional rituals, water contamination, and ecological impacts (Porras Holguín 2019).
In response to the above, research has predominantly focused on adaptive dis-
orders or post-traumatic stress, while largely overlooking other categories also
involved in suffering (Morina et al. 2018). Focusing solely on suffering from a
biomedical perspective hinders the fulfillment of essential principles for restoring
well-being in childhood and youth after forced displacement. These principles are
linked to a sense of security in the new environment, a peaceful atmosphere, a feel-
ing of self-assurance and community security, a connection with their territory, and
a sense of hope (Betancourt et al. 2013). Especially within indigenous communities,
this approach could render other needs that arise from forced displacement invisible
(Acosta 2019; Agudelo-Hernández et al. 2023; Morina et al. 2018).
In this context, suicide among indigenous communities has an intricated eti-
ology with profound historical roots as well as sociocultural factors that play a
crucial role in understanding and responding to life stressors and distressing emo-
tions (Azcona Pastor and Chauca García 2022; Ramírez-Montes et al. 2018). In
Colombia, the territories with the highest suicide rates were Amazonas and Vau-
pés, where the indigenous population predominates, and the primary risk factor
highlighted is cultural clash (Observatory for Childhood Well-being 2018). The
violence related to territory and the sociopolitical context of the country play a
significant role in indigenous communities’ suicide rates.
For indigenous communities in Colombia, “territory is the place that encom-
passes everything; it is the grand home where the spiral of life unfolds… where
the elements and plants of harmony and healing are born” (Ministry of Health and
Social Protection et al. 2022, p.3). Spiritual harmonies are.
[…] a collective good that entails being in harmony with the spirit and thought.
Hence, they are interconnected with the communal context, territory, identity,
autonomy, spirituality, worldview, diverse cultural usages, practices, and cus-
toms (Ministry of Health and Social Protection et al. 2022, p.2).
The Embera Dobida (River Town) predominantly inhabit the Chocó rainfor-
est. Their population is approximately 37,000 individuals (National Indigenous
Organization of Colombia 2020). The suicide death rate among the Embera peo-
ple was 247.9, with 50% of the suicides occurring among youth and adolescents
(Puertas Rizo 2017). The aforementioned rate is higher than the overall suicide rate
in Colombia, which ranged between 4 and 5.7 per 100,000 inhabitants (National
Administrative Department of Statistics—DANE 2022). Prior to 2010, reports of
suicidal behavior among the Embera people were nonexistent (Annex 1).
Equitable representation in studies involving indigenous communities enhances
inclusion in the scientific process and the generalizability of results (Rees et al.

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2022). Although the association between these external causes is increasingly

being better described from an intersectional approach (Bryant et al. 2021; Gha-
semi et al. 2021), studies related to psychological and relational aspects that
address needs identified by individuals within the territory, especially among for-
cibly displaced indigenous communities, are less common. This can potentially
raise ethical dilemmas (Siriwardhana et al. 2013). The objective of this study is to
analyze variables related to spiritual disharmonies and suicidal behavior in chil-
dren and youth, including forced displacement, the relationship with the current
territory, and food security, within an Embera Dobida community.

Materials and Methods

The current study is conducted as a qualitative research, adopting an epistemological

approach closely aligned with contextual constructivism and pluralistic ontology. In
this approach, the pre-existing community, as in this case, can provide information in
a more natural manner prior to the interview process. While not dismissing criteria of
objectivity, it nonetheless offers avenues for reflection for the research team (Freeman
2019).
This method requires an ethical component of co-construction, which entails impli-
cations for the dismantling of power dynamics that are typically inherent in mental
healthcare and research endeavors (Jaramillo 2010). Thus, in order to achieve the stated
objective, knowledge must be reciprocal, with multiple directions of word circulation.
This new epistemological direction in study design considers a cultural realm that ques-
tions rationality and the man–machine paradigm (Escobar 2018), where functions are
solely determined by neurotransmitters, and the separation between body, mind, and
soul is challenged.
Similarly, ontology delves into the understanding of the meaning that situations and
other existences hold for an individual (Agudelo-Hernández 2023), as well as the inter-
pretations that social groups have regarding what they deem as the real world (Esco-
bar 2018). This entails multiple realities without forfeiting an objective sense of reality
(Agudelo-Hernández 2023). This health approach seeks to take into account needs and
desires within a specific time and situation, surpassing a dualistic notion of health and
existence (Wilton et al. 2023). This aligns with Alvarado et al. (2014), who state:
We now understand that it is necessary to stimulate change, that this option of life
is neither acceptable nor desirable. It is imperative for a transformation that leads
us to shift our thinking and build new alternative interpretations of the world –
interpretations that are less exclusionary and more respectful of the dignity and
sovereignty of peoples and individuals (p.15).

Context and Participants

In 2019, around 120 individuals from the Emberá Dobidá community, originating
from Alto Baudó, embarked on an exodus due to issues associated with the armed

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conflict. As is characteristic of this community, they were seeking a place to settle,

preferably near a river. There, they found a region in Caldas near the Cauca River,
where they established crops, huts, and bestowed spiritual significance upon their
new home. However, the river they found lacked fish, and they also could not access
poultry through fowl. Additionally, multiple difficulties arose in terms of territorial
planning, land use permits, health insurance coverage, and other rights.
Currently, the community consists of 158 individuals, with approximately 34.81%
being adult women, 22.15% adult men, and the remaining percentage representing
children under the age of 5. The 25.3% corresponds to the ages of 7 to 17 years,
which comprises the population participating in the current study.
The children and youth who were part of the study group lived in the community
and had relocated with their families from Alto Baudó, Chocó, since 2019. All of
them were engaged in the community’s ethno-educational system, had not received
mental healthcare from professionals, and perceived the research team as approach-
able and welcomed within the community due to previous interactions with pediat-
ric support (Agudelo-Hernández et al. 2023).
The inclusion criteria comprised being aged 7 to 17, being a part of the commu-
nity and a family from Alto Baudó, residing in the Caucamorro community, willing-
ness of both the family and the individual to participate in the study, and agreement
with translation by the Community Governor (a member of the research team) and
the ethnoeducator. No exclusion criteria were taken into account.
The informed consent and assent were read to the 40 participants and their fami-
lies, with translation provided by indigenous authorities. The authorization and par-
ticipation of all individuals were obtained, emphasizing the option to withdraw from
participation at any point and to seek information from the research team whenever
deemed necessary. It was reiterated that identity would be safeguarded, and informa-
tion would be treated confidentially.

Procedure

An approach was established with the community, particularly with its representa-
tives, such as the governor and the ethnoeducator. The research was introduced, and
a decision was reached in consensus with the rest of the community regarding their
participation in the study. The research team has been present in the territory con-
sistently for approximately a year and a half. The current team also included the
community’s governor as a participant.
Spaces were arranged for conducting focus groups with children and youth aged
7 to 17. Three groups were proposed, consisting of two groups with 13 members
each and one group with 14 members. The checklist proposed by Escobar and
Bonilla-Jiménez (2011) was followed, which entails setting an objective, selecting
participants through an invitation from indigenous leaders, analyzing registrants to
guide triggering questions, selecting the ethnoeducator (a person closest to the chil-
dren and youth) as the moderator, arranging the meeting place within the indigenous
community, obtaining informed consent and assent during the meeting, conducting
the session by explaining the research and its objectives, presenting findings and

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conclusions to the indigenous community, and concluding with gratitude and com-
mitments from the research team.
Individuals with health issues were directed to follow the healthcare pathway,
which included specific recommendations based on the findings. The indigenous
community requested the conduction of a Benecuá, a ceremony aimed at warding
off the Jai, a spirit of death, which they associated with suicidal behavior within the
community. The aforementioned event took place after the data collection process.
All the mentioned activities were conducted between October 2022 and February
2023.

Methods of Data Collection

Taking into account the prior engagement with the community, methodological
tools were selected to capture narratives. These included certain sociodemographic
questions that explored the relationship with both the current and previous territo-
ries, along with a structured survey aimed at determining the food security situation.

Semi‑structured Interviews and Personal Narratives

The focal point of the interview revolved around spiritual harmonies, particularly
the relationship of children and youth with the territory, the community, their fam-
ily, and their emotions. Triggering questions were posed generally as follows: What
situations sadden or concern them? What do they like the most about the current ter-
ritory? What do they miss the most from Alto Baudó?
This conversational approach enables a flexible engagement with individuals par-
ticipating in a research study, addressing categories that emerge within the interac-
tion itself (Simons 2011) and that might go beyond the predetermined questions set
prior to the groups. The above approach proves valuable when aiming to analyze the
meaning that children and youth attribute to the phenomena under study.
When the proposed questions did not elicit responses from all participants, par-
ticipants were invited to share personal narratives (Branda 2017) regarding the ter-
ritory, spiritual harmonies, and life history. In this context, the aim was to ensure
that each participant in every group spoke and responded to the questions, selecting
meaningful sentences both for the research team and for themselves.

Colombian Families Food Security Scale

Some questions from the Colombian Families Food Security Scale were used.
This instrument exhibits suitable validity and good reliability across various con-
texts similar to the current research, featuring adequate psychometric properties and
ease of application (Hackett et al. 2008). These properties have undergone concur-
rent validation processes with instruments such as the Latin American and Carib-
bean Food Security Scale (ELCSA, by its acronym in Spanish), also within a similar
Colombian population (Álvarez et al. 2006).

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Analysis

Translation assistance was provided by the Community Governor and the Commu-
nity Educator throughout the entire process. The data was collected and transcribed
by the research team, who conducted systematization and organization into catego-
ries, which were then grouped into themes. This report was presented to the commu-
nity, and they expressed agreement with its contents.
Once this phase was completed, the data was analyzed using the thematic analy-
sis method (Braun and Clarke 2006). This methodology serves to identify, analyze,
and propose patterns or themes. This enables data organization without losing its
specificity.
In collaboration with community authorities, as part of the analysis process, the
following steps were undertaken: firstly, an approach to the data was initiated, not-
ing initial ideas; secondly, codes were generated from relevant data that could sup-
port them; and finally, themes were sought through these codes. Subsequently, the
themes were verified to assess their alignment with code extracts and the entire data-
set. This facilitated the creation of a thematic map.
Finally, the themes were named and defined, and a report was created for pres-
entation and validation by the children, adolescents, and their families. This pres-
entation was conducted by the Community Governor. Minor adjustments were sug-
gested. Quantitatively, the data is summarized in tables of frequency distribution.
Similarly, certain sociodemographic data associated with the variables are catego-
rized to determine percentages.

Ethical Considerations

This research adhered to the principles outlined in the Declaration of Helsinki by

the World Medical Association for biomedical studies. It was approved by the com-
munity through its governor and by the Ethics Committee of the University of Mani-
zales of February 2023, act CB_02-2023.
The participants’ names were kept in strict confidentiality, being replaced with
letters. If health issues were identified, pathways were activated for addressing them
through traditional medicine or the Western healthcare system. Similarly, efforts
were made to uphold the ethical principles outlined by certain indigenous communi-
ties (National Indigenous Organization of Colombia 2020; Watson 2022). To ensure
transparency and data reliability, the systematization of participant responses was
shared with community leaders to be disseminated among participants and their
families. The minutes and a draft version of the manuscript were also shared.

Results

The age had a mean of 9.23 years. Out of the 40 children and youth, 53.7% of
the participants identified as female, while 46.3% identified as male. Regarding

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families, 75% were composed of both parents and siblings, while 25% consisted
only of mothers and siblings. The parents of this latter 25% were killed in their
place of origin.
The main sources of food are plantains and maize. Eighty percent of the children
and youth reported consuming a maximum of two servings of protein per week, pri-
marily from milk, chicken, or eggs. Among the families, 62.5% indicated that they
had not been employed in the last 3 months. As for their occupation, 100% of the
families described their past or current profession as being in agriculture or fishing.
When inquiring about the reasons for migration, responses are categorized as fol-
lows: fear of being assassinated or recruited by armed groups, at a rate of 87.5%, and
employment opportunities and pursuit of prospects, at a rate of 65%. When inquir-
ing about challenges in the new territory, they are grouped into categories as fol-
lows: limited access to water (80%); geographical dispersion (82.5%); few employ-
ment opportunities (77.5%); difficulty being near a clean river (82.5%); restricted
access to meat, eggs, and milk (87.5%); longing for their native territory (97.5%);
experiencing a sense of unfamiliar culture (35%); and settling without land owner-
ship (85%). When asked if they would return to their territory, 95% of the partici-
pants and their families responded negatively.
The results of the Food Insecurity Scale indicate a mean score of 12.72, with
a maximum value of 27 and a minimum value of 8. Table 1 presents the percent-
ages for each item, where the questions with the highest scores are those related
to reduced meals in adults, adult hunger, decreased essential food intake due to
resource constraints, and hunger reported by children. The age groups with the low-
est food availability were 7 and 8 years old.

Thematic Analysis

The main themes that emerged from the thematic analysis were as follows: Ter-
ritorial Suffering and Dying is not being able to communicate. These themes are
expanded in Fig. 1.

Territorial Suffering

In this context, participants specify that the rupture with their territory has both spir-
itual and physical implications (see Fig. 2). In this final point, it is noted that chang-
ing territory also impacted aspects such as food security. J, aged 17, mentions:
We miss Pie de Pató, the river, playing there, swimming, being connected with
the river, but we also miss it because it has a lot of fish, plenty of food; all we
had to do was throw a net and some pieces of bread or crackers, and we would
catch the fish. Here, the river has no fish, it’s far away, and it’s very polluted.
In line with the above, P, aged 9, states, “Over there, I used to play more, have a
better time, there were more chickens, more hens, more happy people.” This high-
lights another point where emphasis is placed: the relationship with water, which

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 Table 1  Responses related to food security
Question*/percentage No Rarely Sometimes Always
Journal of Applied Youth Studies

Lack of money to buy food 55 15 22.5 7.5

Some adult household member ate less than desired due to lack of money to buy food 65 0 30 5
In the household, the number of usual meals was reduced, such as not eating breakfast, lunch, or 87.5 7.5 2.5 2.5
lunch due to lack of money to buy food
Some adult skipped breakfast, lunch, or dinner because of lack of money to buy food 70 17.5 12.5 0
Some adult ate less at the main meal because the meal did not eat for everyone 15 12.5 62.5 10
Some adult complained of hunger due to lack of food at home 0 2.5 97.5 0
Some adult ate less at the main meal because the food was not enough for everyone 15 2.5 72.5 10
Fewer essential foodstuffs for children were purchased because money was insufficient 20 7.5 72.5 0
A child skipped breakfast, lunch, or lunch because of lack of money to buy food 70 10 17.5 2.5
A child ate less at the main meal because the food was not enough for everyone 10 10 70 10
A child complained of hunger due to lack of food in the home 15 0 80 5
A child went to bed hungry because there was not enough money for food 15 2.5 77.5 5
*
Questions taken fromHackett et al. 2008

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Theme Categorie Definition

Missing the Emotional and general health difficulties due to the rupture of
home territory the relationship with the territory, including its meanings and the
availability of food for the families.
Territorial
Suffering
Not having a Sadness and loss of meaning in life due to the lack of a
current territory with which to establish a personal and community
territory relationship.

Difficulties in
learning the Difficulties in learning one's own language attributed to
language eating problems and sadness.
Dying is not
being able to
communicate
Lack of cultural Difficulty of the health system to understand suffering
competence in beyond Western diagnostic categories and beyond Spanish.
health

Fig. 1  Themes and categories of the thematic analysis. Themes and categories of the thematic analysis.
The authors

Fig. 2  Fish in Alto Baudó, a

place formerly inhabited by the
community. Note: fish in the
Alto Baudó, where the commu-
nity used to live. The authors

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becomes an identity-defining factor for the Embera community. In addition to the

aforementioned, it can also serve as a factor associated with overall health. M, aged
16, adds:
We lack water, not just for the fish, but also to stay healthy, to keep clean, for
cooking, for children to play, for purification. The water from the Cauca River
is dirty, it has sand, but no living creatures... It’s not a river that belongs to us.
Some participants also agree that this relationship with the river was being
affected due to the armed conflict, even before the forced displacement. As men-
tioned by J, aged 15:
We’re not entirely happy, but what else can one do? It’s either this or get
involved in the violence in Chocó. Several relatives stayed there, and they
were either taken away or killed themselves to avoid leaving. That happened
to my brother, and that’s why we left. He said he didn’t want to go with them,
and they shot him... Because of so much death, we stopped going to the river
towards the end. Dead bodies would float downstream, and the fish tasted
strange, like death.
To the above, K, aged 17, adds: “What he [J] says is true, we miss how things
were before, before the war.” This aligns with the responses regarding the challenges
in the new territory, where despite expressing dissatisfaction with certain current
situations, no one considers returning.
Regarding the second category of the first theme, Not having a current territory,
it is found that this has impacted, in the words of R, the ethnoeducator, “the value of
life.” One of the questions in the focus group revolved around the primary needs of
the community. The summary of this exercise is presented in Fig. 3. R adds:

Fig. 3  Main needs of the Cau-

camorro Embera community.
Note: main needs of the Embera
community of Caucamorro. The
authors. Date May 6, 2023. At
four in the afternoon, he met
with the community in general,
both men and women, to
analyze the needs asked by the
territorial entities. The answer is
that the Caucamorro community
requires drinking water. We are
28 families displaced without
water, and we want to ask the
national land agency for this
input to fertilize the bananas and
also a hose to bring water. We
are also asking for help with a
communal house because we
have nowhere to meet. Just to
tell you, it is signed by the gov-
ernor and the community leader

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It must be because they don’t have land, but now a young boy feels bad and
thinks about killing himself right there. That wasn’t the case before, they
used to talk to me, to the governor, to their parents, but now the solution is
to end their own lives... As if life didn’t matter, and this happens more since
we are here, that’s why we need the land to live and to reconnect with life.
In relation to this, Y, aged 12, adds further, sharing that they had a suicide
attempt 3 months before the interview: “It’s like anger, like a bad feeling that
takes over you and doesn’t let you see anything else, but even when the anger
goes away, you still don’t feel good… a lot of boredom.”

Dying Is not Being able to Communicate

In relation to the second theme, difficulties in learning to speak Embera were also
a common factor. A, aged 11, mentions, “What’s frustrating is not being able to
speak properly.” To which D, aged 12, responds, “Speaking well and understand-
ing, and parents get angry, but there are words I don’t understand, neither the
teacher.” The educator, R, adds to the above:
Sometimes, the kids can’t tell us what’s bothering them, why they feel
bored... I think it’s because the “evil” [sadness, jai or spirit of death] pos-
sesses them, or it might even be because they don’t eat well and they feel
unenthusiastic, disheartened.
Regarding communication, several participants mention that they are not
understood when they go for medical consultations. Sometimes it is because
they do not speak Spanish and the healthcare staff does not speak Embera, and
other times, it is because even when they manage to convey their health concerns,
there is not a cultural competency to understand non-western expressions of suf-
fering. Hence, the story recounted by the educator, R, about the suicide of his
16-year-old son is particularly noteworthy. His son was one of the translators for
the community.
He would hear noises at night, the boy didn’t want to go to the field, it was
hard for him to get up, he would reject his parents, cry and cry, he felt cats
on the roofs at night... he felt the Jai.
In response to this, the governor directed the young individuals, their mothers,
and fathers to consult the nearest western medical doctor. They followed the recom-
mendation. However, upon consulting the professionals, they found no indicators of
mental health issues or suffering, and the diagnosis was, in the words of the leaders
of this community, “there’s nothing wrong, no illness found.” As outlined in the pro-
cedures agreed upon between the two forms of medicine, if no issues are identified
by the western doctor, it falls to the Jaibaná or traditional healer. In their own words:
When the doctors at the hospital don’t find any illness, there is a spirit of death
that needs to be combated, but the doctors sometimes don’t understand us, and

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Journal of Applied Youth Studies

they say there’s nothing wrong and don’t provide comfort, and since there’s no
traditional healer, it’s like they’re sentencing us to die. Sometimes it helps if
they offer any advice or order a test while we find a Jaibaná.
In this case, the youth and their families followed this process, but due to migra-
tion, they did not have access to a Jaibaná, which, for them, implies that “the afflic-
tion has no solution, that there is no hope,” as mentioned by R.
Two weeks after the initial consultation, the young man died by suicide. More
suicides followed: another young girl, age 14, sister of the first, within a week;
another at 16, a skilled fisherman; another at 15, a mother of a few months; and
another at 18, an assistant at the school. All within a span of 1 to 2 weeks.

Discussion

Suicide in children and young people is increasingly frequent among indigenous

peoples (Livingston et al. 2019). Its understanding requires an intersectional
approach (Ghasemi et al. 2021). Through categories such as spiritual disharmony,
suicidal behavior, forced displacement, the relationship with the current territory,
and food security, this study reaffirms the need for intersectionality to comprehend
suicide in these communities.
Suicide rates among indigenous communities can account for up to 20% of all
suicides in some countries within the region (Ramírez-Montes et al. 2018; Ramos
Camayo and Londoño Pérez 2022). These indicators have been linked to food inse-
curity; for indigenous population, the food system is a specific collective capacity
where community relationships enable individuals to grow and harvest, distribute,
consume, and reuse and recycle foods, medicines, and tools; therefore, food inse-
curity impacts in the population on the physical, intellectual, emotional, and social
development with lasting effects across the life course (Elliott and Bang 2023).
Among Inuit children and youth in Nunavik, Canada, rates of suicidal behavior were
found to be 30 times higher, and difficulties in accessing essential foods were associ-
ated with distress, depression, and slowed thinking (Bradette-Laplante et al. 2020).
It has been found that Native Hawaiians have a higher risk of suicide compared to
non-Native Hawaiians (12.9% vs. 9.6%), similar to indigenous populations in the
USA and New Zealand (Livingston et al. 2019), as well as what has been docu-
mented in Colombian indigenous communities (Puertas Rizo 2017). In the Kuna
community of Panama, an association was also observed between food insecurity,
sadness (OR 0.43), and severe psychological distress (OR 0.68) (Walker et al. 2019).
Similar to what has been described with the Emberá Dodibá, the Inuit Nunangat
from Canada has observed that food insecurity has been associated with poor gen-
eral and mental health and life dissatisfaction as well as an increased risk of dysthy-
mia and thoughts of suicide in adolescent with mortality rates five times higher in
this population (Banerji et al. 2023).
Indigenous populations are the ones who experience higher levels of food inse-
curity compared to the majority population (Walker et al. 2019). The above aligns
with what R, the ethnoeducator, pointed out, stating that communication difficulties

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are related to sadness and nutrition. Indeed, hunger is associated with mental health
issues through biological stress responses and a lack of diverse micronutrients,
which affects the available substrates for building critical neurotransmitters respon-
sible for mood regulation (Cain et al. 2022; Lorena and Sierra 2019). This is par-
ticularly relevant in the community of the current study, where there are also other
nutritional and general health challenges (Agudelo-Hernández et al. 2023).
Losing cultural identity or spiritual and religious practices, forced displacement,
violence (armed conflict, intra-family, gender-based), social vulnerability, and dif-
ficulties in accessing economic resources are associated with mental health issues
(Doriam et al. 2021; Ordenes et al. 2020; Pezzia and Hernandez 2022; Souza et al.
2020). Changes in living conditions, industrialization, environmental pollution, and
problematic substance consumption have led the indigenous population to experi-
ence what is described as “cultural death” (Azuero et al. 2017, p.54).
In Colombia’s indigenous population, mental health issues due to forced displace-
ment and violence have been documented with a higher prevalence among displaced
children than non-displaced counterparts. According to Gómez-Restrepo et al.
(2018), one third of children who were displaced had two or more mental health
issues. Suicidal thoughts were reported by 15% of teenagers displaced in their study,
according to Sánchez et al.
Based on the above, it is crucial to inquire within the communities themselves
and alongside them to understand the meanings of life, sadness, and suffering.
From children in regions with sociopolitical violence, protective aspects have been
observed within the family and community that facilitate new interpretations of life
(Ordoñez Morales et al. 2022). In this sense, resilience depends not only on individ-
ual factors but also on institutional and governmental aspects (Gómez and Hincapié,
2019). Unfortunately, in the majority of these contexts, the response is inadequate
(Livingston et al. 2019).
This study highlights that spiritual harmonies are not disconnected from bodily
health, spiritual well-being, and even environmental health. Therefore, environmen-
tal distress could be a category that better explains the emotional changes in a per-
son who experiences an impacted relationship with their culture and territory. As
mentioned in the Manifesto of Spiritual and Thought Harmonies of Indigenous Peo-
ples of Colombia (Ministry of Health and Social Protection et al. 2022):
The territory is one with the indigenous people; when that connection is lost, it
jeopardizes mental health and leads to disharmony that affects both individual
and collective well-being.
It’s worth asking ourselves:
How is our community connected to the territory?
How is our relationship with sacred sites?
How do we interact with sacred elements and plants for harmony and healing?
(p.6)
From the perspective of the relationship with one’s inhabited place, other stud-
ies have also explored the concept of environmental distress in relation to depressive
symptoms or sadness (Porras Holguín 2019). This study employed depression scales
(Zung Scale), the new ecological paradigm, and solastalgia (Albrecht 2005) to find

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that poor sanitation conditions, such as the presence of rodents, and inadequate hous-
ing conditions associated with environmental changes were correlated with depressive
symptoms (Porras Holguín 2019). Both in this study and in the current research, there
is suffering due to the change in the relationship with the territory, which affects the
conception of time and bodily security (Bourdieu 1999). In the words of Fuster (2004):
In suffering, there is a distinct metaphysical dynamism within the human
being. It involves an ambivalent anthropological movement, which we can
label as exteriority and interiority, through which all dimensions of the human
person become engaged when experiencing suffering (p.267).
As mentioned in the current research, factors such as hunger, communication dif-
ficulties, desolation, homesickness for the territory, poor hygiene conditions, lack
of clean water, and a lack of cultural competence within the healthcare system
are associated with the plight of indigenous communities through suicidal behav-
ior. This underscores the need to support processes that enhance living conditions.
When resources from social ecology are more robust (such as being accepted by
family and community, access to education), children can achieve more positive out-
comes, even in the face of extreme challenges (Betancourt and Khan 2008). From
this, it can be inferred that layers of comprehensive support, along with interven-
tions aimed at rebuilding or strengthening these resources, have the potential to miti-
gate the effects of conflict experiences (Betancourt et al. 2013).
As a limitation of the present study, not having language proficiency within the
research team is noted. All research carries an inherent risk for participants, par-
ticularly due to the inherent vulnerability of these populations (Siriwardhana et al.
2013). These issues stem from the highly traumatic experiences of these popula-
tions, along with their cultural and social backgrounds, especially within the Latin
American context, which must be taken into account before conducting any research
(McLoughlin et al. 2015; Watson 2022).
Future studies should delve into the spiritual explanations of spiritual disharmo-
nies. The goals and paths of healing are often dictated solely by scientific explana-
tions and the reductionist model, which may prioritize certain concepts but often
exclude cultural worldviews, values, and personality concepts within the contextual-
ized culture (Kirmayer et al. 2023).
Cultural traditions have helped shield indigenous children from the effects of
toxic stress, but they have lacked resources for broader implementation (Doriam
et al. 2021). Indigenous communities have identified protective factors such as
strengthening connections with the land; revitalizing the role of knowledgeable
elders; enhancing their own traditional practices, family values; and increasing com-
munity autonomy (O’Keefe et al. 2022).

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Conclusion

Spiritual disharmonies or mental health problems should not be addressed solely

from a psychopathological perspective. It is found that hunger, the weakening of
one’s own culture, armed conflict, migration, and other non-psychiatric clinical con-
ditions are associated with suicidal behavior. In the Emberá community, illnesses
can be of white origin, treated with Western medicine, or they can be of their own,
caused by the spirit of death or Jai, which must be addressed through traditional
medicine under the guidance of a Jaibaná.
New public health strategies for pediatric mental health should consider nutri-
tional factors, social determinants, and living conditions, rather than focusing solely
on suicide as the tip of an iceberg with only one level below being psychopathol-
ogy. The unique ways of individual and collective care of each community must be
acknowledged, along with the ecological and spiritual characteristics.
It is highlighted that, beyond mental illness, young people from indigenous com-
munities are subjected to multiple inequities that further impact their well-being,
including forced displacement and the weakening of their own culture. Furthermore,
the expression of their pain must be understood in a more culturally sensitive way,
in order to build recovery plans with Western institutions that consider these factors.
In this way, recognizing the existing strengths within communities to address health
issues, including mental health, is crucial.
Supplementary Information The online version contains supplementary material available at https://​doi.​
org/​10.​1007/​s43151-​023-​00111-0.

Acknowledgements To Hospital San Vicente de Paúl (Anserma, Caldas), Nancy Millán Echevarría and
the Young Emberas of Caucamorro

Author Contribution FAH: conceptualization, planning leadership, formal analysis, research process,
validation, data presentation, writing, and editing and JMC and NMP: data curation, formal analysis,
research process, methodology, software, validation, data presentation, writing, and editing.

Data Availability The data of the present investigation are available and are attached as supplementary
material.

Declarations
Ethics Approval and Consent to Participate This research adhered to the principles outlined in the Declara-
tion of Helsinki by the World Medical Association for biomedical studies. It was approved by the commu-
nity through its governor and by the Ethics Committee of the University of Manizales of February 2023.

Consent for Publication The authors authorize the publication of these data.

Competing Interests The authors declare no competing interests.

Disclaimer The opinions and concepts expressed in this manuscript are the sole responsibility of the
authors.

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